Practice Patterns and Sociodemographic Disparities in the Clinical Care of Anatomical Narrow Angles in the United States

Abstract

PurposeTo assess treatment and visit patterns among patients with newly diagnosed anatomical narrow angle (ANA) and identify sociodemographic factors associated with disparities in care. DesignRetrospective practice pattern evaluation study. Methods263,422 patients diagnosed with ANA between 2007 to 2019 were identified in the Optum Clinformatics® Data Mart. Inclusion was limited to newly diagnosed ANA, defined as: 1) continuous enrollment during a 2-year lookback period and 1-year study period from first diagnosis, (2) diagnosis by an ophthalmologist or optometrist, (3) no history of pseudophakia, ANA treatments, or prior PACG diagnosis. Outcome measures were treatment with laser peripheral iridotomy (LPI), cataract surgery, or IOP-lowering medications and number of eyecare visits. Logistic and Poisson regression were performed to assess factors associated with treatment and eyecare visits, respectively. ResultsAmong 52,405 eligible cases, 27.7% received LPI, 13.9% received drops, and 15.1% received cataract surgery. Odds of LPI was higher in Asians and Hispanics (OR≥1.16, p<0.001). Non-whites had higher odds of drops (OR≥1.19, p<0.001), but Hispanics had lower odds of cataract surgery (OR=0.79, p<0.001). The mean number of eyecare visits was 2.6±2.1 visits including the day of diagnosis. Older age and treatment were associated with higher rates of eye care visits (RR>1.15, p<0.001). ConclusionMore than a quarter of patients with newly diagnosed ANA receive treatment with LPI. Racial minorities are more likely to receive ANA-specific treatments but less likely to receive cataract surgery. These differences may reflect racial differences in disease severity and the need for clearer practice guidelines in ANA care.