Deprivation and late presentation of glaucoma: case-control study

Area of Science:

• Ophthalmology
• Public Health
• Socioeconomic Determinants of Health

Background:

• Glaucoma is a leading cause of irreversible blindness worldwide.
• Late presentation of glaucoma is a significant risk factor for severe visual field loss and subsequent blindness.
• Understanding socioeconomic disparities in healthcare access and outcomes is crucial for public health interventions.

Purpose of the Study:

• To investigate the association between socioeconomic status and the likelihood of presenting with advanced glaucomatous visual field loss.
• To identify specific socioeconomic risk factors contributing to delayed glaucoma diagnosis.

Main Methods:

• A hospital-based case-control study was conducted with prospective patient identification.
• 220 newly diagnosed glaucoma patients were recruited from three hospital eye departments.
• Cases (n=110) presented with advanced glaucoma, while controls (n=110) had early-stage glaucoma.

Main Results:

• Late glaucoma presenters exhibited higher underprivileged area scores compared to early presenters (P=0.035).
• Factors associated with late presentation included lower occupational class, lack of car access, early departure from full-time education, and being a tenant.
• The impact of deprivation was partly explained by family history, time since last optometry visit, and lack of initial optometric diagnosis.

Conclusions:

• Both area-level and individual-level socioeconomic deprivation are significantly associated with late presentation of glaucoma.
• Deprived populations appear to be at increased risk of blindness due to glaucoma.
• Material deprivation may contribute to both delayed diagnosis and potentially more aggressive disease progression.