Impact of neighborhood-level deprivation on glaucoma prevalence and treatment: A review of the literature

Abstract

We summarize the existing literature describing the associations between neighborhood-level socioeconomic indices and various glaucoma-related health outcomes. Glaucoma remains one of the leading causes of blindness worldwide, and while risk factors have been identified, there remains an incomplete understanding of the relationship between glaucoma and social determinants of health, especially at the neighborhood-level. This is particularly clinically relevant for the treatment of glaucoma due to the importance of early detection, access to specialty care, and long-term medication adherence in slowing disease progression. A review of the literature was completed in MEDLINE (Ovid) and Scopus (Elsevier) from inception to December 4, 2023, of publications describing an association between a neighborhood-level index and a glaucoma-related outcome, yielding 15 studies. A manual networking search was performed on March 1, 2024, and an additional search update was completed on September 19, 2024, resulting in the inclusion of 7 additional studies. After a comprehensive search and full-text review, 22 papers were included in our final analysis. Across all studies encompassing over 60 million total records, the mean patient age was 66.5 years, with 47.4 % being male. The most utilized neighborhood indices were the Social Vulnerability Index (SVI) and Index of Multiple Deprivation (IMD), and nearly all studies were based in either the United States or Europe. The majority of studies found an association between socioeconomic deprivation and 1) higher prevalence of glaucoma, 2) greater visual field loss at initial presentation, or 3) reduced access or delays associated with glaucoma treatment. Of these relationships, the strongest evidence was found linking neighborhood-level deprivation to increased glaucoma prevalence. Our review provides useful insight about the role of neighborhood-level socioeconomic factors and glaucoma, particularly by identifying important relationships that may otherwise remain unnoticed with aggregate, country-level data. The disparities involving glaucoma prevalence, presentation and treatment, especially in underresourced communities, indicate a vital need for earlier, more accessible intervention and greater investment into preventive care. Future studies might look to analyze prospectively patient outcomes and isolate the biggest drivers of disparities in health outcomes at the neighborhood-level, with significant clinical implications.

Keywords: Access to care; Glaucoma; Neighborhood-level factors; Social determinants of health; Treatment adherence.