Disparities in Glaucoma Care

Racial, Ethnic, and Socioeconomic Disparities in Glaucoma Onset and Severity in a Diverse Nationwide Cohort in the United States

Acuff K, Radha Saseendrakumar B, Wu JH, Weinreb RN, Baxter SL¹
Industry support for this study: None

ABSTRACT SUMMARY

This retrospective observational study analyzed patterns of glaucoma diagnosis coding and epidemiologic trends in disease onset and severity among 2,982 patients in the National Institutes of Health All of Us database. Participants were divided into four cohorts based on disease severity (mild, moderate, severe, and unspecified stage).

Notably, 57% of participants (n = 1,714) had an unspecified disease severity. Participants who were Black or from other minority groups were diagnosed with glaucoma at significantly younger ages than White participants (mean ages, 60 years and 60 years vs 66 years; P < .001). Hispanic/Latino individuals also had an earlier mean age of diagnosis (61 vs 65 years; P = .001). Multivariable ordinal regression revealed that Black participants had more than double the odds of severe glaucoma compared to White patients after adjusting for socioeconomic characteristics.

DISCUSSION

What are the study’s real-world implications?

The results of this study confirmed those of another large retrospective cohort study that found racial disparities in baseline glaucoma severity.² Acuff et al found that Black and Hispanic patients were diagnosed at younger ages.¹ Additionally, 57% of patients lacked detailed severity staging in diagnostic codes, limiting disease monitoring and research. These findings highlight the need for targeted public health initiatives, improved diagnostic coding, and equitable access to health care.

Incorporating socioeconomic and demographic data into health care strategies is crucial for improving outcomes in affected populations. The AAO’s current Preferred Practice Pattern guidelines do not recommend increased screening or monitoring for any racial subsets of patients.³

How can the study’s findings help clinicians?

The research by Acuff et al demonstrated the need for earlier and more frequent glaucoma screening in high-risk groups, such as Black and Hispanic/Latino populations, to facilitate timely diagnosis and treatment. The study also highlighted the importance of improving documentation practices by standardizing glaucoma severity staging in diagnostic coding, which could enhance disease monitoring and treatment strategies. AI and telemedicine have the potential to expand patients’ access to care and reduce disparities in glaucoma outcomes.

Large Disparities in Receipt of Glaucoma Care Between Enrollees in Medicaid and Those With Commercial Health Insurance

Elam AR, Andrews C, Musch DC, Lee PP, Stein JD⁴
Industry support for this study: None

ABSTRACT SUMMARY

This retrospective longitudinal cohort study assessed whether the type of insurance (commercial and Medicaid) affected the clinic-based testing obtained in patients newly diagnosed with open-angle glaucoma (OAG) who were 40 years of age or older. Testing included perimetry, fundus photography, and other ocular imaging modalities such as OCT within the first 15 months of OAG diagnosis. The study included 18,372 patients with commercial insurance and 3,394 patients with Medicaid.

All glaucoma testing was disproportionately obtained in the commercial insurance group compared to the Medicaid group (visual field testing 63.1% vs 35.2%, fundus photography 22.3% vs 18.8%, other ocular imaging 53.7% vs 29.8%; P < .001 for all parameters). Medicaid recipients were more likely not to undergo baseline glaucoma testing in the first 15 months after diagnosis than patients with commercial insurance (odds ratio = 3.34, CI 3.07–3.63). This pattern was more pronounced when analyzing race; Black patients with Medicaid received less testing compared to Black patients with commercial insurance (odds ratio = 3.91, CI 3.40–4.49).

DISCUSSION

What are the study’s real-world implications?

Health disparities in OAG care have been documented for at least 30 years⁵ and are still present, as evidenced by the study by Elam et al.⁴ In the United States, 15% of all insured patients are enrolled in Medicaid. These individuals are receiving less glaucoma testing even though the AAO Preferred Practice Pattern guidelines recommend annual testing. Black patients are disproportionately enrolled in Medicaid, and this is of particular concern because Black individuals with glaucoma are more likely than patients of other races and ethnicities to go blind because of OAG progression.⁶

How can the study’s findings help clinicians?

Compared to other commercial or government-sponsored plans, Medicaid reimbursement is lower, and beneficiaries have more difficulty locating providers who accept this form of insurance. The study by Elam et al demonstrated the importance of proper glaucoma care for all patients regardless of their race and insurance status, especially the most at-risk populations.