Rithambara Ramachandran,Aaron T Zhao,Yinxi Yu,Paula Anne Newman-Casey,Joshua D Stein,
{"title":"利用视力结果研究合作(SOURCE)数据预测晚期开角型青光眼的初始表现。","authors":"Rithambara Ramachandran,Aaron T Zhao,Yinxi Yu,Paula Anne Newman-Casey,Joshua D Stein, ","doi":"10.1016/j.ajo.2025.09.032","DOIUrl":null,"url":null,"abstract":"PURPOSE\r\nTo investigate factors associated with initial presentation at tertiary health systems with advanced primary open-angle glaucoma (OAG) in either eye.\r\n\r\nDESIGN\r\nCross-sectional study.\r\n\r\nSUBJECTS\r\nAdults>40 years old diagnosed with OAG initially presenting at one of eleven SOURCE consortium sites between 2016 and 2023.\r\n\r\nMETHODS\r\nOAG severity was dichotomized as \"non-advanced\" (suspect, mild, moderate) or \"advanced,\" based on the most severe stage in either eye within one year of presentation using ICD-10 codes. Logistic regression identified sociodemographic and neighborhood factors linked to \"advanced\" OAG presentation, and ordinal models assessed predictors by stage. Predictors included sociodemographic characteristics, health insurance type, income, education, urbanicity, and neighborhood-level affluence (Distressed Communities Index [DCI]). Associations with intraocular pressure (IOP) and cup-to-disc ratio (CDR) were modeled for all eyes using linear regression with generalized estimating equations.\r\n\r\nMAIN OUTCOME MEASURES\r\nAdjusted odds ratios (aORs) with 95% confidence intervals (CIs) for factors associated with presenting with \"advanced\" OAG.\r\n\r\nRESULTS\r\nAmong 59,409 individuals, 7,560 (12.7%) presented with advanced OAG in at least one eye. Mean age was 65.8(SD 12.7) years; 44.6% male, 56.7% Caucasian. Older age per decade (aOR: 1.74, 95% CI: 1.70-1.78), male sex (aOR: 1.59, CI: 1.51-1.68), Black race (aOR: 1.67, CI: 1.56-1.80), less affluent communities (aOR: 1.04 per 10-unit DCI increase, CI: 1.03-1.05), and non-metropolitan residence (OR range: 1.42-1.99) were associated with advanced presentation. Protective factors included Medicare insurance (aOR: 0.90, CI: 0.90-0.96), higher education (aOR range: 0.74-0.83), and diabetes mellitus (aOR: 0.39, CI: 0.36-0.43). Results were consistent across secondary analyses. Presenting IOP and CDR increased with disease severity and were similarly associated with sociodemographic and neighborhood factors.\r\n\r\nCONCLUSION\r\nIdentifying sociodemographic predictors of late presentation using large population-based datasets may help inform targeted glaucoma screening efforts, since delayed initial presentation is a major risk factor for vision loss from advanced OAG.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"41 1","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Leveraging Sight Outcomes Research Collaborative (SOURCE) Data to Predict Initial Presentation with Advanced Open-Angle Glaucoma.\",\"authors\":\"Rithambara Ramachandran,Aaron T Zhao,Yinxi Yu,Paula Anne Newman-Casey,Joshua D Stein, \",\"doi\":\"10.1016/j.ajo.2025.09.032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"PURPOSE\\r\\nTo investigate factors associated with initial presentation at tertiary health systems with advanced primary open-angle glaucoma (OAG) in either eye.\\r\\n\\r\\nDESIGN\\r\\nCross-sectional study.\\r\\n\\r\\nSUBJECTS\\r\\nAdults>40 years old diagnosed with OAG initially presenting at one of eleven SOURCE consortium sites between 2016 and 2023.\\r\\n\\r\\nMETHODS\\r\\nOAG severity was dichotomized as \\\"non-advanced\\\" (suspect, mild, moderate) or \\\"advanced,\\\" based on the most severe stage in either eye within one year of presentation using ICD-10 codes. Logistic regression identified sociodemographic and neighborhood factors linked to \\\"advanced\\\" OAG presentation, and ordinal models assessed predictors by stage. Predictors included sociodemographic characteristics, health insurance type, income, education, urbanicity, and neighborhood-level affluence (Distressed Communities Index [DCI]). Associations with intraocular pressure (IOP) and cup-to-disc ratio (CDR) were modeled for all eyes using linear regression with generalized estimating equations.