Quality of Care in Patients With Newly Diagnosed Glaucoma.

Abstract

Importance Various communities continue to experience relatively high rates of glaucoma-related visual impairment and blindness. Identifying potential nonmedical influences on glaucoma outcomes may lead to strategies to improve glaucoma care. Objective To assess possible associations between nonmedical variables and quality of glaucoma care among patients with newly diagnosed primary open-angle glaucoma (POAG). Design, Setting, and Participants This retrospective cohort study included 1466 patients with newly diagnosed POAG receiving care at health systems in the Sight Outcomes Research Collaborative (SOURCE) Consortium from January 2010 to December 2022. Data analysis was completed from March 2024 to June 2025. Exposures Various nonmedical variables, including self-reported race and ethnicity, urbanicity of residence, affluence of patients' residential community, and presence of children in the household. Main Outcomes and Measures The primary outcomes were odds of 15% or greater intraocular pressure (IOP) reduction at 12 to 18 months following initial POAG diagnosis and odds of loss to follow-up (LTFU). Results Mean (SD) age of patients was 70 (12) years; among 1466 patients, 793 (54%) were female. By self-reported race and ethnicity, 39 patients (3%) were Asian American, 469 patients (32%) were Black, 95 (7%) were Latinx, and 831 (57%) were White. Among 1030 patients (70%) with 1 or more follow-up evaluations within 12 to 18 months following initial POAG diagnosis, 783 (76%) achieved 15% or higher IOP reduction in 1 or more eyes. Patients in the lowest wealth quartile had 5- to 9-fold lower odds of achieving 15% or greater IOP decrease compared with patients in higher quartiles; the odds of LTFU were 61% lower in the wealthiest patient quartile than in the least-wealthy group (odds ratio [OR], 0.39; 95% CI, 0.18-0.84; P = .02). Patients in rural communities (OR, 5.54; 95% CI, 1.13-27.08) were more likely than urban residents to experience LTFU. Patients with children in the household experienced, on average, a 4-mm Hg (95% CI, 0.99-7.13) greater IOP reduction compared with those without children in the household (P = .01). Conclusions and Relevance In this cohort study, patients with newly diagnosed POAG in the lowest wealth quartile were substantially less likely to achieve the US National Quality Forum's recommended IOP percentage reduction and considerably more likely to experience LTFU than those with higher wealth levels. These findings support the premise that clinicians should understand financial circumstances of patients when making management decisions and reinforce the need for clinicians and payors to find ways to ensure that patients can access IOP-lowering interventions and receive follow-up care in accordance with established guidelines.