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 is 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 represented more than 1,400 patients with newly diagnosed glaucoma were received care at academic healthcare systems belonging to the Sight Outcomes Research Collaborative (SOURCE) Consortium, of which Northwestern is a participating member, from January 2010 to December 2022. The average age of patients was 70 years and 54 of patients 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 in intraocular pressure (IOP) reduction — 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 percent of patients demonstrated a 15 percent or higher IOP reduction in one or both eyes.
Strikingly, the investigators found that patients with lower wealth had a five- to nine-fold lower likelihood of achieving 15 percent or greater IOP reduction compared to patients with higher wealth.
“It’s commonly known that race is a predictor of health outcomes, but what we’re finding now is it’s actually more about wealth and income,” French said. “What we see is wealth is actually the best predictor of really determining how well you do in your medical quality and do you get follow-up appointments.”
Furthermore, the likelihood of loss to follow-up was 61 percent lower in patients with higher wealth than patients with lower wealth. Patients in rural communities were also more likely than patients in urban areas to experience loss to follow-up.
These findings underscore the association between patient wealth and glaucoma care and may help improve the understanding of higher rates of glaucoma-related visual impairment and blindness in certain racial and ethnic groups.
“These findings support the premise that clinicians should understand financial circumstances of patients when making management decisions and reinforce the need for clinicians and payors to find ways to ensure that patients can access IOP-lowering interventions and receive follow-up care in accordance with established guidelines,” the authors wrote.
French said a possible solution could be utilizing AI models to send appointment reminders to patients who are identified as having a higher risk of missing care based on wealth measure.
“It’s really about identifying who’s most at risk and then using that extra effort to make sure that they actually come in and get their appointment,” French said.
Maryam Ige, MD, a resident physician in the Department of Ophthalmology, was the lead author of the study.
Co-authors include Charlesnika Tyon Evans, PhD, MPH, professor of Preventive Medicine in the Division of Epidemiology; Abel Kho, MD, professor of Medicine in the Division of General Internal Medicine and of Preventive Medicine in the Division of Biostatistics and Informatics; and Paul Bryar, MD, ‘95, ‘98 GME, professor of Ophthalmology and of Pathology.
This research was supported by grants from the U.S. National Eye Institute grants 1R01EY034444-01, R01EY032475 and R01EY036341; an unrestricted grant from Research to Prevent Blindness; and a gift from Wendy and Jeffrey Eisenshtadt.
