Access to Eye Care Providers and Glaucoma Severity in the National Institutes of Health All of Us Research Program

Précis: In the “All of Us (AoU) Research Program,” individuals with access to vision care were more likely to have mild, moderate, or severe glaucoma and undergo incisional surgery compared with those without vision care access. Purpose: To examine the associations between access to eye care, glaucoma severity, and incisional glaucoma surgery using data from the National Institute of Health AoU Research Program. Materials and Methods: Individuals with International Classification of Diseases Ninth or 10th Revision codes and who answered the survey question about eye care access in AoU were included in the study. The exposure variable was access to eye care services, with outcome variables (1) glaucoma severitys and (2) likelihood of incisional surgery. Unadjusted multinomial logistic regression compared access to eye care services and glaucoma severity. In addition, unadjusted logistic regression models compared access to eye care and the likelihood of incisional surgery. These were repeated using adjusted analyses, controlling for sex assigned at birth, race and ethnicity, and age. Results: Compared with individuals without access to eye care services, those with access were more likely to have all levels of glaucoma severity [mild adjusted odds ratio (aOR): 5.81, 95% CI: 3.15–10.73, moderate aOR: 4.44, 95% CI: 2.45–8.02, severe aOR: 6.95, 95% CI: 2.69–17.93, and unspecified aOR: 3.06, 95% CI: 2.72, 3.45]. Access to eye care was associated with increased odds of any incisional glaucoma surgery (aOR: 3.00, 95% CI: 1.24–9.90) and of trabeculectomy (aOR: 3.30, 95% CI: 1.02–20.28) but not of tube shunt procedures (aOR: 2.65, 95% CI: 0.80–16.38). Conclusions: This study demonstrated that access to eye care services was associated with a higher prevalence of all levels of glaucoma severity; those with access to eye care services were more likely to undergo incisional surgery than those without access. Future research should focus on methods to best encourage eye care to limit glaucoma progression.