Free Eye Care in Underserved Areas May Improve Disease Detection

A program offering free eye care services in primary care clinics in underserved areas may improve eye disease detection and treatment, a population-based, cross-sectional study suggested.

Among 1,171 participants who said they had not had an eye exam in 2 or more years, 21% screened positive for glaucoma, 20% for cataracts, 6% for diabetic retinopathy, and 1% for age-related macular degeneration, reported Paula Anne Newman-Casey, MD, of the W.K. Kellogg Eye Center at the University of Michigan in Ann Arbor, and colleagues in JAMA Ophthalmology.

Of note, risk factors for eye disease were present in participants in the Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (MI-SIGHT) Program who reported not having had an eye examination in 2 or more years:

• 23% were 65 and older
• 33% self-reported diabetes
• 25% reported a family history of glaucoma
• 3% self-reported glaucoma
• 33% were Black or African-American and 50 and older

“Placing a free eye disease screening program in community clinics that serve medically underserved populations is a great way to identify people who would benefit from eye care and a great way to potentially mitigate disparities in eye disease and vision loss in the U.S.,” Newman-Casey told MedPage Today.

Low-income people often face multiple challenges in regards to eye health, she noted. “Medical insurance does not always pay for glasses, making them often unaffordable for people with low incomes. This is likely why uncorrected refractive error remains the leading cause of visual impairment in the United States,” she said.

In this study, reported reasons for why participants had not had an eye examination included no insurance (28%), no reason to go (22%), and cost of eye examination (16%).

“One study found that people with Medicaid were only 60% as likely to successfully get an appointment with an eye doctor compared to people with private insurance,” Newman-Casey said. “Medicaid does not reimburse enough for eye doctors to maintain their practices, so practices might limit the number of patients with Medicaid that they will see. Compounding these insurance issues are other practical issues, such as a lack of reliable public transportation, making it difficult for people who do not have cars to get to medical appointments.”

In a previous cross-sectional online survey study, 82.4% of respondents ages 50-80 said they’d had their eyes examined within the past 2 years. By contrast, for participants in this study from communities where 70% lived in poverty, the rate was just 40.5%.

The survey study also found that 85% of Black patients reported getting an eye exam within the past 2 years compared with 50% of Black participants over 50 in the current study.

In an accompanying commentary, John S. Wittenborn and David B. Rein, PhD, of NORC at the University of Chicago, wrote that the program “appears to have succeeded in bringing eye care to people who are both in high need of eye care and who otherwise were unlikely to receive it.”

They highlighted potential solutions to improve eye care, such as Medicare coverage for routine eye care, the expansion of community-based programs like MI-SIGHT, and eye health awareness campaigns.

For this study, participants were recruited from primary care clinics serving two low-income communities. Recruitment occurred between June 28, 2020 and June 27, 2021 at a free clinic in Ypsilanti, and between Jan. 27, 2021 and Jan. 26, 2022 at a federally qualified health clinic in Flint.

The screening was partially conducted through telemedicine. University of Michigan ophthalmologists remotely reviewed data from comprehensive eye disease screening exams with ocular imaging. The exams were conducted on site by technicians who could prescribe low-cost prescription eyeglasses if needed. Patients also received assistance in seeking further care if recommended.

Mean participant age was 55 (24% were 65 and older), 62% were women, 54% were Black or African American, 34% were white, and 10% were Hispanic or Latino. Of the participants, 43% had a high school education or less, 70% reported an annual household income of less than $30,000, 35% had Medicaid, and 20% had no insurance.

The study did not measure whether patients diagnosed with eye disease received follow-up treatment, nor whether treatment was successful.

Newman-Casey and team noted other limitations to the study, such as its reliance on survey data, which can be unreliable, and the potential for inclusion bias.

On the other hand, they added that “there may be volunteer bias in which those with a family history of eye disease may be more likely to participate and screen positive, leading to an overestimate of eye disease.”

Continued grant funding of the program is under review by the CDC, Newman-Casey said, and it’s not clear if it will survive past its September end date.

“We hope that the CDC continues to fund this type of program, in addition to research into how to expand eye disease screening among medically underserved communities and how to expand eye disease screening through the national network of federally qualified health centers, whose mission is to provide care to medically underserved communities,” she said.

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