Disparities Observed in Late Detection of Primary Angle-Closure Glaucoma

Benjamin Y. Xu, MD, PhD,

New findings from a retrospective cohort study suggest most patients who receive a new diagnosis of primary angle-closure glaucoma (PACG) in the United States do not have a prior diagnosis of anatomical narrow angle.

The demographics at higher risk of late detection included elderly patients, male patients, and Black patients.

“A need exists for increased disease awareness among providers and more accessible tools to detect patients at risk of developing PACG,” wrote study author Benjamin Y. Xu, MD, PhD, Ophthalmology, Keck Medicine of USC.

The study aimed to assess the proportion of newly diagnosed cases of PACG without and without prior diagnosis of anatomical narrow angle, as well as identifying the sociodemographic risk factors for late decision (PACG without prior anatomical narrow angle diagnosis).

Xu and colleagues identified 102,617 patients with PACG using the Optum Clinformatics Data Mart Database from 2017 - 2019. Individuals with newly diagnosed PACG met criteria including a diagnosis made by an ophthalmologist, disease observable for ≥12 months before diagnosis, and no history of treatment before diagnosis unless preceded by a diagnosis of anatomical narrow angle.

They additionally performed multivariate logistic regression modeling to identify sociodemographic risk factors for late detection. The main outcome was considered the proportion of patients with newly diagnosed PACG without prior anatomical narrow angle diagnosis and sociodemographic factors associated with late detection.

After determining eligibility, the study included a total of 31,044 patients. Data show more than 70% of PACG cases were detected without prior diagnosis, regardless of patient age, sex, or race.

Moreover, the investigators found the odds of late detection were significantly higher (P <.001) among men (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.25 – 1.40), Black patients (OR, 1.25; 95% CI, 1.15 –1.37), and patients 8- years of age or older (OR, 1.28; 95% CI, 1.11 - 1.47).

Additionally, the odds of late detection were higher for those living in Southern (OR, 1.30; 95% CI, 1.22 - 1.40) or Pacific (OR, 1.27; 95% CI, 1.16 - 1.36) regions.

Investigators noted the findings were similar for individuals with PACG with a record of gonioscopy and treatment, or with a 24-month lookback period.

The study, “Racial and Sociodemographic Disparities in the Detection of Narrow Angles before Detection of Primary Angle-Closure Glaucoma in the United States,” was published in Ophthalmology Glaucoma.