Glaucoma is Undertreated Among Minorities | AAO 2023

Patients with glaucoma who are Black, Hispanic, and Native American have worse vision outcomes and less disease monitoring, according to research presented at the annual meeting of the American Academy of Ophthalmology.

Elizabeth Ciociola, M.D.

“While it is well known that racial disparities in healthcare exist, we were surprised by the extent of disparities seen in vision outcomes,” lead researcher Elizabeth Ciociola, M.D., a resident at Johns Hopkins, said in a press release.

Researchers at Johns Hopkins, Wilmer Eye Institute and Harvard University, Massachusetts Eye and Ear Institute evaluated data on nearly 1 million patients. They used the American Academy of Ophthalmology IRIS Registry to evaluate data on 996,297 patients with glaucoma (62% White, 13% Black, 8% Hispanic, 2% Asian/Pacific Islander and 0.3% Native American and Alaska Native).

Researchers found that Black and Hispanic patients were about 30% more likely to develop poor vision or receive a low vision diagnosis, and Black patients were 45% more likely to require invasive glaucoma surgery.

Black and Hispanic patients were less likely to receive outpatient eye exams and optical coherence tomography tests, which are used for disease monitoring but were more likely to have inpatient/emergency eepartment encounters compared with White patients. Researchers said this suggests a lack of disease monitoring and preventive care and greater need for emergent services.

Additionally, Native American patients had the lowest utilization across all measures. These associations remained true among patients who were not lower socioeconomic status, which researchers said suggested these findings cannot be explained by socioeconomic status alone.

“Overall, our results suggest that glaucoma may be undertreated among minorities, putting these patients at increased risk of glaucoma-related vision loss on top of the numerous other health related disparities and poor outcomes seen among minority patients,” Dr. Ciociola said.

The American Academy of Ophthalmology’s Task Force on Disparities in Visual Health and Eye Care has been working to address issues related to disparities in vision care. The task force has several goals, including reducing disparities to prevent visual impairment by 2050; creating a more diverse workforce; implementing innovative care models; and generating scientific evidence.

“Each patient has different needs in terms of ability to get to their appointments, ability to afford medications, understanding of the disease process, social support at home, etc,” Victoria L. Tseng, M.D., an assistant professor of Ophthalmology at UCLA and a leader in the task force said. “All of these factors can influence how these patients are cared for, and each patient's care and treatment plan should be tailored according to their unique needs.”