Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK.
Eye (Lond). 2023 Nov;37(16):3376-3381. doi: 10.1038/s41433-023-02508-w. Epub 2023 Mar 23.
Socioeconomic deprivation is associated with higher odds of chronic diseases, with many individuals living with more than one illness. This study aimed to examine the relationship between deprivation and severity of glaucoma at diagnosis, an important risk factor for glaucoma blindness.
A retrospective study of 472 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital was performed. Glaucoma severity was determined by standard automated perimetry mean deviation (MD) in the worse eye. The Scottish Index of Multiple Deprivation (SIMD) was determined for each patient as a measure of deprivation based on postcode. Regression analyses were performed to determine the relationship between visual field MD and SIMD.
There was a significant relationship between higher levels of deprivation (lower SIMD) and worse severity of glaucoma at diagnosis. 32 of 472 patients (6.8%) had a MD of ≤-6 dB and 11 (2.3%) ≤-12 dB in their better eye. MD in the worse eye was 0.04 dB (95% CI 0.014 to 0.062 dB, P = 0.002) worse for each 100-point decrease in SIMD, with lower SIMD indicating a higher level of deprivation. A higher proportion of patients living in most deprived areas had a MD ≤ -6 dB or ≤ -12 dB at presentation compared to those living in the least deprived areas (14.3% versus 6.8% for ≤ -6 dB and 4.8% versus 0.8% for ≤ -12 dB).
Higher levels of deprivation were associated with worse glaucoma severity at presentation. The reasons for poorer outcomes in those from more deprived communities need further study so that inequalities can be addressed and the frequency of patients presenting with advanced glaucoma reduced.
社会经济贫困与慢性病的高发病风险相关，许多人同时患有多种疾病。本研究旨在探讨贫困程度与诊断时青光眼严重程度之间的关系，后者是青光眼致盲的一个重要危险因素。
对 472 例连续患者进行回顾性研究，这些患者由社区验光师转诊到大学医院的青光眼诊所。使用标准自动视野计的最差眼平均偏差（MD）来确定青光眼的严重程度。根据邮政编码确定每位患者的苏格兰多维贫困指数（SIMD），作为贫困程度的衡量标准。进行回归分析以确定视野 MD 与 SIMD 之间的关系。
较高的贫困程度（较低的 SIMD）与诊断时青光眼严重程度的恶化有显著的相关性。472 例患者中有 32 例（6.8%）在最佳眼的 MD 低于-6dB，11 例（2.3%）低于-12dB。最差眼 MD 比 SIMD 每降低 100 分，相差 0.04dB（95%置信区间为 0.014 至 0.062dB，P=0.002），表明 SIMD 越低，贫困程度越高。与生活在最不贫困地区的患者相比，生活在最贫困地区的患者在就诊时 MD 低于-6dB 或-12dB 的比例更高（MD 低于-6dB 的比例分别为 14.3%和 6.8%，MD 低于-12dB 的比例分别为 4.8%和 0.8%）。
较高的贫困程度与就诊时青光眼严重程度恶化相关。需要进一步研究导致贫困社区患者预后较差的原因，以便解决不平等问题，降低晚期青光眼患者就诊的频率。
