Clinical Vision Research Group (National Eye Institute)
A school-based vision-screening project in which we conducted 17 focus groups that assessed barriers and facilitators to school-based vision screening with school nurses, teachers, and parents from three racial/ethnic groups.
Richard S. Baker, M.D., PI (Rbaker2@ucla.edu
The Department of Ophthalmology of Charles Drew University and its affiliate, Los Angeles Eye Institute (CDU/LAEI), initiated a program to strengthen clinical vision research in, and eye care delivery to South-Central Los Angeles. The multicultural, largely minority population of this area is socio-economically disadvantaged and manifests a high burden of eye disease. It is clear from our clinical experience that healthcare services, and particularly the ability to identify, recognize, and treat eye diseases are deficient. In order to provide better care, we must determine the nature and extent of healthcare disparities in our population and identify the barriers to better delivery. Once the barriers are known, we will be able to design and apply appropriate interventions to remove them. These findings would potentially be generalizable to other similar communities across the nation.
The goal of this application is 1) to produce a sustainable clinical vision research infrastructure dedicated to methodologically rigorous, culturally appropriate research in urban underserved communities; and 2) to take advantage of an unprecedented opportunity to leverage resources from NEI, NCRR, HRSA, Los Angeles County Department of Health Services (DHS), Los Angeles Unified School District (LAUSD), and community partners to develop a replicable, fully validated model for a school based vision screening strategy, whose effectiveness in regard to improving population outcomes is clearly delineated. The data collected in this study will provide information on the extent and degree of vision related disparities (i.e., reduced visual acuity, clinically significant refractive error, amblyopia and strabismus) experienced by school-aged children residing in a large urban multicultural community. These data represent the requisite preliminary information necessary for development of future studies including studies on intervention strategies designed to identify and remove barriers to effective eye care delivery in Los Angeles County. This information begins to address a major objective of the NEI Health Services Research Plan for 1999 – 2003 and is potentially generalizable to many other urban, multicultural communities across the nation.
The primary objective of the proposed activity is the development of a clinical vision research group at CDU/LAEI dedicated to methodologically rigorous investigation of eye care issues related to minority and socioeconomically disadvantaged populations and capable of producing a competitive NIH level program of research. A second objective is the implementation of a school-based vision screening program whose purpose is to identify and test intervention strategies designed to eliminate vision-related health disparities experienced by minority and socioeconomically disadvantaged children and to improve the quality of eye care for all children. Funds are requested as a supplement to RCMI grant RR03026 to establish a clinical vision research support group for CDU/LAEI. CDU/LAEI provides eye care to the medically underserved community of South Central Los Angeles County. This service area is prototypical of multicultural inner city communities across the nation. The infrastructure needs for conducting studies of racial disparities in the delivery of eye care to our minority population are more than the existing RCMI programs can support. If important epidemiologic research on vision dysfunction is to be done in this area, a dedicated vision research epidemiology/biometry unit must be established. We propose to develop such a capability by accomplishing the following Specific Aims during the next two years:
- To develop a Clinical Vision Research Support Group with special emphasis on development of capacity to conduct methodologically rigorous, culturally appropriate, vision related epidemiology and health services research in the setting of urban multicultural and socioeconomically disadvantaged communities. Achievement of this objective includes: a) recruitment of a multidisciplinary vision research unit (epidemiologist, biometrist, data manager, health services researcher); b) development of the research capabilities of current CDU/LAEI ophthalmology faculty; and c) enhancement of the CDU/LAEI vision research infrastructure.
- To conduct a school based vision screening survey for a multicultural sample of Los Angeles County elementary school children representing four different racial/ethnic groups (Hispanic, African American, Asian, and Non-Hispanic White). Achievement of this objective includes: a) age-, race-, and gender- specific comparison of presenting visual acuity, refractive error, clinically significant uncorrected refractive error, amblyopia and strabismus; b) quantitative assessment of the validity of the vision screening protocol including documentation of the sensitivity, specificity, positive predictive value, and negative predictive value specific to the applied screening methodology and referral criteria.
- To assess the clinical effectiveness of a school based vision screening survey of an urban multicultural sample of elementary school children. Achievement of this objective includes: a) Assessment of the number and proportion of children who undergo definitive diagnostic evaluation after being identified as high risk for visual disorders through vision screening (i.e. compliance with post vision screening recommendations)/ b) Assessment of the number and proportion of children who undergo definitive treatment after being definitively diagnosed as having a treatable visual disorder (Compliance with post diagnosis recommendations) and c) Identification of the barriers and facilitators of compliance with post vision screening recommendations (i.e. follow-up evaluation and treatment compliance).