Social Determinants of Glaucoma Risk and Vision-Related Quality of Life in Rural Nigeria

Background: Glaucoma is a leading cause of irreversible blindness. Late presentation is common in sub-Saharan Africa; however, most data on social determinants of glaucoma risk originate from high-income countries. We explored how socioeconomic status (SES) and barriers to care affect intraocular pressure (IOP) and vision-related quality of life (VR-QOL) in Imo State, Nigeria. Objectives: To assess relationships between SES, barriers to care, visual functioning, and glaucoma risk in rural Nigeria. Methods: Thirty-six adults at risk for glaucoma were recruited during a free outreach in South-East Nigeria. SES, VR-QOL, and barriers-to-care questionnaires were administered. Participants received medical exams with IOP measurement. Findings: Transportation source was the most consistent SES predictor of outcomes. Participants with more sophisticated transportation sources had lower IOP (r = -0.71 [95% CI: -0.92 to -0.17], P = 0.019, n = 11) and faced fewer barriers to care (r = 0.37 [95% CI: 0.04 to 0.63], P = 0.026, n = 36). Patients with fewer barriers presented with lower IOP (r = -0.72 [95% CI: -0.92 to -0.18], P = 0.018, n = 11) but longer intervals since their last doctor's visit (r = 0.35 [95% CI: 0.01 to 0.62], P = 0.036). Longer intervals since the prior doctor's visit correlated with worse VR-QOL in reading medicine and food labels (r = -0.39 [95% CI: -0.65 to -0.07], P = 0.017, n = 36). Female participants reported greater cost-related, distance-related, and overall barriers to care (r = -0.44 [95% CI: -0.67 to -0.11], P = 0.008). Conclusions: Transportation limitations and female sex were associated with greater clinical and functional burden. While fewer barriers correlated with lower IOP, longer gaps in care and poorer VR-QOL suggest persistent deficits in glaucoma awareness. Improving transportation access and community health education may support earlier detection and reduce glaucoma burden in rural Nigeria.