Influence of Social Determinants of Health on Presentation and Outcomes of Primary Congenital Glaucoma

Abstract

Purpose

Assess the effect of social determinants of health on presentation and outcomes in primary congenital glaucoma (PCG).

Design

Retrospective case series.

Subjects

Patients with PCG presenting between 2011 and 2023 with > 3 months follow-up.

Methods

The percentage of households with 0, 1–2, or > 3 community resilience estimates (CREs) risk factors and median income for the census tract of residence for each patient were collected. Initial details and final outcomes were correlated with race, ethnicity, insurance type, and census tract data.

Main Outcome Measures

Final best-corrected visual acuity (BCVA).

Results

Of 59 patients (105 eyes, 68% male), the presenting average age was 294 ± 365 days. Black patients (n = 16) were younger (P < 0.001) than White (n = 31) or other race patients (n = 12). Although there was no racial or ethnic differences in initial intraocular pressure (IOP), IOP > 30 mmHg was associated with worse final BCVA. Patients with Medicaid (n = 31) required more glaucoma surgeries compared with those with commercial insurances (n = 28, P = 0.0305), respectively. Linear regression analysis demonstrated that census tracts with higher percentage of households with > 3 CRE risk factors correlated with worse visual acuity (ß = 0.02, P = 0.0028, R² = 0.2). There were no racial, ethnic, insurance type, tract median income, or CRE risk factor differences in IOP, number of glaucoma medications, spherical equivalent, or cup-to-disc ratio at final follow-up.

Conclusions

Type of insurance and census data as markers for social determinants of health demonstrated increased risk factors can be associated with worse visual outcomes in PCG.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.