Patterns of Glaucoma Treatment Use in Asian American Patients With Primary Open-Angle Glaucoma

To characterize racial disparities in glaucoma management by evaluating treatment modality utilization patterns between Asian American and non-Asian American patients with primary open-angle glaucoma (POAG).

This retrospective cohort study utilized the TriNetX US Collaborative Network, a large-scale, multi-institutional electronic medical record database, with data from January 1, 2004, to June 16, 2025. Asian American and non-Asian American patients with POAG were identified via ICD-10 codes and stratified by disease severity (mild-to-moderate vs severe). Cohorts were balanced using 1:1 propensity score matching for demographic characteristics, systemic comorbidities, family history, and smoking status. The primary outcome was the relative utilization of topical medications, laser procedures, traditional surgery, and microinvasive glaucoma surgery.

After propensity score matching, the study evaluated 12,526 patients with mild-to-moderate POAG (6263 per group) and 3410 patients with severe POAG (1705 per group). In the mild-to-moderate cohort, Asian Americans had a higher likelihood of receiving topical medications (odds ratio [OR], 1.041; 95% confidence interval [CI], 1.016-1.068). Conversely, Asian Americans with severe POAG were less likely to receive topical medications (OR, 0.950; 95% CI, 0.906-0.996) or laser procedures (OR, 0.769; 95% CI, 0.630-0.939). No significant differences were observed in surgical or microinvasive glaucoma surgery utilization.

Significant differences exist in POAG treatment utilization for Asian Americans, particularly a relative underutilization of adjunctive medical and laser therapies in severe disease. These findings suggest that current practice patterns may diverge from traditional treatment algorithms for this rapidly growing demographic, highlighting a need for increased awareness of potential systemic or provider-level barriers to equitable care.