The Oregon Vision Health Network is expanding our model of eye care from individual to population health
Casey Eye Institute’s mission to end preventable blindness has always placed a strong emphasis on community outreach. Many people in Oregon’s 96,000 square miles live in rural or semi-rural settings far from an ophthalmologist. Children’s vision screening has been available for decades, but adults who have limited insurance coverage or ability to travel have had scant access to screening for visual acuity and the top three causes of adult-onset vision loss: glaucoma, macular degeneration and diabetic retinopathy, which are often diagnosed late.
As the state’s only academic health center, Oregon Health & Science University has a mission to serve every Oregonian, including those who cannot come to its clinics in Portland. Casey Eye Institute has wholeheartedly embraced that mission. As the Casey Community Outreach Program expands to include the new Oregon Vision Health Network and more than 60 community partners across the state, the population health vision is broader than ever.
Outreach Program director Michell Brinks, M.D., M.P.H., is also a former chair of Vision 2020 USA. The Casey Community Outreach Program has more than a decade’s worth of experience partnering with primary care health clinics and social service agencies to provide eye care services across Oregon with its mobile health clinic.
Recently, a $3.25 million donation from The Roundhouse Foundation and philanthropist Heather Killough is helping establish a larger statewide network of partnership with community clinics. This will expand the current outreach program’s ability to provide eye care to underserved communities. Local community health workers will be trained in adult vision screening and testing for glaucoma, macular degeneration and diabetic retinopathy. Screening and imaging will be free to patients in the network’s first five years.
Creating the OVHN has a special significance for Oregon native Brinks. “I grew up camping, hiking and fishing all around Oregon,” he says. “I know many communities well, and I love going back there.”
Three key programs
The OVHN comprises three programs: telehealth, training vision health navigators and providing screenings with two mobile health clinics. People who need further care are connected to appropriate local clinics and specialists.
The OVHN aims to improve eye health for patients affected by social factors, also called social determinants of health. For example, living a long way from a clinic or speaking no English can prevent someone from seeking care before vision is irretrievably lost.
“We have to address eye health upstream of disease and injury,” says Brinks. “Bringing screening and care out of urban clinical centers is an important way to prevent vision loss.”
At OVHN’s community sites, patients can be screened and visit an eye specialist virtually. These telehealth sites are access points for people who need monitoring for conditions such as diabetic retinopathy and many other eye diseases.
Vision health navigators
Community health clinics such as One Community Health in Hood River, Ore., and the Virginia Garcia Memorial Health Center in Newberg, Ore., are training staff as vision health navigators with basic eye care knowledge.
“We have Oregon Health Authority-certified training for this new tier of the eye care workforce to bridge the gap between routine care and eye subspecialists,” Brinks says. “These folks can now provide risk assessment, eye care education, visual acuity and intraocular pressure testing – and eventually, they may also do the imaging,” Brinks says. “The staff have seen the needs in their community, and being able to help is a dream come true for them.”
Advanced eye imaging with optical coherence tomography, or OCT, will be available at up to eight community clinics. CEI physicians can review the images and make recommendations. Community partners can also connect patients with local eye care providers as needed.
Technology supports mobile eye care and remote screening for disease
Since 2010, Casey’s mobile vision clinic has crisscrossed the state, screening adults at high risk for vision loss. The 33-foot mobile clinic, which recently served its 10,000th patient, has been updated with new equipment to measure visual fields and perform OCT.
“[Former Casey Eye Institute director] David Wilson had the vision for the mobile clinic, and the donors, Casey faculty and many volunteers made it happen,” says Brinks. A second, slightly larger unit will roll out in summer 2023, also with advanced imaging capacities, two private examination areas and a wheelchair lift.
OCT was co-invented by Casey Eye Institute associate director David Huang, M.D., Ph.D. This technology has enormous potential to improve the eye health of rural populations, as specialists hours away can diagnose disease based on precision imaging.
“Sixty percent of common eye diseases may not be found until they have caused irreversible eye injury and people are close to losing their sight,” Brinks says. “But combining OCT, information technology, donor and community resources and the expertise at Casey, we can find and treat disease much earlier.”
The value of community-based care
Brinks emphasizes the value of community-based vision screening and care. “Patients are used to visiting their community resources, going shopping, to school, to meeting places and to their local health center,” he says. “Heading to a specialist is not in their routine, so we’re reaching out with Casey expertise to work through a health clinic people already trust, a place they’re familiar with.”
These existing relationships with community health centers are a key driver behind the OVHN. “Casey doesn’t go in and take over,” Brinks says. “We’re careful how we expend our resources, so we can respect the community clinics.”
The future of eye care is prevention
“The path we’re pursuing represents the Holy Grail of science and innovation in eye care, as well as the rest of health care,” says Brinks. “Ophthalmologists are treating disease that, when first diagnosed, has already caused considerable damage. With the eye measuring just two and a half centimeters front to back, and made of delicate neural and optical tissues, with just a little bit of damage – there’s often no way back.”
From this perspective, the future of eye care is shifting to a proactive clinical science and broadening the connection to early diagnoses on a population scale, rather than solely on an individual, case-by-case basis.
“Ophthalmologists are used to seeing patients in their clinic exam rooms, one by one,” Brinks says. “Moving forward to intervene ahead of this conventional care model may not be in our comfort zone yet, but marrying public health and eye care pays off – not just in dollars, but in quality of life.”