Health disparities in glaucoma management: Revealing a racial divide in visual field testing

Abstract

Purpose : While prior literature suggests the presence of racial disparities in the utilization of visual field testing (VFT) for the diagnosis and monitoring of glaucoma, few studies have considered these differences in the context of baseline glaucoma severity and patient access to healthcare. In a retrospective chart review of glaucoma subjects receiving ophthalmic care in an academic, tertiary care facility, we explored the frequency of VFT as a function of race while controlling for differences in baseline disease severity and socioeconomic disadvantage.

Methods : The records of glaucoma subjects who had VFT at the Department of Ophthalmology, NYU Langone Health from 2018 to 2019 were accessed to determine VFT frequency and establish a ratio of VFT frequency to the total number of office visits (VFT/DoS). Analysis of covariance (ANCOVA) was used to compare VFT/DoS as a function of self reported race while adjusting for gender, age, ethnicity, baseline visual field mean deviation (MD), and Area Deprivation Index (ADI; a measurement for ranking neighborhoods by socioeconomic disadvantage). Tukey’s post-hoc test was performed for pairwise comparisons between races.

Results : Among 2522 subjects (956 White, 479 Black, 204 Asian, and 883 Other), Blacks had the most advanced VF damage at their baseline visit (Table 1). Nevertheless, ANCOVA revealed that VFT/DoS ratios were significantly different between races after adjusting for confounders (p = 0.006). Specifically, Blacks had a 5% lower VFT/DoS rate than Whites (p = 0.012) and a 6% lower VFT/DoS rate than Others (p = 0.003; Table 2). Blacks also had the greatest socioeconomic disadvantage, presenting with ADI rankings significantly higher than Whites (p < 0.001) and Others (p < 0.001).

Conclusions : Blacks had lower rates of VFT compared to Whites and Others despite presenting with the worst disease severity at baseline. These differences remained significant even after controlling for baseline disease severity and socioeconomic disadvantage. Race, by itself, is shown to be a significant contributor to VFT frequency and VFT/DoS. Further investigation into VFT-related health outcomes would allow for a better understanding of downstream impacts of racial disparities in testing frequency.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1: Baseline characteristics

 

Table 2: Estimated differences in VFT/DoS proportions using Tukey post-hoc while adjusting for gender, age, ethnicity, baseline MD, and ADI