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Editors Selection IGR 24-1

Glaucoma as Cause of Blindness: Risk Factors for Blindness in POAG

Comment by Fei Li & Xiulan Zhang on:

112879 Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis, Shah SN; Zhou S; Sanvicente C et al., American Journal of Ophthalmology, 2023; 259: 131-140

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This study by Shah et al. provides important insights into the prevalence and risk factors for blindness among patients newly diagnosed with primary angle-closure glaucoma (PACG) in the United States. Using data from the IRIS Registry, the authors found an alarmingly high prevalence of any blindness (11.5%) and bilateral blindness (1.8%) at the time of PACG diagnosis.

The study's comprehensive approach, including multivariable logistic regression to adjust for ocular comorbidities, provides a nuanced understanding of the risk factors associated with blindness in PACG patients. Notably, the study identified significant racial and ethnic disparities, with Black and Hispanic patients at 1.4 and 1.2 times higher risk of any blindness compared to non-Hispanic White patients after adjusting for ocular comorbidities, which highlights the need for targeted interventions and policy changes to address these disparities. Medicaid and Medicare recipients were also at higher risk. These findings highlight the need for improved disease awareness and detection methods, especially in these vulnerable populations.

The protective effect of a prior diagnosis of anatomic narrow angles is an important finding, suggesting that earlier detection and intervention may help prevent blindness from PACG

The protective effect of a prior diagnosis of anatomic narrow angles is an important finding, suggesting that earlier detection and intervention may help prevent blindness from PACG. This underscores the critical importance of gonioscopy and the need for more convenient angle assessment methods.

The study's large sample size and 'real-world' data from the IRIS Registry are key strengths. While the study effectively identifies risk factors, it could benefit from a more detailed exploration of the underlying causes of these disparities. For instance, the role of access to healthcare, socioeconomic status, and potential biases in clinical practice could be further examined. Additionally, the absence of visual field data is a limitation that should be addressed in future research to provide a more comprehensive assessment of visual impairment.

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