Care of newly diagnosed POAG impacted by patient wealth, area of residence | Ophthalmology Times

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The results of a new cohort study found that newly diagnosed primary open-angle glaucoma (POAG) in patients who were in the lowest wealth quartile was “substantially” less likely to reach the recommended reduction and the patients “considerably” more likely to be lost to follow-up,¹ according to first author Maryam O. Ige, MD. She is from the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago.

The authors reported their results in JAMA Ophthalmology.

Despite the previous recognition that certain patient groups have a greater prevalence of glaucoma and ultimately become visually impaired or blind compared with Caucasian patients,^2-6 the situation has not changed for minority racial and ethic groups.⁷

Ige and colleagues conducted a retrospective study to identify any nonmedical issues that may impact the quality of care in these patients.

They pointed out that if potentially modifiable nonmedical factors are contributing to suboptimal care for patients with POAG, there may be opportunities to address some of these factors and ultimately improve patient outcomes.

The study included 1,466 patients with newly diagnosed POAG receiving care at health systems in the Sight Outcomes Research Collaborative Consortium. The factors analyzed included self-reported race and ethnicity, urban residence, affluence of patients’ residential community, and presence of children in the household.

The primary outcomes were the odds of 15% or greater intraocular pressure (IOP) reduction at 12 to 18 months after POAG was diagnosed initially and the odds of patient loss to follow-up.

The patients were a mean of 70 years of age and 54% were women. The racial backgrounds were as follows: 3% Asian American, 32% Black, 7% Latinx, and 57% Caucasian.

Ige and associates reported, “Among 1,030 patients (70%) with one or more follow-up evaluations within 12 to 18 months following the initial POAG diagnosis, 783 (76%) achieved a 15% or higher IOP reduction in one or more eyes. The patients in the lowest wealth quartile had 5- to 9-fold lower odds of achieving a 15% or greater IOP decrease compared with patients in the higher quartiles. The odds of being lost to follow-up were 61% lower among the patients in the wealthiest patient quartile than in the least wealthy group (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.18-0.84; P = 0.02).”

Other factors that the investigators identified as affecting patient care were residing in a rural community and children residing in the household. Patients in rural area (OR, 5.54; 95% CI, 1.13-27.08) were more likely than urban residents to become lost to follow-up. In addition, patients with children in the household had an average 4 mmHg (95% CI, 0.99-7.13) greater IOP reduction compared with those patients in households in which no children resided (P = 0.01).

The investigators concluded, “Patient wealth, urban residence, and presence of children in the household are important factors associated with follow-up care in the 12 to 18 months after initial POAG diagnosis and, among those with follow-up care, IOP reduction by the amount suggested in practice guidelines. Focused efforts to make follow-up care easier to obtain for patients with POAG who have less wealth, reside in rural communities, or live alone can help improve the quality of care and outcomes for this sight-threatening condition.”

The authors looked toward establishing more opportunities to improve glaucoma care by making eye care interventions more affordable to patients are less wealthy and more accessible to patients who live in rural communities.

References

1. Ige MO, French DD, Chaudhury AX, et al. Quality of care in patients with newly diagnosed glaucoma. JAMA Ophthalmol. 2025; published online September 18. doi: 10.1001/jamaophthalmol.2025.2995

2. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. the Baltimore Eye Survey. JAMA. 1991;266:369-374. doi:10.1001/jama.1991.03470030069026

3. Sommer A, Tielsch JM, Katz J, et al. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. 1991;325:1412-1417. doi:10.1056/NEJM199111143252004

4. Varma R, Ying-Lai M, Francis BA, et al; Los Angeles Latino Eye Study Group. Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004;111:1439-1448. doi:10.1016/j.ophtha.2004.01.025

5. Globe DR, Wu J, Azen SP, Varma R; Los Angeles Latino Eye Study Group. The impact of visual impairment on self-reported visual functioning in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004;111:1141-1149. doi:10.1016/j.ophtha.2004.02.003

6. Population Projections Program, Population Division. (NP-T5-G) Projections of the resident population by race, Hispanic origin and nativity: middle series, 2050 to 2070. US Census Bureau. Accessed December 29, 2024. https://www2.census.gov/programs-surveys/popproj/tables/2000/2000-national-summary-tables/np-t5-f.pdf

7. Ciociola EC, Sekimitsu S, Smith S, et al; IRIS Registry Analytic Center Consortium. Racial disparities in glaucoma vision outcomes and eye care utilization: an IRIS registry analysis. Am J Ophthalmol. 2024;264:194-204. doi:10.1016/j.ajo.2024.03.022