Racial Disparities in Microinvasive Glaucoma Surgery for Management of Primary Open-Angle Glaucoma: A Propensity Matched Cohort Study: Racial Disparities in MIGS for the Management of POAG

Am J Ophthalmol. 2024 Oct 9:S0002-9394(24)00475-6. doi: 10.1016/j.ajo.2024.10.006. Online ahead of print.

Abstract

Purpose: To evaluate racial/ethnic differences in the use of microinvasive glaucoma surgery (MIGS) for the management of mild-moderate primary open-angle glaucoma (POAG) in the United States.

Design: Retrospective cohort study.

Participants: Patients with a diagnosis of mild or moderate POAG, as defined by current procedural terminology (CPT) codes, were included. The experimental group comprised African American (AA) patients and the control group consisted of patients without an AA designation in the TriNetX database.

Methods: Propensity scoring was used to match cohorts for age at diagnosis, Charlson Comorbidity Index, sex, nicotine dependence, glaucoma medications, family history of POAG, Body Mass Index, and weight. Outcome was incidence of MIGS over 1 year of follow up. Odds ratios were calculated between cohorts MAIN OUTCOME MEASURE: Incidence of MIGS over 1 year of follow-up post-POAG diagnosis.

Results: 63,418 POAG patients were included (50% AA, 50% non-AA). AA patients were found to undergo MIGS at a significantly lower rate (1,268 of 31,709) compared to non-AA patients (1,508 of 31,709) (OR 0.834, 95% CI: 0.773 - 0.900).

Conclusion: Although POAG is understood to be more prevalent among African Americans, these patients display lower utilization of MIGS, suggesting a possible nationwide racial disparity in the management of POAG.

Keywords: glaucoma management; microinvasive glaucoma surgery; primary open-angle glaucoma; racial disparities.