Feasibility of Glaucoma Detection Programs for At-Risk Populations Using Existing Health Care Infrastructure

Abstract

Précis: Targeted glaucoma screening strategies performed within retail care–based clinics and Federally Qualified Health Centers (FQHCs) uncover a high prevalence of glaucoma. Objective: To summarize the glaucoma detection and maintenance programs that utilize existing health care infrastructure to promote up-scalable programs. Methods: Health care infrastructure that already exists may facilitate glaucoma detection. This infrastructure includes retail-based optometry practices and FQHC. Persons who are at risk for glaucoma are disproportionately represented within the patient populations served by much of this infrastructure, thus suggesting that it could be useful for deploying glaucoma screening programs. Glaucoma screening within FQHCs reveals a very high prevalence of glaucoma and related disease in the patients seeking care at these facilities. Results: These telemetric-based care delivery programs have a high patient acceptance. A simulated telemedicine program modeled after a telemedicine program based in Walmart Vision Centers for the diagnosis of glaucoma indicated that there was moderate diagnostic agreement between an ophthalmologist’s telemedicine diagnosis and an ophthalmologist’s in-person diagnosis. There was also moderate agreement between an optometrist’s telemedicine diagnosis and the ophthalmologist’s in-person diagnosis. Conclusion: Telemetric care delivery programs that capitalize on existing infrastructure within a retail-based care setting or FQHCs may provide a promising setting to cost-effectively screen for glaucoma and other eye diseases that are potentially expandable nationwide.