Glaucoma :: University of Maryland Project Targets Population at Increased Risk for Glaucoma

Dilated eye exams, in which special eye drops are used to widen the pupils, allow eye care professionals to see into the back of the eye to check for early signs of eye disease such as glaucoma and diabetic retinopathy, two of the leading causes of blindness in this country. But many people, particularly seniors who are at increased risk for these diseases, do not get this important test.

Now through a study known as the Examine Your Eyes (EYE) project, researchers from the University of Maryland Department of Ophthalmology and Visual Sciences are evaluating specific strategies to see if they can get older African-Americans to schedule a dilated eye exam, a test that could save their sight.

?African-Americans are three to four times more likely to develop glaucoma, and they are nearly twice as likely to have diabetes, which also puts them at risk for vision loss. However, we know from our preliminary research that many older African-Americans are not getting a dilated eye exam every two years as recommended, or every year for diabetics,? explains Nancy Ellish, Dr. P.H., assistant professor of ophthalmology at the University of Maryland School of Medicine, who is leading the study.

?We are looking for effective strategies to inform these seniors that a dilated eye exam can identify these diseases earlier, when they can be treated to prevent or slow the progression of vision loss. And we want to see if this information will convince them to schedule a dilated eye exam.?

The researchers will mail newsletters to the homes of more than 300 African- American seniors who enroll in the study. Half the participants will receive a newsletter with general information about glaucoma, the importance of dilated eye exams and a reminder to schedule an appointment for a dilated exam.

The other half will receive a newsletter with specific information tailored to these individuals, based on responses they gave to a questionnaire filled out when they enrolled in the study. For example, if the study participant says he doesn?t need a dilated eye exam because he doesn?t have any eye problems, a section of his newsletter may provide specific information about why he stills needs to get a dilated exam. For someone who says she can?t afford an eye exam, a section of her newsletter may profile a similar person who explains the way she was able to pay for a dilated exam.

?Tailored messaging has been used to try to change behaviors related to smoking cessation, weight loss and mammography. We are interested to see if the tailored messages will be more effective in prompting participants to schedule a dilated exam,? says Dr. Ellish.

Three months after the newsletter arrives, study researchers will call participants to ask if they have scheduled or have had a dilated eye exam. They will follow up again three months later with those who had not previously had the exam.

Dr. Ellish adds, ?The population of the United States is aging, and eye disease is going to become even more of a problem. It is critical to catch these vision problems early.?

With both glaucoma and diabetic retinopathy, symptoms do not appear until the disease has progressed, so by the time people have symptoms, they?ve already lost some of their vision. But a dilated eye exam can reveal these problems much earlier in the disease, when there are ways to treat these diseases to prevent or stop the progression of vision loss.

Glaucoma refers to a group of eye diseases that damage the eye?s optic nerve, which can lead to vision loss and eventually blindness. There is no cure, but early treatment can stop the progression of the disease. The National Eye Institute currently estimates that 2.2 million Americans have glaucoma, with projections of 3.3 million people affected by the year 2020.

Diabetic retinopathy is a common complication of diabetes that affects small blood vessels in the back of the retina. These vessels can leak, break down or become blocked, which leads to impaired vision. The National Eye Institute estimates that 4.1 million Americans have diabetic retinopathy and that more than seven million people may have it by the year 2020.

The University of Maryland researchers chose to focus on African-Americans over age 65 because they are at increased risk for glaucoma and diabetic retinopathy, and Medicare will cover 80 percent of the cost of a dilated eye exam. Many seniors interviewed by the researchers were not aware of this coverage.

?Our initial questionnaire indicates that many seniors are not aware of the importance of a dilated eye exam or even what they are,? says study coordinator Deborah Scott. ?They tell us they?ve had their eyes checked for glasses or that they had a vision screening, but don?t understand that they need to have their pupils dilated so the eye care professional can examine the back of their eyes.?

The National Eye Institute currently recommends that African-Americans over the age of 40 should have a dilated eye exam at least once every two years. Other groups should get a dilated eye exam every two years starting at age 60. In addition, people with diabetes should get a dilated eye exam at least once a year.

The EYE project is part of a four-year grant from the National Institutes of Health. People who are interested in enrolling in the study should call 410-328-2338. Participants will receive some compensation for their time.

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