\\r\\n\\r\\nMAIN OUTCOME MEASURES\\r\\nAdjusted odds ratios (aORs) with 95% confidence intervals (CIs) for factors associated with presenting with \\\"advanced\\\" OAG.\\r\\n\\r\\nRESULTS\\r\\nAmong 59,409 individuals, 7,560 (12.7%) presented with advanced OAG in at least one eye. Mean age was 65.8(SD 12.7) years; 44.6% male, 56.7% Caucasian. Older age per decade (aOR: 1.74, 95% CI: 1.70-1.78), male sex (aOR: 1.59, CI: 1.51-1.68), Black race (aOR: 1.67, CI: 1.56-1.80), less affluent communities (aOR: 1.04 per 10-unit DCI increase, CI: 1.03-1.05), and non-metropolitan residence (OR range: 1.42-1.99) were associated with advanced presentation. Protective factors included Medicare insurance (aOR: 0.90, CI: 0.90-0.96), higher education (aOR range: 0.74-0.83), and diabetes mellitus (aOR: 0.39, CI: 0.36-0.43). Results were consistent across secondary analyses. 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Leveraging Sight Outcomes Research Collaborative (SOURCE) Data to Predict Initial Presentation with Advanced Open-Angle Glaucoma.
PURPOSE
To investigate factors associated with initial presentation at tertiary health systems with advanced primary open-angle glaucoma (OAG) in either eye.
DESIGN
Cross-sectional study.
SUBJECTS
Adults>40 years old diagnosed with OAG initially presenting at one of eleven SOURCE consortium sites between 2016 and 2023.
METHODS
OAG severity was dichotomized as "non-advanced" (suspect, mild, moderate) or "advanced," based on the most severe stage in either eye within one year of presentation using ICD-10 codes. Logistic regression identified sociodemographic and neighborhood factors linked to "advanced" OAG presentation, and ordinal models assessed predictors by stage. Predictors included sociodemographic characteristics, health insurance type, income, education, urbanicity, and neighborhood-level affluence (Distressed Communities Index [DCI]). Associations with intraocular pressure (IOP) and cup-to-disc ratio (CDR) were modeled for all eyes using linear regression with generalized estimating equations.
MAIN OUTCOME MEASURES
Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for factors associated with presenting with "advanced" OAG.
RESULTS
Among 59,409 individuals, 7,560 (12.7%) presented with advanced OAG in at least one eye. Mean age was 65.8(SD 12.7) years; 44.6% male, 56.7% Caucasian. Older age per decade (aOR: 1.74, 95% CI: 1.70-1.78), male sex (aOR: 1.59, CI: 1.51-1.68), Black race (aOR: 1.67, CI: 1.56-1.80), less affluent communities (aOR: 1.04 per 10-unit DCI increase, CI: 1.03-1.05), and non-metropolitan residence (OR range: 1.42-1.99) were associated with advanced presentation. Protective factors included Medicare insurance (aOR: 0.90, CI: 0.90-0.96), higher education (aOR range: 0.74-0.83), and diabetes mellitus (aOR: 0.39, CI: 0.36-0.43). Results were consistent across secondary analyses. Presenting IOP and CDR increased with disease severity and were similarly associated with sociodemographic and neighborhood factors.
CONCLUSION
Identifying sociodemographic predictors of late presentation using large population-based datasets may help inform targeted glaucoma screening efforts, since delayed initial presentation is a major risk factor for vision loss from advanced OAG.
期刊介绍:
The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect.
The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports.
Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.