Evaluation of an eye health program: the vision initiative

The aim of this study was to develop an innovative, rapid and economical assessment methodology to determine the knowledge, attitudes and behaviours regarding eye health and to determine the rates of the most common causes of visual impairment and undiagnosed eye disease.Letters were posted to Seniors Card holders aged 70-79 in 18 randomly selected areas, stratified by socio-economic status. A questionnaire was developed to measure knowledge, attitudes and behaviours regarding eye health. Uncorrected refractive error was determined by measuring presenting and best-corrected visual acuity (VA). Diabetic retinopathy and age-related macular degeneration were assessed using digital non-mydriatic retinal photography. Glaucoma was assessed using Frequency Doubling Technology (FDT) and digital images of the optic nerve head. Cataract was determined using digital retro-illumination images of the lens taken with a non-mydriatic camera. The cost for recruiting, examining and grading images for each participant was calculated by dividing the total study cost by the number of participants examined.Of the 13,483 participants invited to participate in the study, appointments were made for 1860 (13.8%) people with 1,701 (91%) actually attending. Overall, missing data from the 1,695 questionnaires represented less than 1.0% and all participants attended the vision screening over a three-month period. Presenting and best-corrected visual acuity and FDT results on both eyes were obtained on 99% of the sample. The proportion of gradable digital images of the fundus in both eyes in the sample was 89%, while 90% of participants with bilateral presenting VA6/12 had assessable lens images. The cost for recruiting, examining and grading images for each participant was approximately 150 AUS dollars.The recruitment from a mailing obtained the required sample size for the study, allowing a large sample of participants to be examined efficiently over a short period of time. It is important that the most common causes of visual impairment and undiagnosed eye disease can be determined using this rapid assessment methodology.