Improving access to eye care among high-risk persons for glaucoma in Philadelphia

Glaucoma is a major global health problem and the second leading cause of blindness worldwide. To impact this public health problem the Wills Eye Institute, in cooperation with the CDC, is conducting a 2-year demonstration project to implement a community-based intervention to improve detection, management, treatment, and follow-up care of individuals at high risk for glaucoma. The objectives of the intervention are to: 1) identify and engage 5,000 adults in underserved communities in Philadelphia who are most vulnerable to glaucoma, 2) provide on-site educational workshops, 3) perform 2,500 ocular examinations to detect glaucoma, and 4) provide on-site management, treatment, follow-up examinations, and referrals in individuals diagnosed with glaucoma or glaucoma suspect. The ocular examination includes: 1) ocular, medical and family history, 2) visual acuity, 3) pupil examination, 4) biomicroscopy of the anterior segment, 5) intraocular pressure, 6) gonioscopy, 7) undilated optic nerve evaluation by indirect biomicroscopy, and 8) visual field testing. From Jan 2013 to March 2014, 400 individuals have received a complete ocular examination; 20 have been diagnosed with glaucoma, 29 with anatomical narrow angle glaucoma, 104 with glaucoma suspect, 24 with existing glaucoma, and 16 with other eye conditions. Individuals diagnosed with glaucoma who require treatment are recommended for selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or medication. Three individuals have completed SLT treatment, 15 individuals have completed LPI treatment, and 26 individuals have been prescribed medication. The long-term impact of this project will reduce disability, ocular health disparities, and the economic burden from vision loss.