Study Links Patient Wealth to Quality of Glaucoma Care

A recent multi-institutional study published in JAMA Ophthalmology reveals that patients with lower wealth or those living in rural communities are significantly less likely to receive standard glaucoma care compared to wealthier patients. The findings raise important considerations for addressing disparities in care for newly diagnosed glaucoma patients in the U.S.

Investigating Nonmedical Drivers of Care Disparities

Led in part by Dustin French, PhD, Professor of Ophthalmology and Medical Social Sciences at Northwestern Medicine, the study analyzed data from over 1,400 patients across academic health systems in the Sight Outcomes Research Collaborative (SOURCE) Consortium. Data spanned from January 2010 to December 2022 and focused on nonmedical factors such as:

• Self-reported race and ethnicity

• Urban vs. rural residence

• Community wealth

• Household composition (e.g., presence of children)

The average participant age was 70 years, with 54% identifying as female. Racial/ethnic breakdown included 32% Black, 7% Latinx, 3% Asian American, and 57% white patients.

Measuring Glaucoma Treatment Quality

The primary clinical outcome was the likelihood of achieving a ≥15% reduction in intraocular pressure (IOP) within 12 to 18 months of diagnosis, a benchmark set by the U.S. National Quality Forum. IOP is typically reduced using medicated eye drops or surgical interventions.

Out of 1,030 patients who had at least one follow-up in the specified timeframe, 76% achieved the target IOP reduction. However, a significant disparity was found based on wealth:
Patients from lower-wealth communities were five to nine times less likely to meet the IOP reduction target compared to wealthier counterparts.

Wealth, Not Race, Emerges as Key Predictor

While racial disparities in glaucoma care are well-documented, the study found that wealth, not race, was the strongest predictor of care quality and treatment success.

“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,” said Dr. French. “Wealth is the best predictor of whether patients receive high-quality care and keep follow-up appointments.”

Loss to follow-up, defined as patients failing to return for scheduled care, was 61% lower among wealthier patients. Rural patients also showed higher rates of follow-up loss compared to urban residents.

Implications for Clinical Practice

The study highlights how economic and geographic disparities may contribute to the higher rates of glaucoma-related vision loss in some racial and ethnic populations. Authors recommend that clinicians factor in a patient’s financial situation when developing care plans and emphasize the need to reduce structural barriers to follow-up.

Potential Solutions: Leveraging AI for Patient Retention

To help address disparities, Dr. French suggested the use of artificial intelligence tools to identify patients at higher risk of missing appointments.

“It’s really about identifying who’s most at risk and using that extra effort to ensure they come in for care,” French noted.

The findings may inform future strategies aimed at equity-based care delivery, ensuring all patients have access to effective glaucoma treatment regardless of socioeconomic status.

Reference:

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