Abstract
Purpose :
To identify risk factors for developing severe visual impairment (SVI) due to glaucoma using a large electronic health record (EHR) database.
Methods :
In this retrospective cohort study, eyes with glaucoma or suspected of glaucoma were identified in the Bascom Palmer Glaucoma Repository with ICD coding. Pseudophakic eyes were analyzed to eliminate the impact of cataract on visual acuity. If an eye was diagnosed with a confounding ocular condition (e.g., macular degeneration), all ocular data following the first date of diagnosis were excluded. SVI was defined as best-corrected visual acuity 20/200 or worse at the last two visits but not at the initial visit, with ≥3 months of follow-up. Control eyes were defined as those that met inclusion criteria but did not develop SVI. Ocular and demographic data of both groups were extracted from Epic EHR Systems. Median household income data from ZIP code tabulation areas (ZCTA) were obtained using the 2020 American Community Survey. Multivariable regression analysis was performed with generalized estimating equations clustered by patient using R 4.1.2.
Results :
A total of 142 eyes (1.4%) from 139 patients (2.1%) developed SVI, which occurred after 2.4±2.1 years. The control group consisted of 9,701 eyes from 6,524 patients. In a multivariable model, male gender (OR 1.49, p=0.032), higher baseline intraocular pressure (IOP; OR 1.67 per 5mmHg, p<0.001), severe glaucoma at baseline (OR 7.24, p<0.001), prior glaucoma surgery (OR 3.31, p<0.001), and residence in lower income areas (OR 2.76 & 2.25 for 3rd and 4th income quartiles respectively, p=0.002 & 0.018; Fig. 1) were risk factors for developing SVI. Significant interaction effects were noted between baseline IOP & severe disease (OR 0.51, p<0.001) and baseline IOP & prior glaucoma surgery (OR 1.58, p=0.008; Fig. 2).
Conclusions :
In a large, diverse database of patients with or suspected of glaucoma, risk factors for glaucoma-related SVI included male gender, elevated IOP, severe disease at baseline, prior glaucoma surgery, and residence in lower income areas. The latter suggests that additional social risk factors may be key contributors to SVI development.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.