Dr Byron Lam Discusses Impact on SES Factors on Glaucoma Screening Follow-up

Insurance is, by far, the most important factor of whether patients followed up with treatment after getting screened for glaucoma, said Byron L. Lam, MD, professor of ophthalmology, University of Miami Miller School of Medicine's Bascom Palmer Eye Institute.

Transcript

You have published research on the socioeconomic factors impacting glaucoma screening follow-up and insurance was the main culprit. Was it type of insurance or simply being insured vs uninsured?

I think what we found in this paper is that insurance is, by far, the most important factor in terms of follow-up treatment for patients or subjects who receive glaucoma screening. In our subjects who were identified as glaucoma suspect, those who followed up with subsequent treatments and assessments are really the ones who have insurance or a way to get into some sort of insurance. I think this speaks to the fact that glaucoma screening is great; on the other hand, you do have the socioeconomically underprivileged, who don't have insurance. Typically, these will be patients who either are poor, but they are also maybe in a minority group, as well. Some of them may be new immigrants.

We find that in these particular groups, when they don't have insurance, even if you identify them as glaucoma suspect, they really do not get the proper follow-up. I think that's the number one determinant. And I think we need to find a way of, how do we at least provide them with insurance? How do we go ahead and provide care? Because if they have glaucoma that's untreated and they have visual loss, well, they're not going to be able to work; that will be an additional burden to the society.

It's not as though “Oh, we're going to give them free health care,” but it's more like, we need to have some way that they can obtain health insurance through their employment or some way, so that they do not become a burden to society, as well as have better lives.

What were other factors associated with noncompliance with the program?

I think for noncompliance, there were many factors. One, of course, is that some of the subjects are not really acculturated. If you come to a country and you're not really understanding or have relatives and friends who can help you with the systems at work, with health systems, of how to make an appointment, and so forth, you're going to be in a difficult position, even if information is given to you. I think that is also associated with socioeconomic status. I think that's one important determinant.

Then I think the other point associated with that, it's just difficult understanding a condition when you don't have any symptoms. It’s also depending on your educational level, and then your background. I think it all comes down to socioeconomic level, and also that is linked to acculturation.

Reference

Staropoli PC, Lee RK, Kroger ZA, et al. Analysis of socioeconomic factors affecting follow-up in a glaucoma screening program. Clin Ophthalmol. 2021;15:4855-4863. doi:10.2147/OPTH.S346443