Sociodemographic and Economic Factors in Outcomes of Tube Shunts for Neovascular Glaucoma

Shalaby, Wesam Shamseldin; Arbabi, Amirmohsen; Myers, Jonathan S.; Moster, Marlene R.; Razeghinejad, Reza; Katz, L. Jay; Shukla, Aakriti Garg

doi:10.5005/jp-journals-10078-1303

Cited by 8 publications

(10 citation statements)

References 33 publications

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“…Among the studies analyzed, income was the third most frequent health care inequity observed (26 of 75 studies [35%]). Six studies demonstrated that patients with lower income were more likely to have vision impairment, 48,50,51 have worse postsurgical outcomes, 61 and/or use eye care services less. 35,41 Seven studies reported that lower-income patients had lower adherence to both eye examinations and glaucoma medication use, 22,38,62,63 received fewer anti-vascular endothelial growth factor injections, 64 and were more likely to report having glaucoma 65 or diabetic retinopathy.…”

Section: Incomementioning

confidence: 99%

Inequities and Research Gaps in Ophthalmology

et al. 2023

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ImportanceDeficient ophthalmologic care is costly to patients, making the identification of groups not receiving adequate care of vital importance. The current landscape of equity in ophthalmic care has yet to be thoroughly investigated and is important to ensure inclusivity and patient-centered care.ObjectiveTo perform a scoping review of the literature pertaining to health care inequities in the field of ophthalmology.Evidence ReviewA comprehensive database search using MEDLINE (via PubMed) and Ovid Embase was done in July 2022. English-language articles published from 2016 to 2021 were included and encompassed all article types except commentaries or correspondence. The search modeled the National Institutes of Health list of designated US health inequity populations, which includes income, education level, occupational status, rural and underresourced area, sex and gender, lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity, and race and ethnicity. A total of 8170 abstracts and titles were screened by 2 independent investigators, and 189 studies were assessed in full text for eligibility. For inclusion, articles needed to be an ophthalmic study discussing health inequities. In a masked, duplicate fashion, 2 independent investigators screened 75 full-text studies for data extraction using a pilot-tested form. Data extraction included general publication characteristics and health inequity data based on the National Institutes of Health’s defined inequity groups.FindingsA total of 75 publications were included. Notable inequities were found among Black and Hispanic patients associated with negative ophthalmic outcomes and mixed associations regarding sex or gender. Overall, lower-income patients were more likely to have vision impairment, use eye care services less, and have lower adherence to eye examinations. No articles within our sample examined LGBTQ inequities among ophthalmology patients since the 2016 National Institutes of Health classification of sexual and gender minority populations. Substantial research gaps were observed within the ophthalmic literature pertaining to the LGBTQ community, race and ethnicity, and rural and underresourced areas.Conclusions and RelevanceThis scoping review found substantial findings associated with the LGBTQ community, race and ethnicity, and the role of telemedicine in rural and underresourced areas. Because of the importance of ophthalmic care in overall patient health, it is vital to understand the various inequities present and strive to improve the current gaps in the literature. Future studies should (1) examine barriers to clinical study and medical trainee recruitment as well as patient values and preference studies and (2) investigate the implementation of telemedicine in underresourced areas.

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Section: Incomementioning

confidence: 99%

Inequities and Research Gaps in Ophthalmology

et al. 2023

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“…Furthermore, we could not assess for medication compliance because this factor is not reliably documented in the electronic medical records. In addition, this study, similar to those previously published, 27,28,38–40 used Internal Revenue Service data to calculate income. Patients’ actual income may differ from the average of their residential zip code.…”

Section: Discussionmentioning

confidence: 83%

“…36,37 Similarly, adverse economic conditions have been associated with blindness in patients with neovascular glaucoma 18 and worse visual outcomes after tube shunt surgery for this condition. 38 Moreover, studies on age-related macular degeneration have demonstrated that lower-income and non-White race were risk factors for severe vision loss at presentation. 28 Similarly, these were risk factors for fovea-off presentation of rhegmatogenous retinal detachment, subsequent higher risk of reoperation, and worse visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Higher burdens of illness, disability, and mortality have been associated with lower socioeconomic status across medical specialties. [10][11][12][13][14][15] Ophthalmic literature exists on the association between demographic or socioeconomic factors and clinical presentation, 28,36,37 surgical outcomes, 27,38 and adherence to treatment. 39,40 Our study analyzed the relationship between several of these variables and outcomes after PK and found that those with lower income, younger age, and Black race were more vulnerable to graft failure.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have investigated the impact of sociodemographic and economic status on ophthalmic outcomes. 27,28,[36][37][38][39][40] Black individuals and those with lower income were more vulnerable to poor follow-up after intravitreal injection to treat proliferative diabetic retinopathy and retinal vein occlusion. 39,40 Socioeconomic deprivation and African Caribbean race have previously been associated with advanced glaucomatous disease on presentation, making these groups more likely to experience major vision loss from glaucoma.…”

