New study: Racial Disparities in Glaucoma Care Persist, Regardless of Socioeconomic Status

Newswise — SAN FRANCISCO — Nov. 4, 2023 — Many studies have shown that glaucoma is more common and more severe in Black and Hispanics than in Whites, but less is known about the impact of racial differenc­es and socioeconomic status on vision loss and individual utilization of health care resources among glaucoma patients. In the age of big data, it’s becoming easier to answer these questions. Researchers at Johns Hopkins, Wilmer Eye Institute and Harvard University, Massachusetts Eye and Ear Institute evaluated data on nearly one million patients and found that Black, Hispanic, and Native American glaucoma patients have worse vision outcomes and less disease monitoring. These disparities persisted regardless of patients’ socioeconomic status. The study will be discussed today at AAO 2023, the 127th annual meeting of the American Academy of Ophthalmology.

“While it is well known that racial disparities in healthcare exist, we were surprised by the extent of disparities seen in vision outcomes,” said lead researcher Elizabeth Ciociola, MD. “Black and Hispanic patients were approximately 30 percent more likely to develop poor vision or receive a low vision diagnosis, and Black patients were 45 percent more likely to require invasive glaucoma surgery. Additionally, we were not expecting to see such significantly lower eye care utilization rates among Native American patients who are a historically understudied group.”

Dr. Ciociola and her colleagues used the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) to evaluate data on 996,297 glaucoma patients (62% White, 13% Black, 8% Hispanic, 2% Asian/Pacific Islander and 0.3% Native American and Alaska Native). Here’s what they found:

• Black and Hispanic patients were significantly more likely to experience progression of cup-to-disc ratio to greater than 0.80. They were also significantly more likely to develop visual acuity worse than 20/200, receive a low vision diagnosis, or require glaucoma filtering surgery compared to White patients.

• Native American patients were more likely to develop poor vision compared to White patients.

• When stratified by socioeconomic status (SES) non-low SES Black and Native American patients continued to have worse vision outcomes compared to White patients, suggesting race is the primary driver of these observed differences in outcomes instead of SES.

• Black and Hispanic patients were less likely to receive outpatient eye exams and optical coherence tomography tests which are used for disease monitoring but were more likely to have inpatient/Emergency Department encounters compared to White patients, suggesting a lack of disease monitoring and preventative care and greater need for emergent services.

• Native American patients had the lowest utilization across all measures. These associations remained true among the non-low SES groups, suggesting these findings cannot be explained by SES alone.

“Overall, our results suggest that glaucoma may be undertreated among minorities, putting these patients at increased risk of glaucoma-related vision loss on top of the numerous other health related disparities and poor outcomes seen among minority patients,” Dr. Ciociola said.

The Academy’s Task Force on Disparities in Eye Care has provided a comprehensive view of the existing disparities, insight into why and how these disparities persist, and a roadmap for how we can all help eliminate disparities and achieve equity in eye care. Victoria L. Tseng, MD, an assistant professor of Ophthalmology at UCLA and a leader in the task force had this to say about this new study:

“Based on this I think it is important for the ophthalmologist to consider the whole patient when providing care,” Dr. Tseng said. “Each patient has different needs in terms of ability to get to their appointments, ability to afford medications, understanding of the disease process, social support at home, etc. All of these factors can influence how these patients are cared for, and each patient's care and treatment plan should be tailored according to their unique needs.”

About the American Academy of Ophthalmology

The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate and support research to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.