Study Finds Deficient Glaucoma Care in Prison Population

Substantial medication and follow-up nonadherence exists among inmates with glaucoma, according to a study published in JAMA Ophthalmology. To conduct the retrospective cohort study, researchers analyzed data from 82 incarcerated patients treated at the University of Illinois at Chicago’s glaucoma clinic. Data was collected from patients between January 2013 and December 2017.

The study is the first of its kind to assess the glaucoma profile of a prison inmate population recieving treatment at an academic center. Although research has been conducted on barriers to care for inmates with psychiatric conditions and infectious diseases, researchers found there is insufficient data on ophthalmological conditions.

Of the 82 prison inmates (161 eyes) included in this study, the most common diagnoses were suspected primary open-angle glaucoma (POAG) (32.3%) and POAG (32.95). In total, the population visited the clinic 375 times throughout the study period. Advanced glaucoma was present in 53.2% of patients who were confirmed to have the disease.

“Most patients self-reported medication nonadherence, and follow-up visits often were delayed, with approximately one-quarter of visits during the recommended time frame and one-third delayed by more than 1 month,” researchers said.

Specifically, the study yielded the following results:

• 70% of patients (95% CI) reported medication nonadherence during at least 1 visit
• 26.6% of return office visits (95% CI) occurred within the recommended follow-up time frame
• 93 patients (34.8%) were seen more than 1 month after the recommended follow-up

Researchers highlighted potential causes for the lack of effective care. Follow-up information is not shared with the inmate at each visit due to security concerns. In addition, while some inmates are responsible for taking medicine, others have it distributed or administered by a third party.

To resolve these issues, researchers stress the importance of effective communication and suggest clinicians establish follow-up visits while the patient is still in the clinic.

“Ensuring clear communication with the prison staff regarding the recommended treatment management and follow-up for inmates,” will help reduce logistical barriers, researchers said. They continued, “The ophthalmologist should be prepared to seek direct communication with the correctional facility staff in cases in which timely treatment management is important.”

Reference

Kanu LN, Jang I, OG DJ, et al. Glaucoma care of prison inmates at an academic hospital [published online February 20, 2020]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2020.0001.