VIDEO: Addressing disparities in glaucoma care

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There are many, many disparities in glaucoma care. And this is a topic that fascinates me. I practice in New York City and I practice mostly in underserved communities in the Bronx and Queens. I treat a disproportionate amount of patients who are on the Medicaid and the state insurance. One of the things that frustrates me and I think does lead to healthcare disparities is that some of the Medicaid insurances or some of these sort of lower cost, low income insurance options simply don't cover a lot of the excellent procedures, even if those procedures really have excellent data and are covered by Medicare.

And it's very frustrating. I actually just don't understand why there isn't more uproar about it. But for example, I can't put trabecular meshwork bypass stents in Medicaid patients. They've been proven to work well in high-quality studies. Medicare covers them, Medicaid doesn't. And I don't understand why. So that's a constant frustration for me as a practitioner. And then on the other side of things, I think health literacy is always a struggle. For me, that just means, how well can the patient remember the name of their drop? Can they spell their drop? Do they understand the connection between taking their medicine and their disease? And that is something that's all tied up in a variety of socioeconomic factors.

It does tend to lead me towards, in some patients, if they have low health literacy, is it really fair to put them in charge of administering their own therapy? Or is it really okay or maybe even preferable, better, and more ethical for me to deliver a therapy that isn't dependent on them understanding and reading all the instructions. It isn't dependent on them understanding the importance of taking their drops perfectly. I feel like we have all this data on noncompliance. We know our patients struggle taking drops and then the patient doesn't take them. We say, well, that's their fault. And I really am of the mind that it's our fault.

It's our job to understand the patient, what their level of understanding, education, health literacy is, and to treat them in the best way that's gonna help preserve their vision, given everything we know about them or can know about them. So sometimes we participate in these healthcare disparities by asking too much of our patients. Sometimes their health insurance treats them unfairly, in my opinion. And we really just have to quit sort of business as usual, look at each patient individually and do the best we can for them.