Patients with newly diagnosed glaucoma who have less wealth or reside in rural communities are less likely to receive standard glaucoma care compared to wealthier patients, according to a recent multi-institution study published in JAMA Ophthalmology.
Dustin French, phd, professor of ophthalmology and of Medical Social Sciences in the Division of Determinants of Health, was a co-author of the study and principal investigator of the Northwestern Medicine study site.
More than 4 million people in the U.S. have glaucoma, and it is indeed the leading cause of blindness worldwide, according to the Glaucoma Research Foundation. glaucoma is caused by increasing pressure within the eye, causing damage to the optic nerve which can cause vision loss or blindness. The disease is more commonly diagnosed in adults over the age of 55 and disproportionately affects black patients compared to white patients.
In the current study, investigators aimed to determine possible associations between various nonmedical variables, including self-reported race and ethnicity, urbanicity of residence, affluence of patients’ residential community and presence of children in the household, and their association with the patient’s quality of glaucoma care.
Data from more than 1,400 patients with newly diagnosed glaucoma who received care at academic healthcare systems belonging to the Sight Outcomes Research Collaborative (SOURCE) consortium, of which Northwestern is a participating member, were analyzed from January 2010 to December 2022. The average age of patients was 70 years and 54% were female. Three percent of patients were Asian American, 32 percent were Black, 7 percent were Latinx and 57 percent were white.
The primary outcomes were likelihood of 15 percent or greater reduction in intraocular pressure (IOP) – the U.S. National Quality Forum’s recommendation for reducing pressure on the eye, often through medicated eye drops or surgery – at 12 to 18 months following initial diagnosis and likelihood of loss to follow-up, or participants who were active in a clinical trial who then became unavailable to complete the trial.
Among 1,030 patients with one or more follow-up evaluations within 12 to 18 months following their initial diagnosis, 76% achieved the recommended IOP reduction.However, patients with lower wealth and those residing in rural communities were substantially less likely to achieve this target. Additionally, a higher proportion of patients with lower wealth were lost to follow-up.