Abstract
Purpose :
Blindness is a crippling disability, resulting in higher risks of chronic health conditions. To better understand disparities in blindness risk, we identify risk factors upon first presentation using a large clinical database.
Methods :
We performed a retrospective cross-sectional study using the Duke Glaucoma Registry (DGR). The DGR consists of electronic health records (EHR) of over 100,000 patients seen at the Duke Eye Center from 2009 to 2018. Our cohort included patients with glaucoma and a minimum of one good quality visual field and visual acuity measure recorded within 90 days of a first glaucoma encounter (defined as baseline). International Classification of Diseases codes were used to identify glaucoma and exclude concurrent diseases. Patients were classified as being blind by the definition of legal blindness (i.e., central visual acuity less than or equal to 20/200 with correction or a visual field less than or equal to 20 degrees in the better eye). Baseline risk factors included gender, race (Caucasian vs. African American/Black), marital status (married vs. single), intraocular pressure (IOP; measured by Goldmann applanation tonometry), and a history of diabetes. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for risk factors using both univariable and multivariable logistic regression.
Results :
Our cohort consisted of 8,694 glaucoma patients with a complete set of covariates, with 324 (4%) blind upon first presentation. In univariable models, African American/black race (OR: 2.16; 95%CI 1.71, 2.74), single marital status (1.68; 1.32, 2.13), a 10-year increase in age (1.20; 1.10, 1.32), and a standard deviation increase in IOP (1.23; 1.11, 1.35), were all associated with an increased risk of presenting with legal blindness. These associations remained significant in a multivariable regression, with male gender becoming significant (1.42; 1.12, 1.79).
Conclusions :
Using a large real-world clinical database, we identified risk factors associated with presentation to blindness among glaucoma patients. Our results highlight disparities in healthcare outcomes and indicate public health outreach for vulnerable communities can reduce differential outcomes in blindness.
This is a 2021 ARVO Annual Meeting abstract.