Community & Home Eye Screening Services (CHESS)

Abstract Body: 

Purpose: Regular mass eye screenings do not reach out to all in the community especially the elderly, uneducated and frail. Community and Home Screening Service (CHESS) aims to provide First-level Community Eye Screening (FiLCES) and Second-level Eye Consultation (SeLEC) for early detection and management of treatable eye conditions within the accessibility of northern Singapore residents.

Study Design: A trans-disciplinary collaboration involving nurses, optometrist and ophthalmologists to provide community eye care (screening and management) in the Northern part of Singapore.

Methods: CHESS was started in January 2017. It leveraged on and optimised the usage of existing resources:1. FiLCES by trained & accredited nurses from "Ageing-in-Place" program to do patient home visits and Population Health Office to do regular community health screeningsThe nurses conduct visual acuity testing and torch light eye examination test for screening. 2. SeLEC by trained & accredited optometrists at Wellness Centres (used for elderly social engagement and health programs, re-designed to create clinical consult rooms). The optometrist manages referrals from FiLCES via tele-consultation with and supervision by the hospital Ophthalmologist to reduce unnecessary hospital referrals.

Results: To date (September 2017), 1,231 residents underwent FilCES: of which 47.9% (590/1231) were detected to have one/ more eye conditions. Of these, 41.5% (245/590) could be managed at SeLEC. Already 237 out of the 245 patients have been seen at SeLEC. 44.7% (106/237) of them needed specialist referral. The detected abnormalities from SeLEC involved the lens (38.0%), conjunctiva (19.7%), anterior chamber (6.7%), eyelid (15.9%), cornea (7.2%), eye position (1.7%), uncorrected refractive error (7.0%), others (3.8%). This translates to only 8.6% (106/1,231) of the total screened requiring specialist referral. The manpower savings is about $75,000. Financial assessment deem CHESS viable based on a projected screening of 10,000 residents at nominal fees of SGD$2 (FiLCES, 84.1% savings) and SGD$8 (SeLEC, 78.4% savings). KPTH collaborated with NHG Polyclinics (NHGP) to facilitate the follow up of SeLEC patients in the polyclinics for hospital specialist referral. A hassle-free, coordinated workflow and referral process has been set up between the Wellness Centre and Polyclinic.

Conclusions: CHESS is a feasible & cost-effective eye care model to screen and manage some eye conditions in the Northern Singapore community. A significant number of asymptomatic eye conditions were detected.