By Andrew M. Williams, MD and Lisa A. Goldstein
The Healthy Vision Lab at the University of Pittsburgh is unique in its focus on social determinants of health, use of a wide range of analysis (from large datasets to patient-level interviews and health services research), and interdisciplinary relationships with scholars from the School of Public Health and the School of Health and Rehabilitation Sciences.
The lab’s mission is to implement collaborative research programs related to ophthalmology and public health that aim to improve access to eye care and to reduce preventable vision loss. These programs include research on initiatives to increase access to quality eye care; research on interventions to decrease loss to follow up in chronic eye diseases; and research on the influence of social determinants of health on vision-related outcomes.
“Our work is critical because it brings light to disparities in access to eye care and illuminates the relationship between social needs and vision health,” said Dr. Andrew M. Williams, Healthy Vision Lab Director and board-certified ophthalmologist who specializes in glaucoma and cataract surgery. “By examining barriers to care for vulnerable populations, our work can inform future initiatives to engage with populations in need in order to promote access to high-quality eye care for all.”
Dr. Williams’ work on vision health disparities was catalyzed by his investigation into loss to follow up in chronic eye diseases. Diseases such as diabetic retinopathy and glaucoma require routine monitoring to mitigate vision loss, but many patients are not able to follow up as recommended. The Healthy Vision Lab has examined large datasets to examine risk factors for loss to follow up by using data from a large diabetic teleretinal screening program as well as data on glaucoma patients from a nationwide ophthalmic database. Analysis from these sources have revealed that the highest burden of loss to follow up falls on the most vulnerable patients, including those without insurance, the eldest age groups, and those with greater disease severity or blindness.
In addition to examining datasets, the Healthy Vision Lab seeks to understand barriers to eye care by engaging directly with patients. In collaboration with the School of Public Health and a professional call center, the lab directly contacted glaucoma patients with appointment no-show to understand barriers to regular care and reasons for missed appointments. Additionally, they surveyed attendees at a free vision screening event for their reasons for attending and the obstacles faced to receiving regular eye care. These studies revealed patients’ desire for additional appointment reminder messages and highlighted the significant burden of transportation challenges in attending eye clinic appointments.
Fortunately, interventions are possible to mitigate barriers to regular eye care. The lab has published on the success of reminder messages in re-engaging patients after appointment no-show. In addition, they have demonstrated the ability of a patient navigator program to address common barriers to eye care, often by connecting patients with transportation resources. Ongoing work seeks to identify and to address health-related social needs and social determinants of health after implementation of a universal social needs questionnaire in the electronic health record. Additionally, the lab is seeking to leverage natural language processing (NLP) algorithms to extract social needs, such as transportation, from the free text of existing clinic notes to identify patients who may most benefit from local resources to maintain eye care.
The lab was established in 2021 with support from the Hillman Healthy Vision Initiative and has two postdoctoral fellows (Lauren Wasser, MD, and Hai-Wei Liang, PhD), a research assistant (Julie Cassidy), and affiliated faculty members in Drs. José-Alain Sahel and Evan L. Waxman. Funding sources include the American Glaucoma Society, Chandler-Grant Glaucoma Society, the Eye & Ear Foundation of Pittsburgh, National Science Foundation, and Research to Prevent Blindness.