Patterns and Disparities in Recorded Evaluations in the United States

center dot PURPOSE: To assess patterns in gonioscopy during initial glaucoma evaluations in the United States. center dot DESIGN: Retrospective, case-control study. center dot METHODS: Patients undergoing initial glaucoma evaluation between 2009-2020 were identified in the Optum Clinformatics DataMart. Initial evaluation was defined as follows: (1) glaucoma suspect, anatomical narrow angle (ANA), or primary/secondary glaucoma diagnosed by an ophthalmologist; (2) continuously observable during a 36-month lookback period; (3) no history of glaucoma medications, laser, or surgical procedures; and (4) optical coherence tomography (OCT) or visual field performed within 6 months of initial diagnosis. Logistic regression models were developed to identify factors associated with no record of gonioscopy based on Current Procedural center dot RESULTS: Among 198,995 patients, 20.4% and 29.5% had recorded gonioscopy on the day of diagnosis or within 6 months, respectively. On multivariable analysis, odds of recorded gonioscopy within 6 months of initial evaluation was lower ( P < .001) among non-Hispanic Whites (OR = 0.84) but similar for Blacks (OR = 1.02) and Hispanics (OR = 0.96) compared with Asians. Age >= 60 years (OR < 0.82) , pseudophakia/aphakia (OR = 0.58), or residence outside of the Northeast region (OR = 0.660.84) conferred lower odds of recorded gonioscopy ( P < .001). Angle closure glaucoma (OR = 0.85), secondary glaucoma (OR = 0.31), or open angle glaucoma/suspect (OR = 0.12/0.24, respectively) patients were less likely to have recorded gonioscopy compared to ANA patients ( P < .01). center dot CONCLUSIONS: More than 70% patients undergoing initial glaucoma evaluation in the United States do not have a record of gonioscopy, especially elderly, non-Hispanic White, and pseudophakic patients in nonNortheast regions. This pattern does not conform to current practice guidelines and could contribute to misdiagnosed disease and suboptimal outcomes. (Am J Ophthalmol 2024;264: 90-98. (c) 2024 Elsevier Inc. All rights reserved.)