Abstract
Purpose :
Glaucoma is the second leading cause of blindness in the United States, affecting over 3.5 million people. Because of the insidious nature of the disease, consistent vision care is necessary due to the potential for blindness if it is left untreated. The purpose of this study was to leverage the National Institutes of Health “All of Us” (AoU) database to examine the association between self-reported access to vision care and the prevalence and severity of glaucoma.
Methods :
Participants were included if they had International Classification of Disease (ICD) codes in AoU and if they answered a survey question about access to vision care within the past year. The exposure was access to vision care and the outcome was glaucoma defined by ICD code. Multivariable logistic regression was used to examine the relationship between vision care access and (1) glaucoma prevalence and (2) glaucoma severity, adjusting for age, sex, education level, income, and healthcare literacy. Additionally, self-reported reasons for delays in care were analyzed among participants with glaucoma without access to care.
Results :
The study population included 83,252 AoU participants, of whom 54,263 (65.2%) had vision care access and 3,396 (4.1%) had glaucoma. In adjusted analyses, those with vision care access were more likely to have glaucoma than those without access (adjusted odds ratio [aOR]: 3.35, 95% confidence interval [CI]: 2.95-3.83). Compared to those without access, those with vision care access had higher odds of mild (aOR: 8.09, 95% CI: 3.03-21.59), moderate (aOR: 3.87, 95% CI: 1.78-8.38), and severe (aOR: 5.33, 95% CI: 1.97-14.40) glaucoma. Of participants with glaucoma without access, reported reasons for delayed care included paying out of pocket (57/347; 19.66%), high deductibles (38/347; 12.30%), and high insurance copays (37/349; 11.86%).
Conclusions :
In the AoU database, we found that those with access to vision care were more likely to have a diagnosis of glaucoma overall and glaucoma at all levels of severity compared to those without access to vision care. For those who had not seen a vision care provider, financial barriers were the most common reason for a delay in care. Our findings suggest the possibility that increased access to ophthalmic care will lead to a greater likelihood of a diagnosis of glaucoma and treatment, especially in those with financial barriers.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.