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 (CRE) 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<0.0001) than White (n=31) or Other race patients (n=12). While 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 to 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 VA (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.