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Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): optometric exam improves access and utilization of eye care services

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Abstract

Purpose

To describe the benefits of optometric evaluation for detection of vision-affecting conditions in the context of community-based eye health screenings and identify factors associated with having a recent dilated eye exam.

Methods

Enrolled participants were age 40 and older, living independently in affordable housing developments in New York City. Eye health screening failure and criteria for seeing the on-site study optometrist were defined as visual acuity 20/40 or worse in either eye, intraocular pressure 23–29 mmHg, or an unreadable fundus image. The optometrist conducted a manifest refraction using loose lenses and used a portable slit lamp and ophthalmoscope to perform a non-dilated anterior and posterior segment ocular health evaluation. Demographics, social determinants of health, eye health screening results, and rates of suspected ophthalmic conditions were recorded. To determine factors associated with having a recent dilated eye exam, which was the main outcome for this statistical analysis, a stepwise multivariate logistic regression was performed.

Results

A total of 708 participants were screened, 308 attended the optometric exam; mean age 70.7 ± 11.7 [standard deviation (SD)] years. Among this subgroup, 70.1% identified as female, 54.9% self-identified as African American, 39% as Hispanic/Latino, and 26.6% Dominican ethnicity; 78.2% (241/308) had not undergone a dilated eye exam within the last year, 71.4% reported they did not have an eye care provider. Stepwise multivariate logistic regression analysis indicated that participants who self-reported having cataracts (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.03–4.47; p = 0.041), self-reported having glaucoma/glaucoma suspect (OR 5.60; 95% CI 2.02–15.43; p = 0.001), or spoke Spanish as their primary language (OR 3.25; 95% CI 1.48–7.11; p = 0.003) had higher odds of having a recent dilated eye exam.

Conclusions

This community-based screening initiative demonstrated the effectiveness of optometric exams in detecting vision-affecting conditions and identified factors associated with having a recent dilated eye exam. Optometrists play a vital role in increasing access to eye care for high-risk, underserved populations.

Trial registration

ClinicalTrials.gov (NCT04271709).

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Data availability

The data that support the findings of this study are available from the corresponding author (LAH) upon request.

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Acknowledgements

We thank the our project officer, **an Saaddine, MD, MPH, for her guidance and support for the SIGHTSTUDIES. We thank our Columbia University advisors from the Department of Government and Community Affairs (Ross Frommer, Esq.), Wellness Center (Olajide Williams, MD), School of Nursing (Steven Ferrara, DNP, FNP-BC), Mailman School of Public Health (Linda Fried, MD, MPH), Internal Medicine (Rafael Lantigua, MD), and Occupational Therapy (Phyllis Simon, OTD, OTR/L); New York City community partners: New York City Housing Authority (NYCHA) (Marina Oteiza), NYC Department for the Aging (Lorraine Cortés-Vázquez and Edgar Yu) and Senior Center Directors, NYC Department of Health and Mental Hygiene Falls Prevention Coalition, New York Academy of Medicine, Lighthouse Guild, and Vision Services for the Blind and Visually Impaired and Volk Optical, Inc. We thank Warby Parker for providing eyeglasses. We also thank our Data Safety and Monitoring Board: David S. Friedman, MD, PhD, MPH (Harvard Medical School), Cynthia Owsley, PhD, MSPH (University of Alabama Birmingham), Jonathan S. Myers, MD (Wills Eye Hospital), Benjamin E. Leiby, PhD (Jefferson Medical College), David Weiss, PhD (Psychology Specialists of Maine), and Tarun Sharma, MD (Columbia University) for advising us on the study design, clinical decision-making, and evaluation of outcomes. We thank our community health workers (Jaqueline Wright and Rachel Wint) for conducting visual acuity tests.

Funding

This work was supported by the United States Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion (Grant numbers U01DP006435 and U01DP006436), and Research to Prevent Blindness, Inc, New York, NY. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the United States Centers for Disease Control and Prevention. We thank the Centers for Disease Control and Prevention for funding the Manhattan Vision Screening and Follow-up Study.

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Authors and Affiliations

  1. Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Daniel F. Diamond, Sitara Hirji, Jason D. Horowitz, Qing Wang, Lisa Park, Noga Harizman, Jeffrey M. Liebmann, George A. Cioffi & Lisa A. Hark

  2. Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA

    Daniel F. Diamond, Sitara Hirji, Jason D. Horowitz, Qing Wang, Lisa Park, Noga Harizman, Stefania C. Maruri, Desiree R. Henriquez, Jeffrey M. Liebmann, George A. Cioffi & Lisa A. Hark

  3. Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Samantha X. **ng

  4. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA

    Prakash Gorroochurn

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  1. Daniel F. Diamond
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Contributions

All authors made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and gave final approval of the version to be published.

Corresponding author

Correspondence to Lisa A. Hark.

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Ethics approval

The study was approved by the Columbia University Institutional Review Board and was conducted in accordance with the Declaration of Helsinki (CUIMC IRB #AAAR9162). The study is registered with ClinicalTrials.gov (NCT04271709).

Informed consent

All participants provided informed consent before participating in this study.

Competing interests

The authors have made the following disclosures: JDH: Member Medical Policy Council of Superior Vision. JML has received research support from National Institutes of Health, Heidelberg Engineering, Novartis, Inc., and is a consultant to Allergan, Inc., Genentech, Inc., Thea Pharmaceuticals, Inc., and Janssen Pharma, Inc. All other authors have no relevant financial or non-financial interests to disclose.

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Diamond, D.F., Hirji, S., **ng, S.X. et al. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): optometric exam improves access and utilization of eye care services. Graefes Arch Clin Exp Ophthalmol 262, 1619–1631 (2024). https://doi.org/10.1007/s00417-023-06344-2

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