To evaluate racial disparities in vision outcomes and eye care utilization among glaucoma patients. Retrospective cohort study. In this population-based IRIS Registry (Intelligent Research in Sight) study, we included patients with minimum one diagnosis code for glaucoma at least 6 months prior to January 1, 2015 and at least one eye exam, visual field (VF), optical coherence tomography (OCT), or eye-related inpatient or emergency department (ED) code in 2015. Multivariable logistic and negative binomial regression models were used to assess vision and utilization outcomes, respectively, across race and ethnicity from January 1, 2015 to January 1, 2020. Vision outcomes included cup-to-disc ratio (CDR) progression > 0.80, poor vision (visual acuity 20/200 or worse), low vision codes, and need for glaucoma filtering surgery. Utilization outcomes included outpatient eye exams, OCTs, VFs, inpatient/ED encounters, and lasers/surgeries. Among 996,297 patients, 73% were non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic, 3% Asian/Pacific Islander, and 0.3% Native American/Alaska Native. Compared to White eyes, Black and Hispanic eyes had higher adjusted odds of CDR progression (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.08-1.17; OR = 1.28, 95% CI = 1.22-1.34), poor vision (OR = 1.26, 95% CI = 1.22-1.29; OR = 1.26, 95% CI = 1.22-1.31), glaucoma filtering surgery (rate ratio (RR) = 1.47, 95% CI = 1.42-1.51; RR = 1.13, 95% CI = 1.09-1.18). Hispanic eyes also had increased odds of low vision diagnoses (Hispanic OR = 1.18, 95% CI = 1.07-1.30). Black and Hispanic patients were less likely to have eye exams (RR = 0.94, 95% CI = 0.94-0.95; RR = 0.99, 95% CI = 0.99-0.99) and OCTs (RR = 0.86, 95% CI = 0.85-0.86; RR = 0.97, 95% CI = 0.96-0.98), yet Black patients had higher odds of inpatient/ED encounters (RR = 1.64, 95% CI = 1.37-1.96) compared to White patients. Native American patients were more likely to have poor vision (OR = 1.17, 95% CI = 1.01-1.36) and less likely to have outpatient visits (RR = 0.89, 95% CI = 0.86-0.91), OCTs (RR = 0.85, 95% CI = 0.82-0.89), visual fields (RR = 0.91, 95% CI = 0.88-0.94) or lasers/surgeries (RR = 0.87, 95% CI = 0.79-0.96) compared to White patients. We found that significant disparities in US eye care exist with Black, Hispanic, and Native American patients having worse vision outcomes and less disease monitoring. Glaucoma may be undertreated in these racial and ethnic minority groups, increasing risk for glaucoma-related vision loss.

中文翻译：

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青光眼视力结果和眼保健利用率的种族差异：IRIS 登记分析

评估青光眼患者视力结果和眼部护理利用率的种族差异。回顾性队列研究。在这项基于人群的 IRIS 登记（视力智能研究）研究中，我们纳入了 2015 年 1 月 1 日之前至少 6 个月内至少具有一项青光眼诊断代码且至少进行过一次眼科检查、视野 (VF)、光学相干性的患者2015 年断层扫描 (OCT) 或眼部相关住院或急诊科 (ED) 代码。使用多变量逻辑回归模型和负二项回归模型分别评估 2015 年 1 月 1 日至 1 月 1 日期间跨种族和民族的视力和利用结果，2020 年。视力结果包括杯盘比 (CDR) 进展 > 0.80、视力差（视力 20/200 或更差）、低视力代码以及需要进行青光眼滤过手术。使用结果包括门诊眼科检查、OCT、VF、住院/急诊就诊以及激光/手术。在 996,297 名患者中，73% 为非西班牙裔白人，15% 为非西班牙裔黑人，9% 为西班牙裔，3% 为亚洲/太平洋岛民，0.3% 为美洲原住民/阿拉斯加原住民。与白人眼睛相比，黑人和西班牙裔眼睛的 CDR 进展调整后几率更高（比值比 [OR] = 1.12，95% 置信区间 [CI] = 1.08-1.17；OR = 1.28，95% CI = 1.22-1.34），视力不佳（OR = 1.26，95% CI = 1.22-1.29；OR = 1.26，95% CI = 1.22-1.31），青光眼滤过手术（率比 (RR) = 1.47，95% CI = 1.42-1.51；RR = 1.13，95% CI = 1.09-1.18）。西班牙裔眼睛被诊断为低视力的几率也增加（西班牙裔 OR = 1.18，95% CI = 1.07-1.30）。黑人和西班牙裔患者不太可能进行眼部检查（RR = 0.94，95% CI = 0.94-0.95；RR = 0.99，95% CI = 0.99-0.99）和 OCT（RR = 0.86，95% CI = 0.85-0.86） ；RR = 0.97，95% CI = 0.96-0.98），但与白人患者相比，黑人患者住院/急诊室就诊的几率更高（RR = 1.64，95% CI = 1.37-1.96）。美洲原住民患者视力较差的可能性更大（OR = 1.17，95% CI = 1.01-1.36），门诊就诊（RR = 0.89，95% CI = 0.86-0.91）、OCT（RR = 0.85，与白人患者相比，95% CI = 0.82-0.89）、视野（RR = 0.91，95% CI = 0.88-0.94）或激光/手术（RR = 0.87，95% CI = 0.79-0.96）。我们发现，美国眼科护理存在显着差异，黑人、西班牙裔和美洲原住民患者的视力结果较差，疾病监测较少。在这些种族和族裔群体中，青光眼可能得不到充分治疗，从而增加了青光眼相关视力丧失的风险。