Study Reveals Barriers to Glaucoma Care Access

A new study from Northwestern University reveals that racial, economic, and geographic factors significantly impact access to glaucoma care in the United States. The research, published in Translational Vision Science & Technology, found that Black, Hispanic, and Asian American patients, as well as individuals from rural and economically distressed communities, are far less likely to receive essential optic nerve evaluations than white and urban patients.

Glaucoma, a leading cause of irreversible blindness, affects over 3 million people in the U.S. and 76 million worldwide. Because it progresses without noticeable symptoms in its early stages, routine monitoring is crucial for early detection and treatment.

Alarmingly Low Rates of Optic Nerve Exams

Despite the American Academy of Ophthalmology's recommendation for at least two annual follow-up visits—including a yearly optic nerve evaluation—the study found that only 57% of glaucoma patients received an optic nerve exam within three years of their diagnosis.

"This is strikingly low," said senior author Dustin French, PhD, professor of ophthalmology and medical social sciences 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. We need targeted solutions to ensure patients don't slip through the cracks."

Key findings from the study include:

• 56% lower likelihood of receiving an optic nerve evaluation for patients in rural areas compared to urban residents.

• 17% lower likelihood for Black patients compared to white patients.

• 9% lower likelihood for patients from economically distressed communities.

Study Methodology and Key Data Points

The research team analyzed data from 13,582 adults diagnosed with glaucoma across 12 major U.S. health systems over nearly four years. Unlike previous studies, which mainly focused on racial disparities, this research integrated economic and geographic factors using:

• Distressed Community Index Score: Measures socioeconomic distress by ZIP code.

• RUCA Codes: Classifies census tracts by urban vs. rural status to assess accessibility gaps.

These advanced metrics allowed the researchers to pinpoint the combined effects of race, income, and location on glaucoma care disparities.

Addressing Barriers to Care

To combat these disparities, the researchers proposed several solutions:

• Expanding tele-ophthalmology services, like Veterans Affairs' TeleEye Care, to improve remote access.

• Developing home monitoring technology to allow patients to track disease progression without frequent clinic visits.

• Improving transportation and financial assistance programs for patients who face logistical or economic barriers to care.

"Increasing access to remote monitoring and incentivizing providers to serve rural and lower-income communities could make a real difference," French noted. "Future research will focus on testing these strategies to determine their effectiveness."

Conclusion

This study underscores the urgent need to address racial and economic disparities in glaucoma care. By leveraging innovative solutions such as telemedicine, home monitoring, and financial assistance, healthcare systems can work toward ensuring equitable access to sight-saving glaucoma care for all patients.

Reference:

Kunal Kanwar et al, The Association of Social Determinants of Health on Monitoring for Disease Progression Among Patients With Primary Open-Angle Glaucoma, Translational Vision Science & Technology (2025). DOI: 10.1167/tvst.14.3.15