Clinical Publications

MAESTRO

Alabama Screening and Intervention for Glaucoma and Eye Health through Telemedicine (AL-SIGHT): Baseline Results

AUTHORS:

Owsley C, Swain TA, McGwin G Jr, Nghiem VTH, Register S, Asif IM, Fazio M, Antwi-Adjei EK, Girkin CA, Rhodes LA

PUBLICATION:

Am J Ophthalmol. 2024 Jan;257:66-75. doi: 10.1016/j.ajo.2023.09.001. Epub 2023 Sep 7.

Study Purpose

To describe baseline results of the Alabama Screening and Intervention for Glaucoma and Eye Health through Telemedicine (AL-SIGHT) for patients at federally qualified health centers (FQHCs). Candidates were persons at risk for glaucoma-associated diseases (GAD) based on age, race/ethnicity, current diagnosis of GAD, family history, and diabetes

Overview

Study Design

Baseline screening visit followed by remote diagnosis and referral for follow-up examinations at 3 FQHCs

# of Eyes/
Patients

First 500 participants enrolled in the AL-SIGHT program between November 2020 and June 2022; mean age was 58 years; 45.6% were African American and 51.6% White

Study Device

Maestro2 SD-OCT, QuickSee or Retinomax autorefractor, iCare portable rebound tonometer, Humphrey Field Analyzer 3 or Melbourne Rapid Fields

Outcome Measures

Detection rates of eye disease, rate of referral by the ophthalmologist for follow up eye care, rate of patients adhering to attending follow-up care, and patient satisfaction

Results

Remote diagnostic evaluation of ocular screening by an ophthalmologist revealed 29.7% GAD, 6.8% diabetic retinopathy, 37.6% cataract, 67.3% refractive error, 9.2% other eye conditions
Fundus photographs were unreadable for 32 right eyes and 28 left eyes; OCT images were unreadable for 52 right eyes and 61 left eyes. Visual field data were unreliable in the HFA for 168 right eyes and 176 left eyes, and in the Melbourne Rapid Field test for 234 right eyes and 210 left eyes
In all, 47.2% of the participants were referred for follow-up examination and for acuity 20/40 or worse or IOP ≥23 mm Hg in one or both eyes
Follow-up examination attendance was 76.7% for those referred; participants referred for glaucoma had a follow-up rate of 92%
A total of 428 participants (85.8%) reported that they were very satisfied with the vision screening, 83.2% were very satisfied with the time for the complete screening, and 92.2% stated that it was very convenient having their ocular screening in the same clinic as their primary care provider

IMOvifa reduced measurement time by

39%

Conclusions

• The high percentage of patients diagnosed with treatable eye conditions through the AL-SIGHT telemedicine screening and their strong adherence to follow-up eye care suggests that these screenings in FQHCs could be effective and scalable nationwide. • Participants welcomed screenings in their communities. • A strength of the AL-SIGHT program is its use of both structural and functional optic nerve testing. Although the reliability of the visual fields in this study was poor in ~34% of participants, this is in the range noted in other studies and reflects a cohort not considered to be experienced visual field test takers.