Racial and Ethnic Differences in the Prevalence and Treatment Patterns for Neovascular Glaucoma in the American Academy of Ophthalmology IRIS® Registry

IF 2.8 Q1 OPHTHALMOLOGY Ophthalmology. Glaucoma Pub Date : 2024-11-01 DOI:10.1016/j.ogla.2024.07.006
Victoria L. Tseng MD, PhD , Deyu Pan MS , Ken Kitayama MD, PhD , Fei Yu PhD , Anne L. Coleman MD, PhD
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Abstract

Purpose

To examine racial and ethnic differences in the prevalence and treatment patterns for neovascular glaucoma (NVG) in at-risk individuals in the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight).

Design

Observational retrospective cohort study.

Participants

Eyes in the IRIS Registry with a retinal ischemia based on a history of proliferative diabetic retinopathy, retinal vein occlusion, and/or ocular ischemic syndrome.

Methods

Race and ethnicity was defined as Asian, Black, Hispanic/Latino, non-Hispanic White, and other/unknown. In eyes with retinal ischemia, the outcome was NVG. In eyes with NVG, outcomes included treatment of retinal ischemia with pan-retinal photocoagulation (PRP), and surgery to lower intraocular pressure (IOP) with trabeculectomy, tube shunt, and cyclophotocoagulation (CPC). Covariates included age, sex, region of residence, insurance type, smoking status, and systemic and ocular comorbidities. Cox proportional hazards regression was used to examine adjusted associations between race and ethnicity and NVG and each type of NVG treatment.

Main Outcome Measures

Incidence of NVG, PRP, trabeculectomy, tube shunt, CPC, and any IOP-lowering surgery.

Results

Of 312 106 eyes with retinal ischemia, there were 5885 (1.9%) with NVG. Compared to eyes of individuals who identified as non-Hispanic White, eyes of individuals who were Black and Hispanic/Latino had higher hazards of NVG in adjusted analyses (hazards ratio [HR] = 1.28, 95% confidence interval [CI] = 1.15–1.43 [for Black]; HR = 1.32, 95% CI = 1.17–1.47 [for Hispanic/Latino]). Compared with eyes of individuals who were non-Hispanic White, there was higher hazards of trabeculectomy in eyes of individuals who were Hispanic/Latino (adjusted HR = 1.91, 95% CI = 1.08–3.39) and higher hazards of tube shunt (adjusted HR = 1.35, 95% CI = 1.07–1.69) and of any IOP-lowering surgery (adjusted HR = 1.29, 95% CI = 1.09–1.53) in eyes of individuals who were Black. There were no statistically significant differences in the hazards of PRP or CPC.

Conclusions

Eyes of Black and Hispanic/Latino individuals with retinal ischemia in the IRIS Registry had higher likelihood of NVG and of IOP-lowering surgery for NVG. Further study is needed to examine the medical and social factors that preclude optimal management of diabetic eye disease, in order to prevent its blinding complications.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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美国眼科学会 IRIS® 注册表(Intelligent Research in Sight)中新生血管性青光眼患病率和治疗模式的种族和民族差异。
目的:研究美国眼科学会(Academy of Ophthalmology)IRIS® 注册中心(Intelligent Research in Sight)高危人群中新生血管性青光眼(NVG)发病率和治疗模式的种族和民族差异:方法:IRIS 注册表中因增殖性糖尿病视网膜病变 (PDR)、视网膜静脉闭塞 (RVO) 和/或眼部缺血综合征 (OIS) 而导致视网膜缺血的眼睛:种族和民族定义为亚洲人、黑人、西班牙裔/拉丁美洲人、非西班牙裔白人和其他/未知种族。视网膜缺血患者的结果为新生血管性青光眼(NVG)。在患有新生血管性青光眼的患者中,治疗结果包括通过全视网膜光凝(PRP)治疗视网膜缺血,以及通过小梁切除术、导管分流术和环形光凝(CPC)手术降低眼压(IOP)。协变量包括年龄、性别、居住地区、保险类型、吸烟状况以及全身和眼部合并症。采用 Cox 比例危险度回归法检测种族和民族与 NVG 和每种 NVG 治疗之间的调整关联:结果:在 312 106 例视网膜缺血患者中,有 5 885 例(1.9%)患有 NVG。与非西班牙裔白人的眼睛相比,黑人和西班牙裔/拉丁美洲人的眼睛在调整分析中出现 NVG 的风险更高(黑人的风险比 [HR]=1.28, 95% 置信区间 [CI]=1.15, 1.43;西班牙裔/拉丁美洲人的风险比=1.32, 95% CI=1.17,1.47)。与非西班牙裔白人的眼睛相比,西班牙裔/拉丁美洲人的眼睛接受小梁切除术的危险性更高(调整后HR=1.91,95% CI=1.08,3.39),黑人的眼睛接受导管分流术(调整后HR=1.35,95% CI=1.07,1.69)和任何降低眼压手术(调整后HR=1.29,95% CI=1.09,1.53)的危险性更高。PRP或CPC的危险性在统计学上没有显著差异:结论:在 IRIS 登记中,患有视网膜缺血的黑人和西班牙裔/拉丁美洲人的眼睛接受 NVG 和为 NVG 进行降眼压手术的可能性较高。需要进一步研究阻碍糖尿病眼病最佳治疗的医疗和社会因素,以防止其致盲并发症。
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来源期刊
Ophthalmology. Glaucoma
Ophthalmology. Glaucoma OPHTHALMOLOGY-
CiteScore
4.80
自引率
6.90%
发文量
140
审稿时长
46 days
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Reply Editorial Board Contents Posterior Capsular Pigment Deposition in a Case of Pigmentary Glaucoma Iridoschisis: The Shredded Iris
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