Identifying risk factors for blindness from primary open-angle glaucoma by race: a case–control study

Andrew M Williams,1 Wei Huang,2 Kelly W Muir,3,4 Sandra S Stinnett,3 Jordan S Stone,5 Jullia A Rosdahl3 1Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Charlotte Eye Ear Nose & Throat Associates, Charlotte, NC, USA; 3Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; 4Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA; 5School of Medicine, University of California San Diego, La Jolla, CA, USA Purpose: To examine the factors associated with blindness from primary open-angle glaucoma (POAG) among black and white patients at our institution.Patients and methods: For this retrospective, case–control study, patients legally blind from POAG (“cases”) were matched on age, race, and gender with non-blind POAG patients (“controls”). Thirty-seven black case–control pairs and 19 white case–control pairs were included in this study. Clinical variables were compared at initial presentation and over the course of follow-up.Results: Black case–control pairs and white case–control pairs had similar characteristics at presentation, including cup-to-disc ratio and number of glaucoma medications. However, over the course of follow-up, black cases underwent significantly more glaucoma surgeries than matched controls (2.4 versus 1.2, p=0.001), whereas white cases and controls had no significant difference in glaucoma operations (0.9 versus 0.6, p=0.139). Our analysis found that glaucoma surgery is associated with blindness in black patients (odds ratio [OR] 1.6, 95% CI 1.1–2.2) but not in white patients (OR 1.5, 95% CI 0.7–3.2).Conclusion: Black and white case–control pairs with POAG shared similar risk factors for blindness at presentation. However, over the follow-up period, black cases required significantly more glaucoma surgeries compared to black controls, whereas there was no significant difference in surgery between white cases and controls. There was no difference in medication changes in either case–control set. Keywords: health disparities, glaucoma surgery, glaucoma treatment, glaucoma medications