Sociodemographic and economic factors in outcomes of tube shunts for neovascular glaucoma

Abstract

Importance: Few studies have analyzed associations between sociodemographic factors and neovascular glaucoma (NVG) outcomes. Aim and background:To determine the potential impact of sociodemographic and economic factors on the NVG tube shunt surgery outcomes. Design: Retrospective, single-center, comparative case series. Participants: Consecutive patients who underwent tube shunt surgery for NVG and had ≥6 months of follow-up. Materials and methods: Regional average adjusted gross income (AGI) was determined by cross-referencing self-reported residential zip codes with average AGI per zip code supplied by the Internal Revenue Service. Two groups were created: (1) lower-income: individuals from neighborhoods with the lowest 10% of AGI (near the United States poverty line), (2) higher-income: the remaining 90% of individuals. Main outcome measures: Visual acuity (VA), intraocular pressure (IOP), and glaucoma medication number at 6 months and the most recent visit. Results: The mean annual AGI in the higher-income group (130 patients) was $69,596 ± 39,700 and the lower-income group (16 patients) was $27,487 ± 1,600 (p < 0.001). Age, sex, distance to the clinic, language, and all baseline clinical variables (including VA and IOP) were comparable between groups. Lower-income was associated with non-white race (81.3 vs 52.3%; p = 0.024). At month 6, VA in the lower-income group [median: HM (20/70–NLP)] was worse than the higher-income group [median: CF (20/25–NLP)] (log MAR VA: 2.32 ± 0.8 vs 1.77 ± 1.1; p = 0.02); these trends persisted through the most recent visit (p = 0.043). Follow-up IOP and medications were similar between groups. Conclusions and relevance: Lower-income may be associated with worse VA outcomes following NVG tube shunt surgery.