Importance: Few studies have analyzed associations between sociodemographic factors and neovascular glaucoma (NVG) outcomes.
Aim and background: To determine the potential impact of sociodemographic and economic factors on the NVG tube shunt surgery outcomes.
Design: Retrospective, single-center, comparative case series.
Participants: Consecutive patients who underwent tube shunt surgery for NVG and had ≥6 months of follow-up.
Materials and methods: Regional average adjusted gross income (AGI) was determined by cross-referencing self-reported residential zip codes with average AGI per zip code supplied by the Internal Revenue Service. Two groups were created: (1) lower-income: individuals from neighborhoods with the lowest 10% of AGI (near the United States poverty line), (2) higher-income: the remaining 90% of individuals.
Main outcome measures: Visual acuity (VA), intraocular pressure (IOP), and glaucoma medication number at 6 months and the most recent visit.
Results: The mean annual AGI in the higher-income group (130 patients) was $69,596 ± 39,700 and the lower-income group (16 patients) was $27,487 ± 1,600 (p < 0.001). Age, sex, distance to the clinic, language, and all baseline clinical variables (including VA and IOP) were comparable between groups. Lower-income was associated with non-white race (81.3 vs 52.3%; p = 0.024). At month 6, VA in the lower-income group [median: HM (20/70–NLP)] was worse than the higher-income group [median: CF (20/25–NLP)] (log MAR VA: 2.32 ± 0.8 vs 1.77 ± 1.1; p = 0.02); these trends persisted through the most recent visit (p = 0.043). Follow-up IOP and medications were similar between groups.
Conclusions and relevance: Lower-income may be associated with worse VA outcomes following NVG tube shunt surgery.
Hayreh SS. Neovascular glaucoma. Prog Retin Eye Res 2007;26(5): 470–485.
Olmos LC, Lee RK. Medical and surgical treatment of neovascular glaucoma. Int Ophthalmol Clin 2011;51(3):27–36.
Netland PA. The Ahmed glaucoma valve in neovascular glaucoma (An AOS Thesis). Trans Am Ophthalmol Soc 2009;107: 325–342.
Sidoti PA, Dunphy TR, Baerveldt G, et al. Experience with the Baerveldt glaucoma implant in treating neovascular glaucoma. Ophthalmology 1995;102(7):1107–1118.
Budenz DL, Barton K, Gedde SJ, et al. Five-year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology 2015;122(2):308–316.
Alkawas AA, Shahien EA, Hussein AM. Management of neovascular glaucoma with panretinal photocoagulation, intravitreal bevacizumab, and subsequent trabeculectomy with mitomycin C. J Glaucoma 2010;19(9):622–626.
Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet 2017;389(10077): 1431–1441.
Hargraves JL, Hadley J. The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv Res 2003;38(3):809–829.
Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc 2002;94(8):666–668.
Manuel JI. Racial/ethnic and gender disparities in health care use and access. Health Serv Res 2018;53(3):1407–1429.
Waldron H. Trends in mortality differentials and life expectancy for male social security-covered workers, by socioeconomic status. Soc Secur Bull 2007;67(3):1–28.
Chetty R, Stepner M, Abraham S, et al. The association between income and life expectancy in the United States, 2001-2014. JAMA 2016;315(16):1750–1766.
Arora S, Kurji AK, Tennant MT. Dismantling sociocultural barriers to eye care with tele-ophthalmology: lessons from an Alberta Cree community. Clin Invest Med 2013;36(2):E57–E63.
Zambelli-Weiner A, Crews JE, Friedman DS. Disparities in adult vision health in the United States. Am J Ophthalmol 2012;154(6 Suppl):S23–30.e1.
Chou CF, Barker LE, Crews JE, et al. Disparities in eye care utilization among the United States adults with visual impairment: findings from the behavioral risk factor surveillance system 2006-2009. Am J Ophthalmol 2012;154(6 Suppl):S45–52.e1.
Hollar MW, Zhang MM, Mawn LA. Ophthalmic disparities in transgender patients. Semin Ophthalmol 2016;31(4):426–431.
Xu D, Uhr J, Patel SN, et al. Sociodemographic factors influencing rhegmatogenous retinal detachment presentation and outcome. Ophthalmol Retina 2021;5(4):337–341.
Patel SN, Wu C, Obeid A, et al. Sociodemographic factors in neovascular age-related macular degeneration. Ophthalmology 2020;127(2):280–282.
Palacios-Barrios EE, Hanson JL. Poverty and self-regulation: Connecting psychosocial processes, neurobiology, and the risk for psychopathology. Compr Psychiatry 2019;90:52–64.
Office of the Assistant Secretary for planning and evaluation. 2020 Poverty Guidelines. https://aspe.hhs.gov/2020-poverty-guidelines. Published 2020. Accessed January 21, 2020.
Ng WS, Agarwal PK, Sidiki S, et al. The effect of socio-economic deprivation on severity of glaucoma at presentation. Br J Ophthalmol 2010;94(1):85–87.
Fraser S, Bunce C, Wormald R, et al. Deprivation and late presentation of glaucoma: case-control study. BMJ 2001;322(7287):639–643.
Obeid A, Gao X, Ali FS, et al. Loss to follow-up in patients with proliferative diabetic retinopathy after panretinal photocoagulation or intravitreal anti-VEGF injections. Ophthalmology 2018;125(9):1386–1392.
Gao X, Obeid A, Adam MK, et al. Loss to follow-up in patients with retinal vein occlusion undergoing intravitreal anti-VEGF injections. Ophthal Surg Lasers Imag Retina 2019;50(3):159–166.
Thangamathesvaran L, Crane E, Modi K, et al. Outcomes of resident-versus attending-performed tube shunt surgeries in a United States residency program. J Curr Glaucoma Pract 2018;12(2):53–58.
Broadway DC, Chang LP. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma 2001;10(3): 237–249.
Budenz DL, Barton K, Feuer WJ, et al. Treatment outcomes in the Ahmed Baerveldt comparison study after 1 year of follow-up. Ophthalmology 2011;118(3):443–452.
Christakis PG, Kalenak JW, Zurakowski D, et al. The Ahmed versus Baerveldt study: one-year treatment outcomes. Ophthalmology 2011;118(11):2180–2189.
Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 2012;153(5):789–803.e2.
Taubenslag KJ, Kammer JA. Outcomes disparities between black and white populations in the surgical management of glaucoma. Semin Ophthalmol 2016;31(4):385–393.
Zheng Y, Lamoureux EL, Chiang PC, et al. Language barrier and its relationship to diabetes and diabetic retinopathy. BMC Public Health 2012;12:781.
Ndiaye-Sow MN, Seck SM, Dieng M, et al. Profile of neovascular glaucoma in senegalese patients. J Fr Ophtalmol 2018;41(7): 637–641.
Lane M, Lane V, Abbott J, et al. Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2018;63(3):406–436.
Group AS, Group AES, Chew EY, et al. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 2010;363(3):233–244.