{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:03:51Z","timestamp":1779685431187,"version":"3.53.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Glaucoma is the leading irreversible blinding eye disease worldwide and the global prevalence of glaucoma for individuals aged 40\u201380\u202fyears is estimated as 3.54%. Early screening and prevention wherever possible are essential interventions of chronic disease management for glaucoma, but there is currently a lack of a recognized glaucoma screening model for Chinese population. Therefore, this study intends to construct and validate an artificial intelligence (AI)-assisted three-tiered glaucoma screening model based on the community population and assess its cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a community population-based cluster randomized controlled trial with a minimum of 6-year follow-up. A three-tiered glaucoma screening strategy appropriate for Chinese individuals will be established, including a high-risk model questionnaire (primary screening), ophthalmic examinations (secondary screening, combined with physician-based and AI-assisted image interpretation), and definitive diagnosis by tertiary hospitals (tertiary screening). The participants of each community will be randomly divided into three groups (simple cluster randomization): no screening group, routine screening group, and tiered screening group. Participants in the no screening group will receive regular glaucoma-related health education, structured annual follow-up for symptom monitoring and recording of external ophthalmology visits, and a comprehensive ophthalmic screening at the end of the study to compensate for the absence of regular screening. A total of 28,275 participants (9,425 per group) will be recruited, allowing for an anticipated loss-to-follow-up rate of 20%. All primary outcome measures will be analyzed on a per-participant basis. The main endpoint is the glaucoma detection rate, with sensitivity and specificity of the screening as additional primary outcomes. Secondary outcomes involve comparative analyses of the cost-effectiveness of different screening strategies and the diagnostic accuracy of physician-based versus AI-assisted image interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The protocol has been approved by the Biomedical Ethics Review Committee, West China Hospital of Sichuan University [2025(1021)]. All the participants will be required to afford signed informed consent. The study results will be presented at scientific meetings and published in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.chictr.org.cn\/showproj.html?proj=281642<\/jats:uri>\n                      , identifier (ChiCTR2500107852).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1845337","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:42:44Z","timestamp":1779684164000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development, validation, and cost-effectiveness analysis of an AI-assisted three-tiered glaucoma screening model in a community-based setting: protocol for a cluster randomized controlled trial"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiangyu","family":"Fu","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Research Laboratory of Ophthalmology and Vision Sciences, Eye Research Institute, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanming","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The Second People\u2019s Hospital of Yibin","place":["Yibin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haotian","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianjie","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.2147\/JIR.S434989","article-title":"Inflammation and neurodegeneration in Glaucoma: isolated eye disease or a part of a systemic disorder? - serum proteomic analysis","volume":"17","author":"Okruszko","year":"2024","journal-title":"J Inflamm Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"101221","DOI":"10.1016\/j.mam.2023.101221","article-title":"The role of the microbiota in glaucoma","volume":"94","author":"Huang","year":"2023","journal-title":"Mol Asp 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