Barriers to Receiving Follow-Up Eye Care and Detection of Non-Glaucomatous Ocular Pathology in the Philadelphia Glaucoma Detection and Treatment Project

Abstract

This cross-sectional study aimed to evaluate adherence rates and identify barriers to receiving follow-up eye care in participants diagnosed with significant non-glaucomatous eye pathology in the Philadelphia Glaucoma Detection and Treatment Project. This community-based project aimed to improve detection, management, treatment, and follow-up eye care of individuals at high risk for glaucoma in community-based settings. Participants throughout Philadelphia, Pennsylvania, USA were enrolled. After a comprehensive eye examination, follow-up recommendations were given to each participant. A telephone survey was administered to individuals diagnosed with non-glaucomatous ocular pathology 3 months after initial eye examination to assess rates of follow-up and to evaluate potential barriers to follow-up. Of the 1649 participants enrolled in this project, 249 (15 %) were diagnosed with significant non-glaucomatous ocular pathology requiring follow-up care. There were 143 (57 %) who responded to the telephone survey. Respondents had a median age of 72 years, and were predominately female (69 %) and African-American (64 %). Of the respondents, 36 (25 %) attended a follow-up appointment. Participants who did not remember the results of their examinations, did not remember their recommendations, and had not seen an eye doctor within the past year were less likely to make a follow-up appointment (P = 0.04, 0.001 and 0.005, respectively). The Philadelphia Glaucoma Detection and Treatment Program was able to detect a significant amount of non-glaucomatous ocular pathology requiring follow-up care. Actual follow-up rates were sub-optimal. Further research is needed to determine interventions to overcome barriers and increase adherence with follow-up recommendations.

A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma

“…Adherence in this study was defined as 1 or more visits within 1 year of diagnosis, and these rates were similar to what we observed for the same outcome in our intervention group (74.4%). Although the UC rate was much lower in our study, it is consistent with low rates seen in another recent study (26).…”

“…Future studies could consider combining additional interventions to further increase rates of adherence to follow-up eye care. Other interventions that may show promise include providing incentives such as free eyeglass prescriptions or free eyeglasses (26) and providing other financial incentives to encourage at-risk participants to return for follow-up eye examinations (12). The costs of the screening phase have been previously reported (22); the costeffectiveness of our adherence intervention is being evaluated.…”

Self-reported Use of Eye Care Among Adult Chinese Americans: The Chinese American Eye Study

“…5 Other studies of high-risk populations also found that rates of adherence to recommended follow-up care were below 50%, even when major barriers to eye care such as cost and accessibility were minimized. 6–8 These low rates of eye care utilization can be major obstacles to combating vision problems in the United States (US) such as the high prevalence (~2.4 million Americans 9 ) of undiagnosed and untreated glaucoma.…”

Health-Related Quality of Life Among Individuals with Visual Conditions Requiring Eyecare During COVID-19 Lockdown.

“…One unique nding in this study, and probably the most important, is having the perceived need to followup with an ophthalmologist during COVID-19 lockdown as a signi cant negative predictor of participants' HRQoL. Even in normal situations out of health pandemics and its associated lockdowns, many vision patients tend not comply with their ophthalmic follow-up appointments which might negatively impact their vision health (23)(24)(25). Although following up with an ophthalmologists is highly recommended in the literature(54), this was not easy for the majority of this study participants during the lockdown.…”

“…Even during normal situations out of pandemics and lockdowns, the adherence with ophthalmologic follow-up care was not found optimal among many vision patients. (23)(24)(25). Lack of adherence with eyecare follow-up might lead to vision deterioration, which is usually associated with decreased levels of HRQoL and increased levels of mental health symptoms (13,14).…”