Racial and Sociodemographic Disparities in Blindness Associated with Primary Angle Closure Glaucoma in the United States: An IRIS® Registry Analysis

Purpose To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States (US). Design Retrospective cross-sectional study of patients from the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry. Participants Patients in the IRIS® Registry between the years 2015 to 2019 with a new diagnosis of PACG and visual acuity (VA) data on or within 90 days prior to the date of diagnosis. Methods Eligible patients were aged 18 years and older and: (1) were observable in the database at least 24 months prior to the index date of PACG diagnosis; (2) had no history of intraocular pressure (IOP) lowering drops, laser peripheral iridotomy (LPI), cataract surgery, or a diagnosis of pseudophakia unless preceded by a diagnosis of anatomical narrow angle (ANA); and (3) had no history of glaucoma surgery. Multivariable logistic regression models were developed to assess risk factors of blindness. Main Outcome Measures Any (one or both eyes) or bilateral (both eyes) blindness (VA ≤ 20/200) at first diagnosis of PACG. Results 43,901 patients with PACG in the IRIS® Registry met inclusion criteria. Overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (OR=1.42 and 1.21, respectively; p<0.001) and bilateral (OR=2.04 and 1.53, respectively; p<0.001) blindness compared to non-Hispanic White patients adjusted for ocular comorbidities, including cataracts. Other factors associated with any blindness included age <50 or >80 years, male sex, Medicaid or Medicare insurance category, and Southern or Western practice region (ORs>1.28; p≤0.01). Diagnosis of ANA prior to diagnosis of PACG was protective against any (OR=0.56; p<0.001) and bilateral (OR=0.61; p<0.001) blindness. Conclusions Blindness affects 1 out of 9 patients with newly diagnosed PACG in the IRIS® Registry; Black and Hispanic patients and Medicaid and Medicare recipients are significantly more vulnerable. These findings highlight the severe ocular morbidity associated with PACG and the need for increased disease awareness and improved detection methods. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by grants K23 EY029763 from the National Eye Institute, National Institute of Health, Bethesda, Maryland; an IRIS Registry Initiative Award from the American Glaucoma Society; and an unrestricted grant to the Department of Ophthalmology from Research to Prevent Blindness, New York, NY. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of the University of Southern California gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data is not available