Glaucoma Care Affected Most by Patient’s Wealth Class

The presence of other household members who can assist with administering eye drops, remind the patient to take medications, go to the pharmacy and motivate the individual to adhere to their prescriptions may be what’s responsible for the observed IOP reduction of, on average, 4mm Hg, similar to adding two other medication classes to a patient’s regimen. Photo: Michael Chaglasian, OD. Click image to enlarge. Eyecare practitioners who manage individuals with glaucoma know that many factors can influence clinical care. Some communities continue to experience higher rates of visual impairment and blindness related to glaucoma; given these possibilities, researchers want to know what nonmedical influences may be affecting care.A retrospective investigation was published in JAMA Ophthalmology last week that included 1,466 patients with newly diagnosed primary open-angle glaucoma (POAG), with data compiled from health systems in the Sight Outcomes Research Collaborative (SOURCE) Consortium. Of this set, mean patient age was 70 and 54% were women; in the categories of race and ethnicity, 3% were Asian, 32% were Black, 7% were Latino and 57% were white. Researchers were looking to identify factors that may influence the ability to achieve 15% or greater intraocular pressure (IOP) reduction at 12 to 18 months—the standard recommended by the US National Quality Forum—following initial diagnosis, as well as odds of loss to follow-up (LTFU).Of the entire cohort, 70% had one or more follow-up evaluations within 12 to 18 months after initial POAG diagnosis, with 76% of this subset achieving 15% or more IOP reduction in one or both eyes. After analysis, it was found that those in the lowest wealth quartile had five- to nine-fold lower odds of achieving this standard IOP reduction when compared with those in higher quartiles. Related to this, odds of LTFU were 61% lower in the wealthiest patient quartile than the least wealth group. Patients who lived in rural areas were also more likely than urban residents to experience LTFU. However, patients who had children in their household experienced an average IOP reduction of 4mm Hg, which was greater than in households without kids.The authors of the study explain that this relationship of clinical outcomes with wealth may persist due to the needed expense of topical glaucoma medications—especially with more advanced disease necessitating multiple medications regularly. Although insurance may cover parts, the investigators speculate that out-of-pocket expenses may be too steep for long-term use for less wealthy patients, in turn leading to disease progression. To mitigate this inaccessibility, the authors recommend laser trabeculoplasty and for individuals to search for patient assistance programs and prescription drug discounts.Most importantly, the authors relay that “these findings support the premise that clinicians should understand financial circumstances of patients when making management decisions and reinforce the need for clinicians and payors to find ways to ensure that patients can access IOP-lowering interventions and receive follow-up care in accordance with established guidelines.”1An invited commentary—also published in JAMA Ophthalmology—had one commentator echo the importance of these findings, as well as addressing how the researchers could even obtain this level of information: “The fact that less education, minority race and living in rural settings are associated with lower income should not be ignored. But the key message of the authors should prompt attention by all thoughtful clinicians: inferior clinical outcomes for patients in this study are rooted in poverty.”2He then explains that this study was only possible because of the unique analysis done via a big data resource by the SOURCE Consortium. Before, real-world data analysis relied on insurance claims data, which was limited in information listed—with race, education, family wealth and clinical measures like IOP all being absent. The Consortium, however, joined electronic health records to information on education, wealth, race, geographic location and other demographics using tokenization to protect sensitive data.With this relatively novel approach, the commentator posits “the SOURCE Consortium has created a unique tool that promises to give investigators an opportunity to explore novel and important questions to improve vision care. Let us all hop that the message of this investigation will be viewed as a call to the glaucoma community to find ways to bridge poverty to improve vision care.”2 Click here for the journal source and here for the commentary. 1. Ige MO, French DD, Chaudhury AS, et al.; for the Sight Outcomes Research Collaborative (SOURCE) Consortium. Quality of care in patients with newly diagnosed glaucoma. JAMA Ophthlamol. September 18, 2025. [Epub ahead of print].2. Kymes S. Leveraging big data to improve patient care. JAMA Ophthlamol. September 18, 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.