{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:26:05Z","timestamp":1791480365272,"version":"4.3.4"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>While early detection of glaucoma is vital to prevent irreversible vision loss, there are sparse data on the effectiveness of glaucoma referrals and methods to establish evidence-based referral guidelines in large, diverse populations.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the prevalence and risk factors for diagnosed glaucoma and loss to follow-up among adult patients aged 18 to 40 years after a new diagnosis of referable glaucoma (ie, with glaucoma or suspected glaucoma).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study included patients aged 18 to 40 years presenting to Kaiser Permanente Southern California, a large managed health care system, for first-time eye examinations between January 1, 2013, and December 31, 2018. Data analysis occurred between September 2022 and August 2024.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was glaucoma diagnosed within 2 years of the first eye examination. The secondary outcome was the loss to follow-up, defined as failure to receive a glaucoma evaluation with visual field or optical coherence tomography testing within 2 years.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort included 292\u202f453 patients aged 18 to 40 years who underwent first-time eye evaluations (mean [SD] age, 29.8 [6.4] years). Among 12\u202f050 identified patients with referable glaucoma (52.3% female), 6827 (56.7%) completed glaucoma evaluations, of whom 563 (8.2%) were diagnosed with glaucoma (344 [61.1%] with open angle, 28 [5.0%] with angle closure, 84 [14.9%] with secondary glaucoma, and 107 [19.0%] with unspecified glaucoma). On multivariable analysis, male sex (odds ratio [OR], 1.55 [95% CI, 1.07-2.27]), higher intraocular pressure (IOP) (OR, 1.19 [95% CI, 1.15-1.23] per 1 mm Hg), and greater cup-disc ratio (CDR) (OR, 1.53 [95% CI, 1.34-1.75] per 0.1 unit) were associated with greater odds of glaucoma. Dichotomized age, IOP, and CDR models stratified 51 of 1613 patients (3.2%) into the low-risk group and 202 of 1477 patients (13.7%) into the high-risk group. Being younger than 32 years and having an IOP less than 18 mm Hg and a CDR less than 0.7 yielded a negative predictive value of 98.2% for a glaucoma diagnosis.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, the diagnostic yield of glaucoma referrals was low among adults aged 18 to 40 years with first-time eye examinations. A simple risk-stratification strategy could help identify individuals with low and high risks of developing glaucoma, and adoption of evidence-based risk stratification and referral guidelines by health care systems and clinicians could improve equity of glaucoma care and use of eye-care resources.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.57843","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T16:32:15Z","timestamp":1738859535000},"page":"e2457843","source":"Crossref","is-referenced-by-count":9,"title":["Outcomes of Glaucoma Referrals in Adults Aged 18 to 40 Years"],"prefix":"10.1001","volume":"8","author":[{"given":"Tanner","family":"Frediani","sequence":"first","affiliation":[{"name":"Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy","family":"Yoo","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of 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