Section: Discussionmentioning

confidence: 99%

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Demographic and Socioeconomic Determinants of Penetrating Keratoplasty Outcomes

Shalaby

Shukla

Shiuey

et al. 2022

Cornea

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Purpose:The aim of this study was to determine possible associations between demographic and socioeconomic factors and graft survival after penetrating keratoplasty (PK).Methods:This study was a retrospective chart review of patients undergoing PK at a tertiary-care corneal practice at Wills Eye Hospital between May 1, 2007, and September 1, 2018. The first PK of the first eye was included. The primary outcome measure was graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Demographic and socioeconomic factors included yearly average adjusted gross income (AGI) based on residential zip code, age, sex, and race. Two income groups were created: 1) individuals from neighborhoods with the lowest 10% of AGI (N = 82, AGI=$32,100 ± 4000) and 2) the remaining 90% of individuals (N = 740, AGI=$86,900 ± 52,200). Logistic regression analysis was performed to identify factors predictive of graft prognosis.Results:The 822 patients (822 eyes) included had a mean age of 57.1 ± 22.1 years at the time of PK. Over an average of 4.2 ± 3.1 years of follow-up, graft failure occurred in 35.3%. Age, sex, and follow-up duration were comparable between income groups (all P > 0.05). Black race was disproportionately represented in the lower-income group (50.0% vs. 11.5%, P < 0.001). Multivariable analysis identified predictors of graft failure including residing in a lower-income neighborhood [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.24-4.19, P = 0.008], younger age (HR = 0.99, 95% CI = 0.98–1.00, P = 0.046), and Black race (HR = 1.63, 95% CI = 1.03–2.56, P = 0.035).Conclusions:Individuals with a lower income, younger age, and Black race may be more vulnerable to graft failure after PK. Further studies are warranted to identify reasons for these associations.

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Risk of cataract and glaucoma among older persons with diabetes in India: a cross-sectional study based on LASI, Wave-1

Khan

Shaw

2023

Sci Rep

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According to the International Diabetes Federation-2019 estimates, India is home to 77 million diabetic individuals which is projected to grow up to 147.2 million by 2045. Diabetes being a progressive health disorder leads to multiple morbidities and complications including eye diseases and visual impairments. As the burden of diabetes mellitus is increasing, eye problems like cataracts and glaucoma are commonly cited problems among the older adults. In this context, this study aims to provide the public health evidences on diabetes associated burden and risk of developing cataracts and glaucoma among older adults aged 60 and above in India. The analytical sample of this cross-sectional study comprised of 31,464 individuals aged 60 and above. Bivariate cross-tabulation and chi-square test were performed to understand the differential in the prevalence of cataracts and glaucoma by diabetes mellitus including the socio-economic and demographic characteristics of the individuals. Binary logistic regression estimation was executed to estimate the adjusted odds ratio for each of the outcome variables within a multivariate framework. The cataract problem affects more than one-fifth of the older people, while glaucoma affects 2% of them. The prevalence of cataract and glaucoma is 29% among diabetic older adults compared to 22% among non-diabetic persons. In terms of gender, the cataract prevalence is comparatively higher among females (25%) than males (21%). It is important to note that while adjusting for socio-economic and demographic characteristics, the likelihood of cataract (AOR 1.495; p-value < 0.01) and glaucoma (AOR 1.554; p-value < 0.01) is significantly higher among older adults with diabetes than among their counterparts. Medical practitioners should conduct prognosis for diabetic eye problems among patients and raise awareness about the potential risks of developing vision loss, such as cataracts and glaucoma, which are more prevalent among individuals with diabetes.

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Sociodemographic and Economic Factors in Outcomes of Tube Shunts for Neovascular Glaucoma

Cited by 8 publications

References 33 publications

Inequities and Research Gaps in Ophthalmology

Inequities and Research Gaps in Ophthalmology

Demographic and Socioeconomic Determinants of Penetrating Keratoplasty Outcomes

Risk of cataract and glaucoma among older persons with diabetes in India: a cross-sectional study based on LASI, Wave-1

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