This survey found many glaucoma patients are lost to follow-up due to reasons regarding insurance. Photo: Kelly Sikkema on Unsplash

With glaucoma cases rising each year and most cases frequently asymptomatic, the need for screenings—especially in high-risk areas with underserved populations—has become more and more important, but some people aren’t showing up to follow-up appointments. In a recent study, researchers sought to determine what socioeconomic factors are associated with failure to follow-up in a glaucoma screening program.

This retrospective cohort study took place among socially and economically disadvantaged populations, with 72 people responding to a survey. The average age was 52.8, 65% were female, the most common race was African American (69%) and the most common ethnicity was Haitian (51%).

The analysis showed that insurance was the predominant factor affecting follow-up in largely underserved populations. Failure to follow-up occurred in 42% of cases.

“The findings of this study are noteworthy because they demonstrate that despite robust and free glaucoma screening, socioeconomic barriers can limit their effectiveness,” the authors explained. “Our screening program identified 30% of participants as glaucoma suspects, which is similar to other screening programs that target high-risk populations. However, health insurance was a significant factor in determining whether these glaucoma suspects followed up in-clinic. Lack of health insurance was also the most commonly cited reason provided by respondents in the telephone interview for not following up.”

Although previous studies showed race, gender and age were associated with adherence to following up, these authors did not find those associations in this study, despite the different socioeconomic compositions of the subpopulations.

“These results reaffirm previous studies that showed an association between follow-up and insurance status, which suggests that poor access to eye care leads to missed early detection,” the study authors concluded. “Streamlining social services could increase clinical access of glaucoma suspects.”

Staropoli PC, Lee RK, Kroger ZA, et al. Analysis of socioeconomic factors affecting follow-up in a glaucoma screening program. Clin Ophthalmol. 2021;15:4855-63.