Glaucoma Treatment Outcomes in Open Angle Glaucoma Patients of African Descent

Long-term Safety and Performance of a Suprachoroidal Pressure Sensor System: Results of the EYEMATE-SC Trial Follow-up Study

PURPOSE

To evaluate the long-term safety and performance of the EYEMATE-SC sensor system, a suprachoroidal implantable diagnostic medical device designed for measuring intraocular pressure (IOP) in patients with glaucoma that offers direct digitized IOP readings in millimeters of mercury.

DESIGN

This study is part of the prospective, open-label, multicenter interventional EYEMATE-SC trial.

PARTICIPANTS

Twenty-two eyes of 22 patients with open-angle glaucoma who received the implant in conjunction with nonpenetrating glaucoma surgery (NPGS) were included in the study.

METHODS

This 3-year follow-up study analyzed the long-term safety of the EYEMATE-SC suprachoroidal sensor system (Implandata). The telemetric sensor system includes an implantable IOP sensor and a handheld reading device.

MAIN OUTCOME MEASURES

All patients underwent 5 follow-up visits over a 24-month follow-up period from month 12 to month 36 after implantation. Each visit consisted of a comprehensive examination including IOP measurement with the EYEMATE-SC system and Goldmann applanation tonometry (GAT). The agreement between GAT and the EYEMATE-SC was analyzed using Bland-Altman analysis. Adverse events (AEs) and device-related adverse events (ADEs) were recorded at all follow-up visits.

RESULTS

Of 24 eligible patients of the EYEMATE-SC trial, 22 patients (mean age 65.0 ± 10.6 years, 54.5% female) were enrolled. The overall mean follow-up was 2.7 ± 0.6 years (range, 1.0-3.4 years). Limits of agreement between GAT and EYEMATE-SC IOP were -6.2 to 5.7 mmHg (mean absolute difference of 2.3 mmHg), with greatest concordance at 12 months (concordance correlation coefficient [rccc] = 0.802, N = 22) and 18 months (rccc = 0.854, N = 19). A difference of < 5 mmHg was recorded in > 85% of the 86 paired measurements. No serious AEs and ADEs were recorded. Most common AEs were raised IOP in 5 patients, reduced visual acuity in 3 patients, and cataract in 3 patients.

CONCLUSIONS

This study demonstrates the long-term safety of the EYEMATE-SC system. No serious AEs related to the EYEMATE-SC were observed. The agreement between the EYEMATE-SC and GAT was within the standard range of IOP-measuring methods set by regulatory agencies. The EYEMATE-SC system is well tolerated and accurate for self- measurement of IOP throughout the day.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Racial and Gender Disparities for Glaucoma Treatment Rates in Upstate New York

Introduction: Glaucoma is one of the leading causes of irreversible blindness around the world. Black individuals are two times more likely to be diagnosed with glaucoma compared to White individuals. In 2019, the prevalence of glaucoma in Monroe County was highest amongst older individuals aged 85 and non-Hispanic Blacks. This study seeks to explore differences in glaucoma treatment rates that may be exacerbating disease severity and prognosis for individuals most acutely affected by glaucoma in Monroe County, NY. Methods: We used data from the Center for Disease Control's National Vision and Eye Health Surveillance System (VEHSS) to assess the rates of glaucoma treatment for different racial, gender, and age demographic groups in Monroe County, NY. The source data were from individuals enrolled in Medicare who filed a claim. We stratified the data based on the glaucoma treatment type: laser glaucoma surgery, glaucoma drainage devices, other glaucoma surgery, or glaucoma prescription drugs. The main outcome variable was the prevalence rate of various types of glaucoma treatment in Monroe County, NY. The data were analyzed by potential risk covariates such as race/ethnicity, age, and gender. A descriptive data analysis was performed to assess for demographic trends. Results: The most common form of glaucoma treatment in Monroe County, NY was prescription drug therapy (36.82%), which was predominant across all racial, gender, and age groups. This was followed by laser surgery (3.26%), glaucoma drain (1.47%), and other forms of glaucoma surgery (0.58%). Women displayed a higher incidence of laser surgery, glaucoma drainage, and other glaucoma surgeries (3.58%, 1.77%, and 0.69%, respectively) with a lower incidence of prescription drug usage (36.14%) compared to men. Black non-Hispanic patients had a higher incidence of laser surgery and prescription drug usage (3.39% and 47.20%, respectively), but a lower incidence of glaucoma drainage and other glaucoma surgeries (1% and 0%, respectively) compared to other racial groups. Conclusions: This study elucidates the differences in glaucoma treatment types across different racial, gender, and age groups in Monroe County, NY. The results underscore the disparities in treatment rates for Medicare patients diagnosed with glaucoma in Monroe County. The results justify the need for increased interventions to increase access to a variety of glaucoma treatment options to mitigate disparities in glaucoma outcomes.

Racial Disparities in Glaucoma Vision Outcomes and Eye Care Utilization: An IRIS Registry Analysis

PURPOSE

To evaluate racial disparities in vision outcomes and eye care utilization among glaucoma patients.

DESIGN

Retrospective cohort study.

