Recent study finds racial, ethnic, rural disparities in POAG monitoring

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A recent study published in Translational Vision Science and Technology has found that people who are racial and ethnic minorities or live in rural communities are less likely to receive monitoring for primary open-angle glaucoma (POAG) progression in terms of NQF and AAO guidelines.¹ The retrospective cohort study included adults with POAG from 12 tertiary-care health systems participating in the SOURCE Ophthalmology Big Data consortium in the US, according to a news release.

“These disparities highlight an urgent need to address the social determinants of health that influence patient care,” said first author Kunal Kanwar, a third-year medical student at Feinberg, in a Northwestern University article.² “Patients in rural and poor communities face significant barriers to care, which may lead to higher rates of irreversible vision loss.”

The SOURCE repository that data was pulled from for the study includes patient demographics, diagnoses as determined by International Classification of Diseases (ICD-9 and ICD-10) billing codes, outpatient medication prescribed, and orders and charges for visits and diagnostic and therapeutic procedures as captured using Current Procedure Terminology (CPT-4) procedure codes. While SOURCE data is deidentified, patients are each assigned privacy-preserving tokens from Datavant that permit longitudinal follow up over time. SOURCE sites have contributed 10 years of longitudinal data from 2012 to 2022.¹

Inclusion criteria consisted of adults 18 years old or older that have been diagnosed with POAG in 1 or both eyes based on ICD-9 or ICD-10 billing codes. Additionally, eligible patients were also required to have at least 1 visit to an eye care provider during the 15 months in SOURCE after their initial POAG diagnosis and a total of at least 45 months of follow up with any health care professional in SOURCE after their initial POAG diagnosis. Patients were excluded that were younger than 18 years, glaucoma suspects or patients with other types of glaucoma, and patients with insufficient follow up.¹

The study sample included 13,582 patients with a mean age at the data of initial diagnosis of 67.7 (10.3) years, and included 7621 (56.1%) women, 8162 (60.1%) White patients, 4050 (29.8%) Black patients, 559 (4.1%) Asian Americans, and 452 (3.3%) persons of Latinx ethnicity. The proportion of White patients (25%) and Asian patients (35%) with commercial insurance was higher than the proportion of Black patients (18%) with the same insurance type. Black patients had a higher rate of “other” insurance than any other race at 22%. Additionally, the majority of patients resided in urban communities at almost 81%.¹

Researchers found that almost 82% of patients had 1 or more optic nerve evaluation during all 3 consecutive 15-month intervals, about 57% had at least 1 optic nerve evaluation during all 3 consecutive 15-month intervals, and 11% of patients had no record of any optic nerve evaluations during the 45-month follow up period. In terms of evaluation of patterns of optic nerve evaluations, the most common were across all races and ethnicities were consistent optic nerve evaluation in all 3 time intervals and no optic nerve evaluation in any of the time intervals studied.¹

However, while Asian Americans had a 43% greater odd of receiving an evaluation, the population had a 34% lower odd (aOR = 0.66; CI, 0.48–0.92) of having no record of any optic nerve evaluations in the 45 months of follow up compared to White patients. Black patients also had a 15% lower odd (aOR = 0.85; CI, 0.75–0.95) of undergoing 1 or more optic nerve evaluations in all 3 15-month time periods.¹

Additionally, patients with POAG living in isolated rural communities had a staggering living in isolated rural communities also had a staggering 167% (aOR = 2.67; CI, 1.38–5.15) greater odds of receiving no optic nerve evaluations in the 45-month follow up period after initial glaucoma diagnosis compared to patients in urban communities. Patients in rural communities also had 58% decreased odds of receiving 1 or more optic nerve evaluations in the first 15 months after initial POAG diagnosis, 56% reduced odds of receiving care in accordance to published guidelines, and at a 30% greater odds of never having received any optic nerve evaluations in the 45-month follow-up period.¹

“We hypothesize that factors affecting health care utilization are multifactorial and may be influenced by other [social determinants of health, or] SDH besides a patient's race or ethnicity,” study authors noted. “To the best of our knowledge, few studies have considered other SDH such as patient income, educational attainment, urbanicity, language, number of household dependents, and affluence of a patient's community of residence on the receipt of high-quality care for glaucoma. Many of these SDH are not routinely captured in the electronic health record as part of routine patient care activities to permit researchers to consider them.”

References:

1. Kanwar K, Ramachandran R, Stein J, et al. The association of social determinants of health on monitoring for disease progression among patients with primary open-angle glaucoma. Trans Vis Sci & Tech. 2025;14(3). doi:https://doi.org/10.1167/tvst.14.3.15

2. Schamisso B. Glaucoma monitoring lags in low-income and rural areas. Northwestern University. March 17, 2025. Accessed March 24, 2025. https://news.northwestern.edu/stories/2025/03/glaucoma-monitoring-lags-in-low-income-and-rural-areas/