The influence of socioeconomic and clinical factors upon the presenting visual field status of patients with glaucoma

Abstract

Purpose To investigate the relationship between socioeconomic status and the extent of visual field loss in POAG and treated OHT patients at their first presentation to Manchester Royal Eye Hospital. Methods A cohort of 113 glaucoma patients seen between 1995 and 2005 was reviewed. The clinical parameters intraocular pressure, C : D ratio, family history of glaucoma, visual acuity, extent of visual field loss, and demographic parameters: age, gender, ethnicity, and residential postcode were extracted from hospital records. The socioeconomic status of each patient was estimated from the patient's residential postcode with the ACORN index (group 1: affluent and group 2: socioeconomically deprived). Results In comparison to group 1 (n ¼ 49), patients in group 2 (n ¼ 64) presented with more advanced field loss, lower educational attainment (18 vs 98% with no or unknown qualification), and were less aware of glaucoma in the family (27 vs 17%). Patients with a number of systemic health problems had worse vision, more severe visual field loss, and worse clinical attendance (Po0.05). Conclusions The extent of visual field loss in glaucoma patients at first presentation is related to a combination of clinical and socioeconomic factors including the patient's postcode. This finding could be used to target future case-finding resources.

Treating patients presenting with advanced glaucoma--should we reconsider current practice?

“…In the most recent study, more than a third of patients presenting had severe disease in at least one eye at presentation 10. Those most at risk include the socially disadvantaged with no family history of glaucoma, those with high intraocular pressure (IOP) and those who do not attend an optometrist regularly 10 16 17…”

Severity of Glaucoma at First Presentation to Hospital Eye Services

“…As glaucoma is more common with ageing and older patients will have had more time to accumulate damage, it is to be expected that older patients will have a greater likelihood of having advanced disease at presentation. Other reasons for older people presenting with more advanced disease might also include poor awareness of glaucoma or lack of regular eye examination, however it seems probable that older people are likely to be more aware of chronic diseases affecting their peers and more likely to seek regular eye exams [10,17,21,24].…”

“…Furthermore, we believe that not all risk factors for late presentation were identified in this study. Although, we investigated the association between IOP, CCT, family history, gender, and age, other studies have identified other factors for late presentation such as lower socioeconomic status, African-Caribbean ethnicity, method of referral to hospital other than optometrist, and longer period of time since last visit to optometrist [10,[16][17][18]21]. It would be particularly important to investigate a potential link between socio-economic status and late presentation, as this is a potentially confounding factor in the interpretation of our results and the finding of a relationship between lower socio-economic status and late presentation would support the need to introduce interventions to break down any barriers associated with access to eye care services in areas of higher deprivation [29].…”

“…As glaucoma is usually asymptomatic until there has been substantial loss of visual field, patients who do not have regular eye health checks may not attend their optometrist until they develop symptoms [21]. The other possibility is that patients may be having regular eye examinations but receive a poor level of care, enduring diagnostic and treatment delay [22,23].…”

Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

“…A review investigating inequalities accessing eye services in the UK found an association poor SES and poor attendance of eye health services [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] ; late stage of eye disease at presentation to eye services [57][58][59][60][61][62][63][64] ; uncorrected refractive error 65,66 ; increased waiting times for treatment 67,68 ; and poor treatment compliance.- 64,69 Articles meeting the inclusion criteria have been extracted and evaluated in Tables 2 and 5. There was an equal split between articles reporting no association and those reporting a significant association between poor SES and access to eye services.…”