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Editors Selection IGR 18-2

Miscellaneous: Socioeconomic factors impacting glaucoma diagnosis

Comment by Yvonne Buys on:

66749 Impact of Socioeconomic Status on the Diagnosis of Primary Open-Angle Glaucoma and Primary Angle Closure Glaucoma: A Nationwide Population-Based Study in Taiwan, Ko YC; Hwang DK; Chen WT et al., PLoS ONE, 2016; 11: e0149698

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In glaucoma the key to improve patient outcomes is early diagnosis. This can be a challenge, since in most cases glaucoma is an asymptomatic disease in the early stages. In order then to improve outcomes, understanding patient characteristics that may influence glaucoma diagnosis are important in order to develop strategies to target vulnerable groups. Previous studies have found that lower socioeconomic status is associated with late glaucoma diagnosis specifically for primary open-angle glaucoma (POAG). It is uncertain if lower socioeconomic status is a barrier to access to vision care or directly contributes to disease susceptibility for example through poor nutrition. The National Health Insurance Program (NHIP) in Taiwan attempts to reduce inequities to access of care by waiving fees for health services to low income individuals. An evaluation of glaucoma disease prevalence in this cohort may answer this question. In this study using data from the NHIP the authors found that increased age and increased frequency of health care utilization were associated with glaucoma. In addition, male gender and urbanization were associated with POAG. After adjusting for these factors lower socioeconomic status was associated with primary angle-closure glaucoma (PACG) and higher socioeconomic status was associated with POAG. To explain this finding the authors attempt to link refractive error to socioeconomic status suggesting that low socioeconomic status is associated with lower education which in turn is associated with less myopic shift (a risk for PACG) and higher socioeconomic status is associated with higher education and myopia (a risk for POAG). Although this explanation is possible more conclusive evidence is required to link socioeconomic status with refractive error. This study does, however, support public awareness campaigns regarding the importance of regular comprehensive visual examinations to aid in the diagnosis of glaucoma.

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