For people who may not know they have an eye disease, screening is only the first step toward care. Penn Medicine's Scheie in MOTION mobile unit brings eye screenings to Philadelphia communities and connects patients who need additional care with physicians for follow-up. At a recent stop outside Chosen 300 Ministries in West Philadelphia, the van screened for glaucoma, diabetic retinopathy, macular degeneration and cataracts.
Launched in September, the unit travels to underserved Philadelphia communities with the goal of increasing access to screening and detecting disease before it causes permanent vision loss, according to WHYY. These conditions can lead to blindness, and some are linked to chronic diseases such as diabetes and hypertension. The National Eye Institute says serious eye diseases including cataracts and macular degeneration affect millions of Americans; the World Health Organization estimates that nearly half of visual impairment cases worldwide could have been prevented or addressed early.
Who's Running the Screenings
Lama Al-Aswad, an ophthalmologist, professor and the lead physician of the mobile program, said the effort is about meeting people where they are. “[The program] brings care to patients and provides education,” she said, per WHYY's reporting. Al-Aswad has also seen firsthand how diabetes can quietly damage eyesight, noting that some patients with diabetic retinopathy did not even know they had diabetes, and that uncontrolled diabetes typically precedes diabetic retinopathy by about 10 years.
Roughly 1 in 4 people with diabetes develop diabetic retinopathy, and the condition often produces no warning signs. CBS News Philadelphia reported that Dr. Allen Ho said only about half of patients with diabetes get eye exams, and the outlet noted that because symptoms may be absent, annual diabetic eye exams are essential even when vision seems normal.
Inside the Van
Built to Penn Medicine's specifications, the 11.5-foot-tall, 26-foot-long van is designed to serve as many as 25 people a day across six screening stations operated by three to four crew members, according to Penn Medicine. Equipment on board tests intraocular pressure and peripheral vision and images the optic nerve and retina. Penn student technicians and clinicians conduct the exams, while an ophthalmologist is on call and available through telemedicine every time the unit goes out, reviewing exams and images remotely to help diagnose conditions and formulate treatment plans.
Andrea McCord, the mobile unit's manager, said the van measures intraocular pressure and uses cameras for advanced imaging. She also said the team can spend 30 to 45 minutes walking patients through their exam results and explaining their conditions, time that routine clinical visits rarely allow.
Closing the Follow-Up Gap
A screening does not guarantee that a patient will receive treatment. Al-Aswad told the Inquirer that, in her experience, only about half of patients follow up after learning they have a disease. Barriers can include forgetting, transportation challenges and not recognizing the condition as urgent.
Penn Medicine staff connect patients to medical specialists for treatment of underlying chronic conditions, since an eye disease diagnosis can also reveal previously unknown health problems elsewhere in the body. The program prioritizes that follow-up pathway to treat and manage whatever is found, and Penn Medicine has said a pathway was created specifically to help uninsured patients get the care they need. The mobile unit was funded by gifts from Rick Campbell and his family, the Save Vision Foundation, and Envision Health Technologies, with Rick Campbell and his family specifically funding eye disease treatment for patients who lack insurance or need financial assistance.
A West Philadelphia Partnership
Chosen 300 Ministries, founded by Brian Jenkins to support people facing homelessness and food insecurity, hosted the mobile van outside its West Philadelphia location. Jenkins said mobile units coming to the center make health care access worthwhile, and he's observed that people are more likely to accept care when a health unit comes directly to them rather than the other way around. He pointed to a reality many of his clients face: people juggling financial tradeoffs may prioritize income from a side job over a doctor visit they can't easily get to.
The unit held its first community screening event September 19 at the West Powelton Village Fall Fling, according to Penn's Scheie in MOTION program site. The team plans to visit neighborhoods throughout Philadelphia and gradually increase screening volume. It also plans to develop artificial intelligence programs to help detect eye disease from patient data and imaging and support treatment decisions, and to assess patients' baseline eye-health knowledge to study how education affects follow-up rates and disease burden.
Part of a Broader Mobile Health Push
The eye van isn't Penn Medicine's first foray into bringing screenings on the road: the health system launched another mobile unit the previous summer that offers mobile breast cancer screenings. Other health systems have run similar efforts for years. OHSU's Casey Community Outreach Program in Oregon operates two 33-foot mobile eye clinics that provide free medical vision screenings, and the program says it has reached more than 15,000 people since 2010.
Philadelphia's Mobile Vision-Care Context
The Philadelphia Department of Public Health estimated that 11.4% of city adults had diabetes in 2017; a different survey in 2018 estimated 14%. These are citywide estimates, not measures of eye-exam access across neighborhoods or of the mobile unit's impact, according to the Philadelphia Department of Public Health. A separate, school-focused Philadelphia effort dates to September 2019, when Vision To Learn says it partnered with The Eagles Charitable Foundation to expand vision services to students throughout the School District of Philadelphia. That work is distinct from Scheie in MOTION's community-based screening for eye diseases and referral of patients who need follow-up care, according to Vision To Learn.
A separate telemedicine glaucoma-screening study conducted in Philadelphia between April 2015 and February 2017 enrolled 906 participants at primary care offices and Federally Qualified Health Centers, using eye photographs, visual acuity tests and intraocular-pressure measurements that were read remotely by a trained retina reader and a glaucoma specialist, according to a report in the American Journal of Ophthalmology. Separately, a Diabetes Day event offered free diabetic eye screenings at several locations including Philadelphia, per CBS News Philadelphia's report.
