Telemedicine Vision Threatening Diseases and Wellness Screenings in Uninsured Latino Community During COVID-19

ABSTRACT

Purpose: Limited access to eye-care among Latinos can lead to missed Vision Threatening Diseases (VTDs) defined as Age-related Macular Degeneration (AMD), cataracts, Diabetic Retinopathy (DR) and glaucoma. As 50% of the people with VTD's are unaware of their condition made worse during COVID-19, comprehensive eye screenings to assess ocular wellness was implemented using telemedicine, Artificial Intelligence (AI) and robotic consultations. Methods: State-sponsored screenings were conducted at a church in West New York, NJ (78% Latino, mostly from Colombia) over 3 weekends during the 2021 Pandemic. All participants had received two-dose vaccinations and wore a surgical mask during screenings. Nine first-year medical students and 6 community volunteers took part in the wellness evaluation including medical history, blood pressure, visual acuity, automated refraction, puff tonometry, 45-degree non-mydriatic retinal photography AI. To confirm findings: 6-micron resolution ocular coherence tomography (OCT) B-scan was performed. Screened subjects had their data reviewed by an onsite ophthalmic grader using a Spanish-speaking interpreter. As 80% of screened subjects are lost to follow-up, remote robotic ophthalmology consultation via HIPAA compliant Wi-Fi was utilized in real-time to connect with an off-site ophthalmologist. Results: 153 subjects, (71 Female (46%), median age 55) had 127 ocular findings (Table 1) found in 85 (55%) subjects, of which 98% of findings were previously unknown and 40 (47%) classified as VTD. 23(15%) subjects had multiple findings. OCT confirmed 23 cases of AMD and glaucoma. AI referred 39 cases. 36 individuals took part in robotic virtual consults. Findings were cataracts 70 (45%), glaucoma 32 (20%), and AMD 25(16%). Among those with findings, 82% were uninsured and 90% had >2 years since last eye exam. 32 (32/153) subjects had undertreated or untreated hypertension. 93% were un-familiar with telemedicine. Conclusions: Latinos without health insurance and ease of access to eyecare may have a higher burden of multi-VTDs. An exception was DR which could be a limitation of population bias. This pilot study supports comprehensive wellness eye screenings that may allow for early detection, confirmation, and referral of single or multiple VTD in high-risk low-income communities. Further studies are needed using larger sample populations. (Figure Presented).