Impact of Social Determinants of Health on Monitoring for Disease Progression Among Patients with Primary Open-Angle Glaucoma

Abstract

Purpose : Patients with primary open-angle glaucoma (POAG) should undergo a careful evaluation of their optic nerve (ON) and retinal nerve fiber layer (RNFL) tissue at least once a year to check for disease progression. We studied the impact of race, ethnicity, and other social determinants of health on timely receipt of ON evaluation to assess for structural evidence of POAG progression.

Methods : We identified all adults with POAG across 11 US health systems in the SOURCE Ophthalmology Big Data consortium. Eligible patients had ≥1 visit to an eye care professional, ≥1 visit with diagnosis of POAG, and ≥45 consecutive months in the repository following initial POAG diagnosis to assess for timely ON or RNFL evaluations. Patients were considered to have an ON or RNFL evaluation if they had EHR documentation of ≥ 1 description of their ON, cup-to-disc estimate, RNFL OCT, or ON photography in one or both eyes in the 1^st, 2^nd, and 3^rd 15-month period following initial POAG diagnosis. Logistic regression modeling identified factors associated with receiving timely ON evaluations in all three 15-month windows.

Results : Among the 13582 eligible patients with POAG in SOURCE, 7812 (57%) had timely ON evaluations during the 45 months following initial diagnosis. There were 1532 (11.3%) patients who had no record of any ON evaluations during the 45-month follow-up period. More Whites (61%) with POAG had timely ON evaluations compared with Asians (52%) and Blacks (53%) (p<0.001) and more non-Hispanic patients (58%) had ON evaluations compared with Hispanics (52%) (p=0.045). The odds of a patient with POAG undergoing timely evaluation were 17% lower for Blacks compared with Whites (OR=0.83, CI 0.73-0.93), 55% lower for patients living in isolated rural communities (OR=0.45, CI 0.26-0.78) compared to those living in urban areas, and lower for patients living in more impoverished communities as defined by the Distressed Communities Index (OR=0.92, CI 0.87-0.95).

Conclusions : Among individuals with POAG, racial and ethnic minorities, patients in less affluent communities, and those in isolated rural communities are less likely to receive timely ON evaluations. These factors may contribute to worse outcomes and higher rates of blindness, highlighting the need for interventions to ensure access to timely care for these vulnerable groups.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Odds Ratios of POAG patients undergoing timely evaluation