Implementation of a vision-screening program in rural northeastern United States
Authors Tsui E, Siedlecki A, Deng J, Pollard M, Cha S, Pepin S, Salcone E
Received 26 June 2015
Accepted for publication 6 August 2015
Published 7 October 2015 Volume 2015:9 Pages 1883—1887
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Edmund Tsui,1,2 Andrew N Siedlecki,3 Jie Deng,3 Margaret C Pollard,3 Sandolsam Cha,3 Susan M Pepin,4 Erin M Salcone4
1Department of Surgery, Dartmouth–Hitchcock Medical Center, Lebanon, NH, 2Department of Ophthalmology, New York University School of Medicine, New York, NY, 3Geisel School of Medicine at Dartmouth, Hanover, NH, 4Section of Ophthalmology, Dartmouth–Hitchcock Medical Center, Lebanon, NH, USA
Background: Rural populations comprise almost 20% of the US population and face unique barriers in receiving health care. We describe the implementation of a medical student-run free vision-screening clinic as a strategy to overcome barriers in accessing eye care in New Hampshire and Vermont.
Methods: Medical students were trained by an ophthalmologist to administer screening eye examinations. Patients from New Hampshire and Vermont were enrolled through a free community clinic. Screening included a questionnaire, distance and near visual acuity, extraocular movements, confrontational visual fields, and Amsler grid. Patients who met predetermined screening criteria were referred to an ophthalmologist or optometrist for further evaluation. Data including patient demographics, appointment attendance, level of education, and diagnoses were recorded and analyzed.
Results: Of 103 patients (mean age of 45.5±12.3 years, 63% female), 74/103 (72%) were referred for further evaluation, and 66/74 (89%) attended their referral appointments. Abnormal ophthalmologic examination findings were observed in 58/66 (88%) patients who attended their referral appointment. Uncorrected refractive error was the most common primary diagnosis in 38% of referred patients. Other diagnoses included glaucoma suspect (21%), retinal diseases (8%), amblyopia (8%), cataract (6%), others (6%), and normal examination (12%). Of the 8/74 (11%) referred patients who did not attend their appointments, reasons included patient cancellation of appointment, work conflicts, or forgetfulness. Patients traveled a mean distance of 16.6 miles (range: 0–50 miles) to attend screening examinations. Mean time for patients’ last effort to seek eye care was 7.1 years (range: 1–54 years).
Conclusion: This study underscores the high prevalence of unmet eye care needs in a rural population. Furthermore, it demonstrates that using community health centers as a patient base for screening can yield a high referral attendance rate for this at-risk population and facilitate entrance into the eye care system in a rural setting.
Keywords: vision screening, rural health, uninsured
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