Hundreds of thousands of Americans with glaucoma are not receiving necessary care, according to a new study by Northwestern University. The research highlights significant disparities in optic nerve evaluations among different racial and economic groups.
Published in the journal Translational Vision Science & Technology, the study reveals that Black, Hispanic, and Asian American patients, as well as those from rural and economically distressed areas, are less likely to receive crucial optic nerve exams compared to white and urban patients. This examination is vital for monitoring glaucoma progression.
Glaucoma affects over 3 million people in the U.S. and 76 million worldwide. It is a leading cause of irreversible blindness. Regular evaluations are essential because the disease often progresses without symptoms. The American Academy of Ophthalmology advises at least two follow-up visits per year for most glaucoma patients, including an annual optic nerve evaluation. However, only 57% of patients received such an exam within three years after diagnosis.
"This is strikingly low," stated Dustin French, senior author and professor at Northwestern University Feinberg School of Medicine. "If nearly half of glaucoma patients aren’t getting the recommended follow-ups, that’s a serious failure in care."
The odds of receiving recommended follow-up exams were found to be significantly lower for patients in isolated rural communities compared to urban areas (56% lower), Black patients compared with White patients (17% lower), and those living in impoverished communities (9% lower).
"These disparities highlight an urgent need to address the social determinants of health that influence patient care," said Kunal Kanwar, first author and medical student at Feinberg.
The study analyzed data from 13,582 adults treated across 12 major U.S. health systems over nearly four years using data from the SOURCE Ophthalmology Big Data Consortium. Researchers assessed how geographic and economic factors impacted patient care using tools like the Distressed Community Index Score and RUCA codes.
To improve care for vulnerable populations, the study suggests expanding tele-ophthalmology services such as Veterans Affairs’ TeleEye Care program. Advancing home monitoring technology could help track conditions without clinic visits. Improving transportation options and offering financial support could also increase access.
"Increasing access to remote monitoring and increasing provider incentives to serve rural and lower-income communities could make a real difference," French added.
The study was supported by grants from several organizations including the National Eye Institute.