Ige Maryam O, French Dustin D, Chaudhury Azraa S, Li Yang, Andrews Chris A, Kanwar Kunal, Zhou Xueqing, Marwah Shikha, Evans Charlesnika T, Kho Abel N, Bryar Paul J, Stein Joshua D
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Ophthalmol. 2025 Sep 18. doi: 10.1001/jamaophthalmol.2025.2995.
Various communities continue to experience relatively high rates of glaucoma-related visual impairment and blindness. Identifying potential nonmedical influences on glaucoma outcomes may lead to strategies to improve glaucoma care.
To assess possible associations between nonmedical variables and quality of glaucoma care among patients with newly diagnosed primary open-angle glaucoma (POAG).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 1466 patients with newly diagnosed POAG receiving care at health systems in the Sight Outcomes Research Collaborative (SOURCE) Consortium from January 2010 to December 2022. Data analysis was completed from March 2024 to June 2025.
Various nonmedical variables, including self-reported race and ethnicity, urbanicity of residence, affluence of patients' residential community, and presence of children in the household.
The primary outcomes were odds of 15% or greater intraocular pressure (IOP) reduction at 12 to 18 months following initial POAG diagnosis and odds of loss to follow-up (LTFU).
Mean (SD) age of patients was 70 (12) years; among 1466 patients, 793 (54%) were female. By self-reported race and ethnicity, 39 patients (3%) were Asian American, 469 patients (32%) were Black, 95 (7%) were Latinx, and 831 (57%) were White. Among 1030 patients (70%) with 1 or more follow-up evaluations within 12 to 18 months following initial POAG diagnosis, 783 (76%) achieved 15% or higher IOP reduction in 1 or more eyes. Patients in the lowest wealth quartile had 5- to 9-fold lower odds of achieving 15% or greater IOP decrease compared with patients in higher quartiles; the odds of LTFU were 61% lower in the wealthiest patient quartile than in the least-wealthy group (odds ratio [OR], 0.39; 95% CI, 0.18-0.84; P = .02). Patients in rural communities (OR, 5.54; 95% CI, 1.13-27.08) were more likely than urban residents to experience LTFU. Patients with children in the household experienced, on average, a 4-mm Hg (95% CI, 0.99-7.13) greater IOP reduction compared with those without children in the household (P = .01).
In this cohort study, patients with newly diagnosed POAG in the lowest wealth quartile were substantially less likely to achieve the US National Quality Forum's recommended IOP percentage reduction and considerably more likely to experience LTFU than those with higher wealth levels. These findings support the premise that clinicians should understand financial circumstances of patients when making management decisions and reinforce the need for clinicians and payors to find ways to ensure that patients can access IOP-lowering interventions and receive follow-up care in accordance with established guidelines.
不同社区的青光眼相关视力损害和失明发生率仍然相对较高。识别对青光眼治疗结果可能产生的非医学影响，或许能催生改善青光眼护理的策略。
评估新诊断的原发性开角型青光眼（POAG）患者的非医学变量与青光眼护理质量之间可能存在的关联。
设计、设置和参与者：这项回顾性队列研究纳入了2010年1月至2022年12月期间在视力结果研究协作组（SOURCE）联盟的医疗系统接受治疗的1466例新诊断的POAG患者。数据分析于2024年3月至2025年6月完成。
各种非医学变量，包括自我报告的种族和族裔、居住的城市化程度、患者居住社区的富裕程度以及家中是否有孩子。
主要结局是初次诊断POAG后12至18个月眼压（IOP）降低15%或更多的几率以及失访（LTFU）几率。
患者的平均（标准差）年龄为70（12）岁；在1466例患者中，793例（54%）为女性。根据自我报告的种族和族裔，39例（3%）为亚裔美国人，469例（32%）为黑人，95例（7%）为拉丁裔，831例（57%）为白人。在初次诊断POAG后12至18个月内进行了1次或更多次随访评估的1030例患者（70%）中，783例（76%）的一只或多只眼睛眼压降低了15%或更多。与处于较高财富四分位数的患者相比，处于最低财富四分位数的患者眼压降低15%或更多的几率低5至9倍；最富裕患者四分位数组的失访几率比最不富裕组低61%（优势比[OR]，0.39；95%置信区间，0.18 - 0.84；P = 0.02）。农村社区的患者（OR，5.54；95%置信区间，1.13 - 27.08）比城市居民更易出现失访。家中有孩子的患者与家中没有孩子的患者相比，眼压平均降低幅度更大，为4毫米汞柱（95%置信区间，0.99 - 7.13）（P = 0.01）。
在这项队列研究中，与财富水平较高的患者相比，处于最低财富四分位数的新诊断POAG患者实现美国国家质量论坛推荐的眼压降低百分比的可能性大幅降低，且失访的可能性显著更高。这些发现支持了这样一个前提，即临床医生在做出管理决策时应了解患者的经济状况，并强化临床医生和支付方寻找方法以确保患者能够获得降低眼压的干预措施并按照既定指南接受后续护理的必要性。
