Visual impairment, the second-leading cause of disability among American Indians living in the Pacific Northwest, contributes to diminished quality of life. Only 2 of the 43 American Indian tribes in the Pacific Northwest have an eye care provider, and most tribal members must travel 60 miles or more to have an eye exam. Researchers aimed to increase residents’ access to eye exams, improve the quality of life for residents by providing prescription eyeglasses, reduce the risk of blindness for residents who have diabetes, and determine the extent and possible causes of the community’s visual impairments. The center collaborated with the Tribal Community Advisory Council, the Northwest Portland Area Indian Health Board, and the Devers Eye Institute to design, implement, and evaluate three studies, among Pacific Northwest American Indian and Alaska Native (AI/AN) participants.
The first study included 481 residents from 3 tribes—Umatilla in Oregon, Shoshone-Bannock in Idaho, and Lummi in Washington. Researchers performed 7 screening tests for eye disease and provided a free prescription for eyeglasses if needed. All participants with a positive result for any of the seven screening tests received a full eye exam, onsite by an ophthalmologist. A few participants with negative screening results for each of the seven tests received a full eye exam, onsite by an ophthalmologist, to help researchers determine the accuracy of initial screening tests. Results from the ophthalmologist exam showed that pictures of the eye could be used in screening for diabetic retinopathy. The prevalence of visual impairment for study participants was 3.1%, and the most common causes included cataracts and age-related progressive loss of sight. Researchers also learned that Northwest AI/AN have an unmet need for vision correction and that the provision of eyeglasses should be incorporated into future projects.
The second study determined how making eyeglasses available to AI/AN who need them can improve their quality of life. Researchers enrolled 114 participants from the same 3 tribes in the Pacific Northwest and adapted a survey tool (NEI-VFQ-25) to measure vision-related quality of life by including activities common in AI/AN communities. The survey tool was found to be valid and sensitive to changes in quality of life among AI/AN. Researchers found that eyeglasses increased the general vision-related quality of life score by 58%, which is greater than the improvement seen with cataract surgery (36%). This finding suggests that the provision of eyeglasses may improve vision-related quality of life more than cataract surgery does; further study is needed to confirm the finding.
The third study assessed the use and accuracy of telemedicine, in which a picture is taken of the eye and sent electronically to an offsite eye specialist who recommends appropriate care. Researchers enrolled 588 people with diabetes from the Umatilla tribe in Oregon and from Hunter Health clinic in Wichita, Kansas, and randomly assigned them to one of two groups: a camera group and a usual care group (control). Participants in the camera group had pictures taken of their eyes at the clinic by trained nonprofessionals who sent the pictures electronically to Devers Eye Institute, Portland, Oregon, where an eye care provider made a diagnosis and follow-up recommendations, which were then sent to the clinic. Participants in the usual care group were given an appointment to see an eye doctor and transportation, if needed. Only 40% of the participants in the control group went to their eye care provider, and 6% of participants from both groups had diabetic retinopathy requiring treatment. All participants in the camera group received the telemedicine eye exam, and the picture taken was not usable for only 6 percent. This low rate showed that non-licensed professionals can photograph the eye and maintain good diagnostic precision so that an eye care provider can diagnose eye diseases.
The results suggest that a greater proportion of people with diabetes receive retinal exams when telemedicine is used than when referred to an eye care provider. The project investigators are completing five years of follow-up before making final assessment of the accuracy and feasibility of the telemedicine technique.
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McClure TM, Choi D, Becker T, Cioffi GA, Mansberger SL. The effect of visual impairment on vision-related quality of life in American Indian/Alaska Natives. Ophthalmic Epidemiology 2009;16(2):128-35.
McClure TM, Choi D, Wooten K, Nield C, Becker TM, Mansberger SL. The impact of eyeglasses on vision-related quality of life in American Indian/Alaska Natives. American Journal of Ophthalmology 2011;151(1):175-182.e2.
Mansberger SL, McClure T, Wooten K, Becker T. Telemedicine to detect diabetic retinopathy in American Indian/Alaska Natives and Other Ethnicities. Paper presented at: Advocate, communicate and translate to enhance research and practice. 2010 Joint Conference of the Society for Public Health Education and the Prevention Research Centers Program; 2010 April 7-9; Atlanta, Georgia.