# Health economic evaluation of a nurse-assisted online eye screening in home healthcare to reduce avoidable vision impairment (iScreen): study protocol for a cluster randomized controlled trial

## TL;DR

This study tests if online nurse-assisted eye screening in home healthcare can reduce avoidable vision impairment among older people and if it is cost-effective.

## Contribution

The study introduces a nurse-assisted online eye screening program for home healthcare patients, evaluating its cost-effectiveness and impact on vision impairment.

## Key findings

- The study will assess the cost-effectiveness of online eye screening in reducing avoidable vision impairment.
- It will measure visual acuity changes over 12 months in home healthcare recipients.
- The trial involves 240 older participants receiving home-based nursing care.

## Abstract

Among older people undiagnosed and untreated vision impairment and blindness are common. The leading causes are uncorrected refractive errors and cataracts. Vision problems are associated with a lower quality of life, several health problems, and a higher chance of falling accidents and fractures. To eliminate avoidable vision impairment and blindness, targeted eye screening programs are recommended. Older patients, receiving home healthcare, have not yet been considered as a population at risk who could benefit from eye screening.

A cluster-randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of online nurse-assisted eye screening in home healthcare, compared to care as usual, in reducing avoidable vision impairment. A healthcare and societal perspective will be used. The study will be performed in collaboration with several home healthcare organizations in the Netherlands. The online eye screening consists of near and distance visual acuity, followed by an Amsler grading test. Measurements in both groups will take place at baseline and after 6 and 12 months of follow-up. A total of 240 participants will be recruited. Older men and women (65 +), who receive home-based nursing and are cognitively able to participate, will be included. The primary outcome will be the change of two lines or more on the Colenbrander-1 M visual acuity chart between baseline and 12-month follow-up.

An eye screening for populations at risk contributes to the detection of undiagnosed and untreated vision impairment. This may reduce the health-related consequences of vision loss and the high economic burden associated with vision impairment.

ClinicalTrials.gov NCT06058637. Registered on 27 September 2023.

The online version contains supplementary material available at 10.1186/s13063-023-07882-0.