June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Access to Vision Care and Prevalence of Glaucoma in the National Institutes of Health “All of Us” Database
Author Affiliations & Notes
  • Megan E. Paul
    Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Victoria L Tseng
    Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California, United States
  • Ken Kitayama
    Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California, United States
    Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
  • Fei Yu
    Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
  • Anne L Coleman
    Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California, United States
    Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Megan Paul Research to Prevent Blindness Medical Student Fellowship, Code F (Financial Support); Victoria Tseng American Glaucoma Society MAPS Award, Code F (Financial Support), RPB/AAO Award for IRIS Registry Research, Code F (Financial Support); Ken Kitayama None; Fei Yu None; Anne Coleman None
  • Footnotes
    Support  Megan Paul is a recipient of the Research to Prevent Blindness (RPB) Medical Student Eye Research Fellowship. Additionally, this work was supported by unrestricted grant funding from Research to Prevent Blindness to the UCLA Department of Ophthalmology.
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 117. doi:
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      Megan E. Paul, Victoria L Tseng, Ken Kitayama, Fei Yu, Anne L Coleman; Access to Vision Care and Prevalence of Glaucoma in the National Institutes of Health “All of Us” Database. Invest. Ophthalmol. Vis. Sci. 2023;64(8):117.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

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