A new study published in JAMA Ophthalmology found that patients with lower wealth or those living in rural areas are significantly less likely to receive standard glaucoma care or achieve target eye pressure reduction compared to wealthier patients.*

The study sheds light on an important and often overlooked issue: how financial and geographic barriers can affect eye health, even after diagnosis.

“It’s commonly known that race is a predictor of health outcomes,” said Dr. Dustin French, a co-author of the study and professor of Ophthalmology at Northwestern Medicine. “But what we’re finding now is that it’s actually more about wealth and income.”

About the Study

Researchers from Northwestern Medicine and other academic centers in the Sight Outcomes Research Collaborative (SOURCE) analyzed data from more than 1,400 patients newly diagnosed with glaucoma between 2010 and 2022.

• The average patient age was 70 years.
• 54% were women.
• Participants identified as 3% Asian American, 32% Black, 7% Latinx, and 57% white.

The researchers tracked patients for 12 to 18 months after diagnosis, looking at:

1. Whether eye pressure (IOP) was reduced by at least 15% — a key goal in glaucoma treatment.
2. Whether patients stayed in care or were “lost to follow-up.”
   

Key Findings

Wealth and Care Quality

Patients with lower wealth were 5 to 9 times less likely to reach the 15% eye pressure reduction goal compared to those with higher wealth.

Meanwhile, patients with higher wealth had a 61% lower chance of being lost to follow-up, meaning they were more likely to keep their appointments and continue treatment.

In other words, money and access matter; not because wealth changes the biology of glaucoma, but because it affects whether people can afford medications, travel to appointments, or take time off work for follow-up care.

“Wealth was actually the best predictor of how well you do in your medical care and whether you get follow-up appointments,” Dr. French explained.

Rural vs. Urban Access

The study also found that patients living in rural communities were more likely to drop out of care than those in urban areas.
This may be due to fewer eye specialists nearby, longer travel distances, and limited access to transportation or telehealth options.

Why This Matters

Glaucoma affects more than 4 million Americans and is the leading cause of irreversible blindness worldwide. Consistent care, especially regular eye pressure monitoring and follow-up, is critical to preserving vision.

The findings help explain why some groups, particularly Black and rural patients, experience higher rates of glaucoma-related vision loss. Socioeconomic challenges, not just genetics, play a major role.

The study authors emphasized that eye doctors and insurance providers should take patients’ financial situations into account when planning care and work to remove barriers that make ongoing treatment harder to maintain.

“Clinicians should understand the financial circumstances of patients when making management decisions,” the authors wrote, “and find ways to ensure that patients can access IOP-lowering interventions and follow-up care.”

Possible Solutions

Dr. French suggested that technology could help bridge some of these gaps, for example, using AI tools to identify patients who are most at risk of missing appointments and sending automated reminders to encourage follow-up.

But broader efforts are still needed, including:

• Expanding insurance coverage for medications and transportation
• Improving access to specialists in rural areas
• Offering flexible appointment options and telemedicine follow-ups
• Raising awareness about the importance of routine care

What This Means for You

If you’re living with glaucoma, this study is an important reminder of just how vital consistent care is. Missing follow-ups or skipping medication, even for a few months, can increase the risk of vision loss.

Here are a few steps that can help:

• Keep up with every scheduled appointment. If transportation or cost is a challenge, ask your clinic about support programs.
• Talk openly with your care team about any financial or access barriers; they may be able to connect you with assistance resources. Prevent Blindness offers a comprehensive list of financial support for glaucoma patients here: https://preventblindness.org/glaucoma-financial-assistance-information/
• Encourage loved ones to get screened if you have a family history of glaucoma.
• Share information in our community; hearing how others manage challenges can help everyone find practical solutions.

* Northwestern University News (October 6, 2025). “Patient Wealth is Associated with Quality of Glaucoma Care” northwestern.edu

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