Village-Integrated Eye Worker Trial II (VIEW II) Extension

PROJECT SUMMARY/ABSTRACT The World Health Organization estimates that 80% of blindness worldwide is avoidable. However, in resource-limited settings progressive eye diseases such as glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD) often go undiagnosed until it is too late. New approaches that detect progressive

eye diseases before they cause irreversible vision loss could help reduce visual impairment of communities. One such approach is community-based eye disease screening. The Village Integrated Eye Workers Trial II (VIEW II) is an ongoing cluster-randomized trial in which communities in Nepal receive visual acuity screening and are

subsequently randomized to receive either a community-based eye disease screening intervention consisting of optical coherence tomography (OCT) and intraocular pressure (IOP) assessment, or to no intervention. The goal of the screening intervention is to detect cases of glaucoma, diabetic retinopathy, and age-related macular

degeneration—all of which are progressive and cause irreversible vision loss if left untreated—and refer these cases to the local eye hospital for management. A door-to-door census is performed four years after starting the screening intervention to determine the effectiveness of screening for reducing vision impairment relative to

communities not receiving the screening intervention. This is a proposal for the extension of the VIEW II trial, maintaining the original randomization and continuing the same screening intervention in the study clusters except that fundus photography is also included in the screening intervention and that the targeted age group is expanded to those ≥50-years. The specific aims

of the proposal are (1) to determine if the screening intervention is effective for preventing vision loss at the community level over 7-years, (2) to compare text messages versus community volunteers for improving linkage to care, and (3) to determine the natural history of OCT measurements over time in a population-based study.

Glaucoma, DR, and AMD are slowly progressive diseases, and given interruptions to study activities caused by the COVID-19 pandemic, the originally planned 4-year endpoint in the original VIEW II trial may not be long enough to observe the full effect of the screening intervention. Extending the trial will provide a more accurate

assessment of any benefit of screening. Extending the trial also allows for repeated OCTs in a population-based sample, providing much needed data on the natural history of OCT parameters to help clinicians better determine what constitutes progression. This research is significant because it will provide the strongest type of evidence

to guide national eye health programs – results from a randomized controlled trial. Ultimately, this trial will benefit blindness prevention programs worldwide in deciding how to allocate limited resources to optimally detect eye disease.