Hispanic patients with POAG had lower success rates after glaucoma surgery compared with patients of European descent

A study reported lower success rates associated with initial trabeculectomy with mitomycin C (MMC) in Hispanic patients compared with those who were of European descent. This information may be useful when considering patient candidacy for glaucoma surgery,¹ according to first author Sajad Besharati, MD, who is from the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles.

The researchers, who published their findings in JAMA Ophthalmology, explained that over the previous few decades, the prevalence rate of primary open-angle glaucoma (POAG) among patients of Hispanic descent has been shifting. Early on, from 2001 and 2005 through 2007, the prevalence rate was “modest” but was found to be high in older Hispanics, ie, 16% in patients over 70 years.^2-4

By 2011, they pointed out, “Hispanic individuals accounted for approximately 27% of all POAG cases in the US, a figure projected to reach 50% by 2050.⁵” This trend reflects the growth and aging of the Hispanic population and enhanced disease detection.^6-8 

Because the outcomes of filtering surgery in Hispanic patients have not been well reported, they wanted both to compare the surgical outcomes achieved with initial trabeculectomy with adjunctive MMC in a retrospective analysis that compared Hispanic patients with glaucoma with those of European descent and to determine any factors that are prognostic for failure.

The study under discussion, which was carried out at one tertiary academic center, included 111 eyes of 96 patients of Hispanic descent that were matched to 111 eyes from 108 patients of European descent. All patients underwent an initial trabeculectomy with MMC, the authors recounted.

They described three criteria by which they defined qualified success based on the final intraocular pressure (IOP): A, a final IOP of 18 mmHg or lower; B, 15 mmHg or lower; and C, 12 mmHg or lower, with respective corresponding IOP reductions of 20% or more, 25% or more, and 30% or more, or a decrease of 2 or more medications. Complete success was defined as meeting the criteria without the need for medication.

Results of the retrospective matched-cohort study

The patients of Hispanic descent included 59 women (61.5%) and 37 men (38.5%) who were a mean ± standard deviation age of 69.1 ± 9.9 years. The patients of European descent included 53 women (49.1%) and 55 men (50.9%) who were a mean ± standard deviation age of 69.2 ± 9.4 years.

“The qualified success rates at 5 years in the Hispanic descent and European descent patients were, respectively, 52% and 68% based on criteria A (difference, 16.7%; 95% confidence interval [CI], 4.0%-29.4%; P < 0.001); 45% and 61% according to criteria B (difference, 16.2%; 95% CI, 3.2%-29.1%; P = 0.01); and 31% and 51% based on criteria C (difference, 20.0%; 95% CI, 7.3%-32.6%; P = 0.002),” Dr. Besharati and colleagues reported.

The results of multivariable analyses indicated that Hispanic descent was associated with higher failure rates with all complete and qualified success criteria (hazard ratio range, 2.07-3.03; P < 0 .001). The results showed that early bleb leaks occurred more frequently in patients of Hispanic descent (14 eyes vs. 6 eyes; P = 0 .10).

“We found that being of Hispanic descent was a strong and consistent predictor of failure of initial trabeculectomy with MMC as compared with being of European descent. Our results demonstrated notable differences in qualified and complete success rates between patients of Hispanic descent and patients of European descent according to all three criteria during the 5-year period after surgery,” the authors commented.

They concluded, “This study highlights the association of Hispanic ethnicity with lower success rates of initial trabeculectomy with MMC. Our findings demonstrate that patients of Hispanic descent were at a higher risk of surgical failure compared with patients of European descent. Future research ideally should include larger, prospective cohorts to confirm these findings and attempts to minimize potential biases. Including diverse Hispanic subgroups and assessing socio-economic factors, such as health care access and follow-up adherence, is crucial for identifying modifiable barriers. Additionally, understanding genetic and biological factors influencing the response to filtering surgery in Hispanic patients might lead to more individualized treatment approaches ultimately improving surgical outcomes for this higher-risk group.”

References

1. Besharati S, Mohammadzadeh V, Ashrafkhorasani, et al. Outcomes of trabeculectomy with mitomycin C in patients of Hispanic vs European descent. JAMA Ophthalmol. 2025; doi: 10.1001/jamaophthalmol.2025.2815

2. Kapetanakis VV, Chan MP, Foster PJ, Cook DG, Owen CG, Rudnicka AR. Global variations and time trends in the prevalence of primary open angle glaucoma (POAG): a systematic review and meta-analysis. Br J Ophthalmol. 2016;100:86-93. doi:10.1136/bjophthalmol-2015-307223

3. Gupta P, Zhao D, Guallar E, Ko F, Boland MV, Friedman DS. Prevalence of glaucoma in the United States: the 2005-2008 National Health and Nutrition Examination Survey. Invest Ophthalmol Vis Sci. 2016;57:2905-2913. doi:10.1167/iovs.15-18469

4. Friedman DS, Wolfs RC, O’Colmain BJ, et al.. Eye Diseases Prevalence Research Group. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol. 2004;122:532-538. doi:10.1001/archopht.122.4.532

5. Vajaranant TS, Wu S, Torres M, Varma R. The changing face of primary open-angle glaucoma in the United States: demographic and geographic changes from 2011 to 2050. Am J Ophthalmol. 2012;154:303-314.e3. doi:10.1016/j.ajo.2012.02.024

6. Davuluru SS, Jess AT, Kim JSB, Yoo K, Nguyen V, Xu BY. Identifying, understanding, and addressing disparities in glaucoma care in the United States. Transl Vis Sci Technol. 2023;12:18. doi:10.1167/tvst.12.10.18

7. Zhang X, Cotch MF, Ryskulova A, et al. Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys. Am J Ophthalmol. 2012;154(suppl):S53-62.e1. doi:10.1016/j.ajo.2011.08.045

8. Acuff K, Radha Saseendrakumar B, Wu JH, Weinreb RN, Baxter SL. Racial, ethnic, and socioeconomic disparities in glaucoma onset and severity in a diverse nationwide cohort in the United States. J Glaucoma. 2023;32:792-799.doi:10.1097/IJG.0000000000002261