Women are 24% less likely to be treated for glaucoma than men, and younger individuals are far less likely to be treated than older ones, according to a study in the September issue of Ophthalmology. Factors associated with a greater likelihood of glaucoma treatment include male gender, glaucoma diagnosis, older age, region and longer follow-up.
The study included 35,754 patients who were diagnosed as glaucoma suspects, 5,265 patients with diagnosed glaucoma and 2,633 patients who had cupping of the optic disc.
Researchers examined the predictors of glaucoma treatment through linked pharmacy and patient care information. Predictors included in logistic regression models were diagnostic group (glaucoma suspect or diagnosed glaucoma), age, gender, region of the United States, provider at initial visit (optometrist or ophthalmologist), diagnosis period (1995 to 1998 or 1999 to 2001) and health plan enrollment duration after the initial diagnosis.
After adjusting for glaucoma status, age, region, initial provider, and diagnosis date, the researchers found that women were 24% less likely than men to undergo glaucoma treatment with topical hypotensives, argon laser trabeculoplasty or surgery. Younger patients were also less likely to be treated than older patients. Treatment varied by region of the country.
Treatment rates among races and gender have differed for many diseases other than glaucoma, says optometrist Ian Ben Gaddie of Louisville, Ky. For example, women who have coronary artery disease generally receive less aggressive treatments than men, including fewer referrals for bypass grafting surgery. There is no clear answer for why women are treated less aggressively, but it has been speculated that, among other factors, women tend to have less severe vascular disease, Dr. Gaddie says.
Can the same be said about glaucoma? Although patients may be considered suspects or have been diagnosed with glaucoma, treatment is often withheld until confirmed visual field changes occur, Dr. Gaddie says. In this study, the severity of glaucoma was unknown for each patient. Patients can maintain borderline findings for many years before confirmed conversion to glaucoma occurs and treatment is warranted, Dr. Gaddie says.
Friedman DS, Nordstrom B, Mozaffari E, Quigley HA. Variations in treatment among adult-onset open-angle glaucoma patients. Ophthalmology 2005 Sept;112(9):1494-99.