December 02, 2025
2 min read
Key takeaways:
- Patients in the lowest quartile of wealth were the least likely to meet an IOP reduction benchmark following a glaucoma diagnosis.
- Loss to follow-up was 61% less likely among the most wealthy patients.
The personal wealth of patients newly diagnosed with primary open-angle glaucoma is significantly linked with their outcomes 12 to 18 months later, according to a study published in JAMA Ophthalmology.
“A large, compelling body of evidence suggests that factors, such as the conditions in which people live, the quality of schools or workplaces they attend, and the composition of their social networks, may be root causes of suboptimal health outcomes in certain communities,” Maryam O. Ige, MD, of the department of ophthalmology at Northwestern University Feinberg School of Medicine, and colleagues wrote. “If potentially modifiable nonmedical factors are contributing to suboptimal care for patients with primary open-angle glaucoma, there may be opportunities to address some of these factors and ultimately improve patient outcomes.”
The personal wealth of patients newly diagnosed with primary open-angle glaucoma is significantly linked with their outcomes 12 to 18 months later. Image: Adobe Stock
Ige and colleagues analyzed data on 1,466 patients with newly diagnosed primary open-angle glaucoma treated at tertiary care health systems in the Sight Outcomes Research Collaborative consortium.
Electronic health records were linked to the platform AnalyticsIQ for data on education, children in the household and wealth, defined as the average value of known taxable assets in households in each patient’s ZIP code.
The researchers assessed how many patients in each group achieved 15% or greater IOP reduction in at least one eye, a benchmark recommended by the U.S. National Quality Forum. They also examined the number of patients lost to follow-up, which they defined as not having any IOP measurements in the 12 to 18 months after diagnosis. Logistic regression models were used to evaluate links between patient factors and glaucoma outcomes.
Overall, 76% of patients who had at least one follow-up evaluation in that 12- to 18-month period achieved a 15% or greater IOP reduction in at least one eye.
Patients in the lowest quartile of wealth were the least likely to achieve this IOP reduction in multivariable logistic regression models. This reduction was more than ninefold more likely to be achieved among those in the second quartile and more than fivefold more likely in both the third and fourth quartiles.
Compared with patients in the lowest wealth quartile, those in the highest quartile had 61% lower odds of being lost to follow-up (P = .02). Those in rural areas were five times more likely to be lost to follow-up vs. those in urban areas.
A sensitivity analysis found that patients with children in the household had an average of 4.06 mm Hg greater reduction in IOP vs. those in households without children (P = .01). The researchers speculated that having more people in the household could help with administering eye drops, reminding patients to use drops and motivating patients to adhere to the treatment regimen.
“These findings highlight the potential importance of patient wealth in assuring proper glaucoma care and may help explain the higher rates of glaucoma-related visual impairment and blindness in particular racial and ethnic groups,” Ige and colleagues wrote, adding the results “may help identify opportunities for health policymakers and the ophthalmic community to improve quality of [primary open-angle glaucoma] care for all patients.”
Perspective
The findings by Ige and colleagues highlight an often-unspoken truth in glaucoma care: When monitored correctly, glaucoma can be complex and expensive. We still lack a perfect diagnostic test. Proper care depends on synthesizing structural and functional information over time, repeating imaging and fields, and identifying subtle patterns that only emerge longitudinally. As with breast or colon cancer screening, the goal is to detect the small number of cases that could become devastating before symptoms appear. I explain this to patients as a form of insurance: You hope the investment in monitoring never has to “pay out.”
High-quality glaucoma care cannot be rushed or delivered by volume. It requires time, education and individualized discussion of risk tolerance. I often see patients seeking second opinions, and the most impactful intervention is usually helping the patient understand their situation and their options. When patients feel like a number, they disengage, even if the prescribed treatment is technically correct. When care is tailored and specific concerns, lifestyle and comfort with uncertainty are respected, patients participate more fully, return for follow-up and adhere better.
Mark Eltis, OD, FAAO
Disclosures: Eltis reports no relevant financial disclosures.
Sources/Disclosures
Source:
Ige MO, et al. JAMA Ophthalmol. 2025;doi:10.1001/jamaophthalmol.2025.2995.
Disclosures:
Ige reported receiving grants from the National Eye Institute and Research to Prevent Blindness during the conduct of the study. The study was funded by grants from the National Eye Institute, Research to Prevent Blindness and a gift from Wendy and Jeffrey Eisenshtadt. Please see the study for all other authors’ relevant financial disclosures.
Ask a clinical question and tap into Healio AI’s knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio’s exclusive daily news coverage of clinical data
