Study Identifies Factors Associated with Initial Presentation of Advanced Glaucoma

Glaucoma continues to be a burden for individuals and the larger healthcare system. With early stages often being asymptomatic, it is important to understand which demographics may be at higher risk to encourage screening and deliver prompt treatment.In a new study published in American Journal of Ophthalmology, researchers investigated factors associated with patients whose initial presentation received a diagnosis of advanced primary open-angle glaucoma (POAG) in either eye. The investigators used Sight Research Collaborative (SOURCE) data and included 59,409 individuals over 40 years of age who were diagnosed with POAG at presentation. Older age was found as a strong predictor of presenting with advanced POAG, likely due to age-related increases in optic nerve vulnerability and diminished resilience to oxidative stress and IOP. Photo: James L. Fanelli, OD. Click image to enlarge. Of this population, 12.7% presented with advanced POAG in at least one eye. Mean age was 65.8, 44.6% were male and 56.7% were Caucasian. Advanced presentation was found to be associated with factors of older age, male sex, Black race, less affluence and non-metropolitan residence. Conversely, Medicare insurance, higher education and diabetes presence all existed as protective factors. Unsurprisingly, intraocular pressure (IOP) and cup-to-disc ratio increased with severity and were similarly linked with sociodemographic and neighborhood factors.The authors of the study elaborate on all these factors in their discussion. Male sex, they explain, accounted for 52.4% of advanced cases here, and they suggest that this may be due to lower engagement in preventive eye care among men.One major factor found to influence severity was socioeconomic distress, measured by a metric called the Distressed Communities Index score, with higher scores linked with greater likelihood of advanced presentation. Similarly, lower patient income was associated with increased severity at presentation. The index is a composite of economic factors including poverty rate, housing vacancy, employment and others. The authors also add that this type of index incorporates racial and ethnic composition, making it more sensitive to inequities in health outcomes.Yet another vital characteristic in predicting severity was access to care via insurance. The study cohort had 48.4% subjects with Medicare or Medicaid who were less likely to have advanced stage disease than those with commercial insurance plans; however, this relationship was not seen when excluding glaucoma suspects. This suggests that screening and preventive care varies by insurance type, as Medicare and Medicaid do provide annual glaucoma screenings for high-risk individuals, fostering earlier diagnosis and treatment. Commercial insurance, however, is not mandated to provide these screenings at a federal level and routine eye exams aren’t covered uniformly for diagnosing ocular conditions.Individuals with diabetes may be less likely to present with advanced POAG due to the need for regular diabetic eye exams, in turn leading to incidental glaucoma detection earlier in the disease course. Patients with diabetes had 61% lower odds of advanced disease at presentation, and this stayed even when suspects and those already treated for glaucoma were excluded.With many socioeconomic factors found to play a role, the authors write in their paper that “by showing how disparities translate into measurable physiologic damage, our findings underscore the real-world consequences of delayed detection and suboptimal access to eye care.”They recommend that, “rather than a one-size-fits-all model, future screening guidelines should incorporate individual and neighborhood-level risk factors to more effectively allocate resources toward those at highest risk” and “by integrating social determinants of health, demographic characteristics, and diabetes status into glaucoma screening strategies, healthcare systems can more precisely identify and reach the populations at greatest risk for irreversible vision loss.” Click here for the journal source. Ramachandran R, Zhao AT, Yu Y, Newman-Casey PA, Stein JD, on behalf of the Sight Outcomes Research Collaborative (SOURCE) Consortium. Leveraging Sight Outcomes Research Collaborative (SOURCE) data to predict initial presentation with advanced open-angle glaucoma. Am J Ophthalmol. September 23, 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.