Objective: To evaluate the impact of the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program (MI-SIGHT) on visual acuity (VA), vision-related quality of life (VRQOL), satisfaction, follow-up visit attendance, and costs among medically underserved participants receiving primary care at community health centers.

Methods: Prospective cohort study with an embedded randomized controlled trial. Methods: MI-SIGHT participants ≥18 years. Methods: MI-SIGHT participants underwent an eye disease screening exam with a trained ophthalmic technician, received assistance ordering low-cost glasses, and completed surveys. Participants could return for a repeat screening after 1 year. The prevalence of disease identified was compared to national rates using z-tests. VA and VRQOL were compared between initial and repeat visits with paired t-tests and Wilcoxon signed-rank tests. Satisfaction was summarized with descriptive statistics. Participants who screened positive for disease were assessed for attendance at recommended follow-up with a clinician, including those with glaucoma who were randomized to care navigation plus personalized education and health coaching (treatment) or care navigation plus written education (control). Attendance rates were calculated and compared between arms of the trial with Chi-Square tests. Methods: 1) Eye disease prevalence; 2) Change in VA and VRQOL; 3) Program satisfaction; 4) Follow-up attendance; 5) Costs.

Results: 3714 participants were included; 11.5% were visually impaired, 9.3% had un- or undercorrected refractive error causing visual impairment; 22.4% had glaucoma/suspected glaucoma; 4.7% had diabetic retinopathy (rates higher than national averages at p<0.0001); 99% were satisfied or very satisfied, and 68% attended recommended follow-up. 943 participants completed repeat screening (mean of 1.2±0.3 years after initial screening). At repeat screening, worse eye presenting logMAR VA improved (mean±SD, 0.25±0.59 to 0.21±0.52, p=0.0012) as did VRQOL (NEI VFQ9 composite score 81.1±14.1 to 86.4±12.0, p<0.0001). Of the 490 participants who screened positive for glaucoma/suspected glaucoma and were randomized (n=247 treatment, n=243 control), follow up attendance did not differ (61% vs 59% p=0.7). The program cost $110.99/participant served, and $206.72/case of eye disease detected.

Conclusions: Expanding glaucoma and eye disease screening and treatment of refractive error to community health centers with care navigation support could improve vision and eye health outcomes.