Social Deprivation and the Risk of Screening Positive for Glaucoma in the MI-SIGHT Telemedicine-Based Glaucoma Detection Program

Purpose: To assess whether increased poverty is associated with increased risk of screening positive for glaucoma or suspected glaucoma in a large public screening and intervention program. Design: Cross-sectional study from 2020 to 2022.Participants: Adults >= 18 years old without acute ocular symptoms. Methods: Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI -SIGHT) program participants' sociodemographic characteristics and area deprivation index (ADI) values were summarized from the clinical sites, which included a free clinic and a Federally Qualified Health Center (FQHC). The ADI, a composite measure of neighborhood deprivation (range, 1-10; 10 is worst deprivation), was assigned on the basis of the participants' addresses. Group comparisons were performed via 2-sample t tests or Wilcoxon Mann -Whitney tests for continuous measures and chi-square tests or Fisher exact tests with Monte Carlo simulation for categorical measures; Holm adjustment was used for multiple comparisons.Main Outcome Measures: Risk factors for screening positive for glaucoma or suspected glaucoma.Results: Of the 1171 enrolled participants, 1165 (99.5%) completed the screening: 34% at the free clinic and 66% at the FQHC. Participants were on average aged 55.1 +/- 14.5 years, 62% were women, 54% self-reported as Black/African-American, 34% White, 10% Hispanic or Latino, and 70% earned < $30 000 annually. The mean ADI was 7.2 +/- 3.1. The FQHC had higher (worse) ADI than the free clinic (free clinic: 4.5 +/- 2.9, FQHC: 8.5 +/- 2.1, P < 0.0001). One-quarter (24%) of participants screened positive for glaucoma or suspected glaucoma. Screening positive for glaucoma or suspected glaucoma was associated with being older (P = 0.01), identifying as Black/ African-American (P = 0.0001), having an established eyecare clinician (P = 0.0005), and not driving a personal vehicle to the appointment (P = 0.001), which is a proxy for increased poverty. Participants who screened positive had worse ADI than those who screened negative (7.7 +/- 2.8 vs. 7.0 +/- 3.2, P = 0.002). A larger percentage of White participants screened positive at the FQHC compared with White participants at the free clinic (21.3% vs. 12.3%, P = 0.01). FQHC White participants had worse ADI than free clinic White participants (7.5 +/- 2.5 vs. 3.7 +/- 2.7, P < 0.0001).Conclusions: Personal poverty, assessed as not driving a personal vehicle to the appointment, and neigh-borhood-level poverty were both associated with increased rates of screening positive for glaucoma or suspected glaucoma.