Filtering Surgery Failure More Likely in Patients of Hispanic Descent

In a UCLA study published in JAMA Ophthalmology, 41.4% of Hispanic patients experienced complications after glaucoma surgery, compared to 26.1% of patients of European descent. Hispanic ethnicity was linked to two to three times higher surgical failure rates across multiple success criteria. With a follow-up loss rate exceeding 50% after the first year, findings highlight disparities in outcomes and access to care for Hispanic individuals with glaucoma. Photo: Justin Schweitzer, OD. Click image to enlarge. Racial and ethnic disparities among patients with glaucoma have been elucidated by recent research, particularly impacting those in the Hispanic and Black populations. Not only is glaucoma the leading cause of blindness in these groups, but studies have shown a concerning trend that Hispanic individuals accounted for approximately 27% of all primary open-angle glaucoma (POAG) cases in the US in 2011, a figure projected to reach 50% by 2050. With this treatment burden at the forefront, and considering that individuals with African descent have previously shown a higher susceptibility to treatment failure in filtering surgeries, researchers explored how Hispanic patients would compare to those of European descent. Their findings were published last week in JAMA Ophthalmology.1Included in this retrospective matched-cohort study were 111 eyes from 96 patients of Hispanic descent and 111 eyes from 108 patients of European descent, all of whom were identified in clinical records from UCLA’s Stein Eye Institute’s Glaucoma Division between 1999 and 2023. The Hispanic cohort included 59 women (61.5%) and 37 men (38.5%) with a mean age of 69.1. The European descent cohort included 53 women (49.1%) and 55 men (50.9%) with a mean age of 69.2 years. The baseline meanIOP was 18.7mm Hg in patients of Hispanic descent and 20mm Hg in patients of European descent. The mean number of preoperative glaucoma medications was 3.0 and 2.7, respectively. The median follow-up time was 2.3 years for Hispanic patientsand 3.3 years for patients of European descent.Results were judged on three criteria—labeled as A, B and C—which defined qualified success as final intraocular pressure (IOP) of 18mm Hg or less, 15mm Hg or less, and 12mm Hg or less, respectively, with corresponding IOP reduction of 20% or more, 25% or more and 30% or more, or a decrease of two or more medications. Complete success required meeting the above criteria without medication use. Researchers concluded the following:The overall incidence of complications was higher i nHispanic patients compared with patients of European descent (41.4% vs. 26.1%).Early wound leaks were more common than late bleb leaks with 12.6% of Hispanic patients experiencing early leaks compared with 5.9% for the European cohort. Late hypotony (IOP less than 6mm Hg for more than three months) rates were comparable: 13.5% Hispanic, 13.3% European.Based on criteria A, B and C, for qualified success, Hispanic descent was a risk factor for failure with all three criteria.For complete surgical success, Hispanic descent was consistently associated with an increased risk of failure across A, B and C criteria.According to the study, hazard ratios (HRs) ranged from 2.07 to 3.04, indicating a clinically relevant difference in surgical outcomes between the two ethnic groups. “Worse glaucoma damage at the time of surgery consistently predicted higher failure rates across all criteria,” the authors wrote. “A 1 dB decrease in baseline visual field MD (worse MD) was associated with a 2% to 3% increased risk of failure.” Also, the total number of complications was higher among the Hispanic patients studied.The reasons for the higher failure rates in patients of Hispanic descent are not immediately clear, the authors wrote; however, they speculate that these higher rates could be driven by the same factors observed in other patients with darker skin pigmentation. “Previous studies explored the influence of ethnicity on glaucoma severity at presentation or disease progression,” they continued in their paper, citing studies that showed Hispanic individuals had greater disease severity at presentation and underwent fewer visual fields tests during follow-up, compared with white patients. Additionally, limited English proficiency and lack of trust in eyecare professionals may be contributing factors.Limitations cited by the researchers include the self-reporting of race and ethnicity, as well as the retrospective design, which is inherently subject to selection bias, they wrote. “The sample size was relatively small and the Hispanic cohort enrolled in this study may not fully represent the diversity within the Hispanic population, as we were unable to identify various subsets within the Hispanic cohort or evaluate outcomes across such subsets. Lastly, Hispanic patients had a higher follow-up loss rate exceeding 50% after the first year.”An invited commentary on this study, also published in JAMA Ophthalmology, says this new research makes a pivotal contribution to understanding these outcomes among Hispanic individuals, but cautions that future research needs to include a better understanding of barriers to follow-up care.2“Notably, the authors acknowledged a high rate of loss to follow-up among patients of Hispanic descent, exceeding 50% after the first year,” the commentary states. “This disparity may result in biased estimates that overinflate failure rates among patients of Hispanic descent if only those who are ill (e.g., experiencing bleb failure or complications) contribute to the survival estimates. In contrast, if patients of European descent who may have better access to insurance and more time off are less likely to be lost to follow-up, then their survival estimates would include both sick and healthy individuals. This would make a direct comparison of failure rates between patients of Hispanic vs. European descent problematic.”The authors continued, “Therefore, it is essential that future research priorities include a better understanding of the barriers to obtaining necessary follow-up care. These efforts not only aim to improve glaucoma outcomes across all populations—especially those at greatest risk—but also to strengthen the validity of future survival analyses in related populations.”Click here for the study and here for the commentary. 1. Besharati S, Mohammadzadeh V, Ashrafkhorasani MA, et al. Outcomes of trabeculectomy with mitomycin C in patients of Hispanic vs European descent. JAMA Ophthalmol. August 21, 2025. [Epub ahead of print.]2. Vajaranant TS, Edward DP, Joslin CE. Glaucoma surgery in Hispanic individuals. JAMA Ophthalmol. August 21, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.