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Social Factors Associated With the Risk of Glaucoma Suspect Conversion to Glaucoma
TAKE-HOME MESSAGE
- In this study, the authors examined social factors associated with the risk of conversion from glaucoma suspect (GS) to definite glaucoma. Overall, conversion from GS to glaucoma occurred in 14.9% of the included patients. On multivariate analysis, older age (HR, 1.17), being African American (HR, 1.70), male sex (HR, 1.30), history of intraocular surgery (HR, 1.60), and delayed healthcare access (HR, 2.27) were significantly associated with the risk of glaucoma conversion. For non–African American patients, the 1-year risk of conversion was approximately <5%, with a 5-year conversion rate of approximately 13%; for African American patients, the conversion rate was approximately 9% and 19%, respectively.
- Various social factors may be implicated in the conversion from GS to glaucoma, which may be of interest to eye care providers for patient monitoring.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To examine social factors associated with the 5-year risk of glaucoma suspects (GS) converting to open-angle glaucoma (OAG).
DESIGN
Retrospective cohort analysis.
SUBJECTS
We screened for participants diagnosed with GS in the All of Us database. Cases that converted to OAG within 5 years of GS diagnosis (the "conversion group") were compared with control cases that did not convert.
METHODS
Demographic, socioeconomic and health-care utilization data of the cases were extracted and compared between the conversion group and the control group. Multivariable Cox proportional hazards modeling was used to identify potential factors associated with the risk of conversion.
MAIN OUTCOME MEASURES
Hazard ratios (HRs) of significant factors associated with the risk of conversion.
RESULTS
A total of 5274 GS participants were identified, and 786 (15%) cases converted to OAG within 5-year follow-up. The 2 groups showed significant differences in age, race, gender, employment status, income/education level, history of intraocular surgery, and health-care utilization patterns. In the multivariable model, African American/Black race (HR : 1.70 [95% confidence interval (CI), 1.44-2.00]), older age at GS diagnosis (1.17 [95% CI, 1.09-1.25]), male gender (1.30 [95% CI, 1.13-1.50], no history of recreational drug use (1.23 [1.07-1.42]), history of intraocular surgery (1.60 [95% CI, 1.02-1.53]), and having more reasons for delayed health-care access (2.27 [95% CI, 1.23-4.18]) were associated with a greater hazard of conversion, while being employed (0.71 [95% CI, 0.60-0.86]) was associated with a smaller hazard of conversion (P < 0.05 for all).
CONCLUSIONS
Several social factors were associated with the conversion from GS to OAG, which may help to identify patients at higher risk of disease progression. Future studies are needed to examine the basis for these findings and the potential interventions that could address them.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Additional Info
Social Factors Associated with the Risk of Glaucoma Suspect Conversion to Glaucoma: Analysis of the Nationwide All of Us Program
Ophthalmol Glaucoma 2024 Nov 01;7(6)551-562, JH Wu, W Halfpenny, J Bu, M Brar, RN Weinreb, SL BaxterFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Glaucoma can be difficult to diagnose in its early stages. Clinicians use a diagnosis of "glaucoma suspect (GS)" for patients who they believe are at risk of converting to open-angle glaucoma (OAG). Patients with GS need to be monitored to determine if they convert to OAG so that treatment can be started early.
Using a relatively new national database, All of Us,1 this retrospective cohort study examined social factors while following glaucoma suspects for 5 years.2 This database collects genetic and clinical data from volunteers.
The 5274 participants in the GS study were aged ≥18 years. GS diagnosis was defined as having a diagnostic code for GS, open angle with borderline intraocular pressure, or open angle with borderline findings at low or high risk. During the 5-year follow-up period, 786 cases converted to OAG, and the 4488 cases that did not convert became the control group.
The social factors associated with a greater risk of conversion from GS to OAG included being African American, older age at diagnosis of GS, male sex, no history of recreational drug use, history of intraocular surgery, and more reasons for delayed healthcare access. Approximately 14% of OAG cases were diagnosed as moderate to severe glaucoma.
Several of the social risk factors identified in this study are well-known, including race, older age, and male sex.3,4 More reasons to delay care and employment status, which are associated with delayed access to care, are not surprising risk factors. When considered in conjunction with clinical findings, such as increased intraocular pressure, the appearance of the optic disc and retinal nerve fiber layer, and visual fields, social risk factors can be helpful in determining the frequency of follow-up for patients identified as glaucoma suspects.
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