Investigating the influence of social social determinants of health (SDH) on the quality of care received by primary open-angle glaucoma (POAG) patients across the US, a Northwestern University Feinberg School of Medicine study has highlighted disparities in optic nerve (ON) monitoring, and revealed that race, income, and geographic location all significantly affect adherence to clinical guidelines.
Using data gathered from the Sight Outcomes Research Collaborative (SOURCE), the researchers analyzed 13,582 patients with POAG across 12 tertiary care centers. The study examined whether these patients had received at least one ON evaluation every 12 months over a 45-month period, as recommended by the American Academy of Ophthalmology (AAO) and the National Quality Forum (NQF).
The study found that racial and ethnic disparities were readily apparent in glaucoma monitoring, with white patients having the highest adherence to ON evaluations (61 percent) when compared to Black (53 percent) and Asian American (52 percent) patients. Black patients were found to have a 17 percent lower chance of receiving ON evaluations in accordance with guidelines when compared to white patients.
Geographic location also played a significant role in disparities, with patients living in isolated rural communities having a 56 percent lower likelihood of receiving regular ON evaluations when compared to those living in urban areas. Similarly, rural patients were noted as having a 167 percent higher risk of never receiving an ON evaluation over the entire study period. Patients from less affluent communities were also found to be less likely to receive ON evaluations, with a 3 percent decrease in adherence for every 10-unit increase in community distress scores.
The study highlights the critical role of social and economic factors in determining access to quality glaucoma care. To bridge the gap in disparities, the researchers recommend expanding teleophthalmology services to better reach underserved rural areas; increasing access to home-based monitoring technologies; enhancing targeted glaucoma screening programs in high-risk communities; and implementing policy incentives that would encourage eye care professionals to serve disadvantaged populations.
