- Design
- Retrospective multi-institutional cohort
- Population
- 48,196 US glaucoma patients with ≥3 years' follow-up
- Primary outcome
- Frequency and regularity of visual field and RNFL OCT testing
- Effect
- Rural: regular OCT OR 0.82 (0.74 to 0.90); VF OR 0.95 (0.88 to 1.04)
A US multi-institutional cohort followed 48,196 glaucoma patients for at least three years, comparing rural and urban residents.
Visual field testing was the same in both groups, about 0.91 tests a year. But rural patients had slightly fewer retinal nerve fibre layer OCT scans (0.57 vs 0.63 a year) and lower odds of regular OCT monitoring (adjusted OR 0.82). Medicaid coverage was associated with much lower odds of regular monitoring for both visual fields (OR 0.35) and OCT (OR 0.62).
The absolute difference by rural residence is small. The larger gap was by insurance, a marker of income and access. In India, where OCT is concentrated in cities, the lesson about structural imaging gaps outside cities is likely to apply even more strongly.
- Check that every glaucoma patient has both structural and functional tests on a regular schedule
- Plan visits so OCT and visual fields happen on the same day for patients who travel far
- Flag patients whose last OCT was more than 18 months ago
- Consider outreach or shared-care arrangements for patients with limited access
Why it matters
Progression can be missed if structural imaging lapses, even when visual fields continue.
Don't overread it
An association in academic US centres; it does not show worse visual outcomes in rural patients.
The statistics, in plain English
An OR of 0.82 means about 18% lower odds of regular OCT for rural patients. The OR of 0.35 for Medicaid on visual fields is a much bigger gap.
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