METHODS

In this population-based IRIS Registry (Intelligent Research in Sight) study, we included patients with minimum one diagnosis code for glaucoma at least 6 months prior to January 1, 2015 and at least one eye exam, visual field (VF), optical coherence tomography (OCT), or eye-related inpatient or emergency department (ED) code in 2015. Multivariable logistic and negative binomial regression models were used to assess vision and utilization outcomes, respectively, across race and ethnicity from January 1, 2015 to January 1, 2020. Vision outcomes included cup-to-disc ratio (CDR) progression > 0.80, poor vision (visual acuity 20/200 or worse), low vision codes, and need for glaucoma filtering surgery. Utilization outcomes included outpatient eye exams, OCTs, VFs, inpatient/ED encounters, and lasers/surgeries.

RESULTS

Among 996,297 patients, 73% were non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic, 3% Asian/Pacific Islander, and 0.3% Native American/Alaska Native. Compared to White eyes, Black and Hispanic eyes had higher adjusted odds of CDR progression (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.08-1.17; OR = 1.28, 95% CI = 1.22-1.34), poor vision (OR = 1.26, 95% CI = 1.22-1.29; OR = 1.26, 95% CI = 1.22-1.31), glaucoma filtering surgery (rate ratio (RR) = 1.47, 95% CI = 1.42-1.51; RR = 1.13, 95% CI = 1.09-1.18). Hispanic eyes also had increased odds of low vision diagnoses (Hispanic OR = 1.18, 95% CI = 1.07-1.30). Black and Hispanic patients were less likely to have eye exams (RR = 0.94, 95% CI = 0.94-0.95; RR = 0.99, 95% CI = 0.99-0.99) and OCTs (RR = 0.86, 95% CI = 0.85-0.86; RR = 0.97, 95% CI = 0.96-0.98), yet Black patients had higher odds of inpatient/ED encounters (RR = 1.64, 95% CI = 1.37-1.96) compared to White patients. Native American patients were more likely to have poor vision (OR = 1.17, 95% CI = 1.01-1.36) and less likely to have outpatient visits (RR = 0.89, 95% CI = 0.86-0.91), OCTs (RR = 0.85, 95% CI = 0.82-0.89), visual fields (RR = 0.91, 95% CI = 0.88-0.94) or lasers/surgeries (RR = 0.87, 95% CI = 0.79-0.96) compared to White patients.

CONCLUSIONS

We found that significant disparities in US eye care exist with Black, Hispanic, and Native American patients having worse vision outcomes and less disease monitoring. Glaucoma may be undertreated in these racial and ethnic minority groups, increasing risk for glaucoma-related vision loss.

Racial, Ethnic, and Socioeconomic Disparities in Glaucoma Onset and Severity in a Diverse Nationwide Cohort in the United States

PRCIS

Racial/ethnic minorities are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. In addition, we highlight a gap in the use of diagnosis codes.

PURPOSE

The purpose of this study was to analyze patterns of diagnosis coding usage and validate epidemiologic patterns of glaucoma onset and severity among primary glaucoma patients within the National Institutes of Health All of Us database.

PATIENTS AND METHODS

We used International Classification of Disease diagnosis codes to build 4 cohorts of patients with mild, moderate, severe, and unspecified stage glaucoma (N=2982). Descriptive analyses were stratified by disease stage, and mean age at diagnosis was compared across racial and ethnic groups. Multivariable ordinal regression was used to examine risk factors for increasing glaucoma severity.

RESULTS

Of 2982 participants, 1714 (57%) had unspecified severity staging. Black/African Americans and other races were diagnosed with glaucoma at significantly younger ages compared with Whites (means 60 and 60 vs. 66 y; P <0.001). Hispanic/Latino participants also had an earlier mean age of diagnosis (61 vs. 65 y; P =0.001). Black/African Americans had higher odds of more severe glaucoma (odds ratio: 2.20, 95% CI, 1.62-3.30; P <0.001) than Whites when adjusting for socioeconomic characteristics.

CONCLUSIONS

Black, Hispanic/Latino, and other minority participants are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. These findings validate prior population-based studies. Furthermore, we observed a gap in the use of diagnosis codes, as only 43% of participants had a specified severity stage in this national cohort. This may have implications for large-scale observational research concerning glaucoma severity, as electronic health records and claims databases typically lack other measures of disease progression, such as imaging and visual field data.

Heterogeneity of Ocular Hemodynamic Biomarkers among Open Angle Glaucoma Patients of African and European Descent

This study investigated the heterogeneity of ocular hemodynamic biomarkers in early open angle glaucoma (OAG) patients and healthy controls of African (AD) and European descent (ED). Sixty OAG patients (38 ED, 22 AD) and 65 healthy controls (47 ED, 18 AD) participated in a prospective, cross-sectional study assessing: intraocular pressure (IOP), blood pressure (BP), ocular perfusion pressure (OPP), visual field (VF) and vascular densities (VD) via optical coherence tomography angiography (OCTA). Comparisons between outcomes were adjusted for age, diabetes status and BP. VF, IOP, BP and OPP were not significantly different between OAG subgroups or controls. Multiple VD biomarkers were significantly lower in OAG patients of ED (p < 0.05) while central macular VD was lower in OAG patients of AD vs. OAG patients of ED (p = 0.024). Macular and parafoveal thickness were significantly lower in AD OAG patients compared to those of ED (p = 0.006-0.049). OAG patients of AD had a negative correlation between IOP and VF index (r = -0.86) while ED patients had a slightly positive relationship (r = 0.26); difference between groups (p < 0.001). Age-adjusted OCTA biomarkers exhibit significant variation in early OAG patients of AD and ED.