A public health approach to promote Glaucoma screening in at risk populations at Stroger cook county hospital: Evidenced based program evaluation

Background: African Americans, Caribbeans and Hispanics with diabetes, hypertension and family history of glaucoma are at higher risk of developing glaucoma and are ideal candidates for inclusion in screening.

Objective of Screening Program: To evaluate referral patterns of primary care physicians, sensitivity of specific indicators among individuals diagnosed with co-morbidity of hypertension and diabetes, and to maximize early diagnosis and treatment of those screened positive.

Methods: Referral patterns, patient clinical data and screening outcomes were derived from 835 patients seen in the screening clinic between 10/24/2004 and 08/10/2006 using a quasi-experimental cross-section design. The sensitivity of specific risk factors, including sex, race, FDT, CD ratio, history of diabetes, hypertension, and family history of glaucoma, and IOP were assessed.

Results: Early identification of glaucoma patients based only on referrals to screening from primary care using specific indicators was assessed using a one tailed T-test. Significant positive differences were found between average diagnosis of glaucoma in screening vs. general clinic over a 2-year period (p <.05). The screening identified 42.6% of African Americans, and 35.9% of Hispanics having glaucoma from the total population screened. In addition 20% of the African Americans and 17% of Hispanic patients were identified as having glaucoma using 4 similar predictors (diabetes, hypertension, abnormal FDT, and vertical elongation of optic nerve).

Conclusions: Vision-screening clinics can serve as an effective means for the early detection of glaucoma. The findings support the need for triangulation in screening, incorporating a needs assessment, observation, and quantitative data, for optimal programmatic impact.