June 2022

OPHTHALMOLOGY

REDUCING HEALTH DISPARITIES IN GLAUCOMA TREATMENT

Routine eye examinations and follow-up care are crucial for detecting and treating vision-threatening diseases, particularly among people with glaucoma. However, people from populations that have historically had limited access to medical care often do not receive the eye care necessary due to multiple barriers. A Northwestern Medicine Ophthalmology research program led by Angelo P. Tanna, MD, is focused on better understanding sociodemographic disparities in glaucoma management and outcomes.
 
In a recent study of more than 5,800 adults with glaucoma published in Ophthalmology, Northwestern Medicine scientists found that non-Hispanic Black adults and patients with public health insurance were significantly less likely to receive outpatient glaucoma follow-up care. This is likely to lead to worse outcomes among patients who are already at a higher risk of glaucoma-related blindness.
 
Because effective management of glaucoma requires patients to understand their disease and engage in treatment, health literacy is a key consideration for glaucoma management. Scientists at Northwestern Medicine sought to characterize the barriers and implications of health literacy for patients with glaucoma. In a study published in the Journal of Glaucoma, they evaluated online glaucoma patient education materials and found the average online glaucoma materials are written at a 10th to 11th grade reading level. This does not align with the American Medical Association’s recommendation that patient education materials be written at or below a 7th grade reading level.
 
In addition, ineffective eye drop instillation, which is more common among patients with low health literacy, is associated with progression of glaucoma according to a recent study published in the Journal of Glaucoma. The Northwestern Medicine research team found that a significantly higher percentage of patients who instilled eye drops ineffectively at baseline subsequently met clinical criteria for disease progression or required incisional surgery.
 
In research presented at the 2022 Association for Research in Vision and Ophthalmology Annual Meeting, Northwestern Medicine scientists reported that adults with glaucoma and low health literacy:
  • Were prescribed more glaucoma medications
  • Incurred higher medication costs
  • Were more likely to be prescribed multiple classes of glaucoma medications

​Their findings suggest that there are opportunities to improve management of glaucoma among this population.
 
Together, these studies suggest low health literacy may contribute to lower patient engagement, worse clinical outcomes, and greater disparities in glaucoma management. We hope that this research conducted at Northwestern Medicine will inform efforts to reduce disparities in glaucoma care and outcomes. 
Angelo P. Tanna, MD, is vice chair and director of Glaucoma in the Department of Ophthalmology and professor of Ophthalmology at Northwestern Medicine.

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