Racial Disparities in Glaucoma Vision Outcomes and Eye Care Utilization: An IRIS® Registry Analysis.

To evaluate racial disparities in vision outcomes and eye care utilization among glaucoma patients. Retrospective cohort study. Population-based IRIS Registry (Intelligent Research in Sight) study. Patients with minimum one diagnosis code for glaucoma at least 6 months prior to Jan 1 Multivariable logistic and negative binomial regression models were used to assess vision and utilization outcomes, respectively, across race and ethnicity from Jan 1 Among 996,297 patients, 73% were non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic, 3% Asian/Pacific Islander, and 0.3% Native American/Alaska Native. Compared to White eyes, Black and Hispanic eyes had higher adjusted odds of CDR progression (odds ratio (OR)=1.12, 95%CI=1.08-1.17; OR=1.28, 95%CI=1.22-1.34), poor vision (OR=1.26, 95%CI=1.22-1.29; OR=1.26, 95%CI=1.22-1.31), glaucoma filtering surgery (rate ratio (RR)=1.47, 95%CI=1.42-1.51; RR=1.13, 95%CI=1.09-1.18). Hispanic eyes also had increased odds of low vision diagnoses (Hispanic OR=1.18, 95%CI=1.07-1.30). Black and Hispanic patients were less likely to have eye exams (RR=0.94, 95%CI=0.94-0.95; RR=0.99, 95%CI=0.99-0.99) and OCTs (RR=0.86, 95%CI=0.85-0.86; RR=0.97, 95%CI=0.96-0.98), yet Black patients had higher odds of inpatient/ED encounters (RR=1.64, 95%CI=1.37-1.96) compared to White patients. Native American patients were more likely to have poor vision (OR=1.17, 95%CI=1.01-1.36) and less likely to have outpatient visits (RR=0.89, 95%CI=0.86-0.91), OCTs (RR=0.85, 95%CI=0.82-0.89), visual fields (RR=0.91, 95%CI=0.88-0.94) or lasers/surgeries (RR=0.87, 95%CI=0.79-0.96) compared to White patients. We found that significant disparities in US eye care exist with Black, Hispanic, and Native American patients having worse vision outcomes and less disease monitoring. Glaucoma may be undertreated in these racial and ethnic minority groups, increasing risk for glaucoma-related vision loss.

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