by Melissa Rohman,Northwestern University

Credit: CC0 Public Domain

Patients with newly diagnosed glaucoma who have less wealth or reside in rural communities are less likely to receive standard glaucoma care compared to wealthier patients, according to a recent multi-institutional studypublishedinJAMA Ophthalmology.

Dustin French, Ph.D., professor of Ophthalmology and of Medical Social Sciences in the Division of Determinants of Health, was a co-author of the study and principal investigator of the Northwestern Medicine study site.

More than 4 million people in the U.S. haveglaucoma, and it is the leading cause of blindness worldwide, according to the Glaucoma Research Foundation. Glaucoma is caused by increasing pressure within the eye, causing damage to the optic nerve which can causevision lossor blindness. The disease is more commonly diagnosed in adults over the age of 55 and disproportionately affects Black patients compared towhite patients.

In the current study, investigators aimed to determine possible associations between various nonmedical variables, including self-reported race and ethnicity, urbanicity of residence, affluence of patients' residential community and presence of children in the household, and their association with the patient's quality of glaucoma care.

Data represented more than 1,400 patients with newly diagnosed glaucoma who received care at academic health care systems belonging to the Sight Outcomes Research Collaborative (SOURCE) Consortium, of which Northwestern is a participating member, from January 2010 to December 2022. The average age of patients was 70 years and 54% of patients were female. Of the total participants, 3% of patients were Asian American, 32% were Black, 7% were Latinx and 57% were white.

The primary outcomes were likelihood of 15% or greater inintraocular pressure(IOP) reduction—the U.S. National Quality Forum's recommendation for reducing pressure on the eye, often through medicated eye drops or surgery—at 12 to 18 months following initial diagnosis and likelihood of loss to follow-up, or participants who were active in a clinical trial who then became unavailable to complete the trial.

Among 1,030 patients with one or more follow-up evaluations within 12 to 18 months following their initial diagnosis, 76% of patients demonstrated a 15% or higher IOP reduction in one or both eyes.

Strikingly, the investigators found that patients with lower wealth had a five- to nine-fold lower likelihood of achieving 15% or greater IOP reduction compared to patients with higher wealth.

"It's commonly known that race is a predictor of health outcomes, but what we're finding now is it's actually more about wealth and income," French said. "What we see is wealth is actually the best predictor of really determining how well you do in your medical quality and if you get follow-up appointments."

Furthermore, the likelihood of loss to follow-up was 61% lower in patients with higher wealth than patients with lower wealth. Patients inrural communitieswere also more likely than patients in urban areas to experience loss to follow-up.

These findings underscore the association between patient wealth and glaucoma care and may help improve the understanding of higher rates of glaucoma-related visual impairment and blindness in certain racial and ethnic groups.

"These findings support the premise that clinicians should understand the financial circumstances of patients when making management decisions and reinforce the need for clinicians and payers to find ways to ensure that patients can access IOP-lowering interventions and receive follow-up care in accordance with established guidelines," the authors wrote.

French said a possible solution could be utilizing AI models to send appointment reminders to patients who are identified as having a higher risk of missing care based on wealth measure.

"It's really about identifying who's most at risk and then using that extra effort to make sure that they actually come in and get their appointment," French said.

More information: Maryam O. Ige et al, Quality of Care in Patients With Newly Diagnosed Glaucoma, JAMA Ophthalmology (2025). DOI: 10.1001/jamaophthalmol.2025.2995 Journal information: JAMA Ophthalmology

Provided by Northwestern University