{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:04:19Z","timestamp":1785409459865,"version":"3.56.0"},"posted":{"date-parts":[[2026,6,4]]},"group-title":"Ophthalmology","reference-count":28,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Center for Advancing Translational Science, National Institutes of Health","award":["KL2TR001854"],"award-info":[{"award-number":["KL2TR001854"]}]},{"name":"National Center for Advancing Translational Science, National Institutes of Health","award":["UL1TR001855"],"award-info":[{"award-number":["UL1TR001855"]}]},{"name":"National Eye Institute, National Institutes of Health","award":["EY035677"],"award-info":[{"award-number":["EY035677"]}]},{"name":"National Eye Institute, National Institutes of Health","award":["EY032985"],"award-info":[{"award-number":["EY032985"]}]},{"id":[{"id":"https:\/\/ror.org\/029hv3472","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009410","name":"Southern California Clinical and Translational Science Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009410","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006034","name":"University of Southern California","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006034","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100001818","name":"Research to Prevent Blindness","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001818","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>To evaluate the incidence and baseline predictors of intraocular pressure (IOP)-lowering treatment following detection of referable glaucoma by teleretinal screening.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective cohort study.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants were derived from a safety-net teleretinal diabetic retinopathy screening program (2013-2024). Participants included individuals who screened positive for referable glaucoma (cup-to-disc ratio [CDR] \u22650.6 or CDR asymmetry \u22650.2) and completed in-office diagnostic evaluation. The primary outcome was initiation of IOP-lowering treatment (medication, laser, or surgery) and the secondary outcome was intervention with surgery. Cumulative incidence functions were estimated, accounting for loss to follow-up. Fine-Gray models were used to identify baseline screening predictors to risk stratify each outcome. Glaucoma diagnosis was approximated using diagnostic codes and chart review.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>2,367 participants were included. The cumulative incidence of treatment was 19.6% (95% CI: 18.0-21.2) at Year 1 and 45.1% (42.1-48.1) at Year 8. Early treatment occurred primarily in glaucoma cases, whereas treatment accumulated longitudinally in glaucoma suspects, reaching 36.5% (31.6-41.5) by Year 8. Surgery was less common (8-year incidence: 5.3%). Baseline screening data predicted treatment and surgery, enabling risk stratification. At Year 8, cumulative incidence differed substantially between high- and low-risk groups (treatment: 59.9% vs. 31.2%; surgery: 9.7% vs. 1.0%). Older age (sub-distribution hazard ratio [SHR] 1.03 per year, p&lt;0.001), Black race (SHR 1.50, p&lt;0.001), and personal history of glaucoma (SHR 1.90, p&lt;0.001) were associated with treatment; Asian race was protective (0.71, p=0.03). Older age (SHR 1.06, p&lt;0.001), worse visual acuity (SHR 5.11 per logMAR unit, p&lt;0.001), and screening at a hospital-based site (SHR 2.46, p=0.003) were associated with surgical treatment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Nearly half of safety-net diabetic patients screening positive for referable glaucoma initiated IOP-lowering treatment over 8 years, while few received surgery. Baseline screening characteristics enabled risk stratification of treatment and surgery. These findings address an evidence gap about longitudinal consequences of screening and suggest that its impact extends beyond detection of prevalent glaucoma to include identification of high-risk glaucoma suspects who warrant ongoing surveillance.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Highlights<\/jats:title>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>Longitudinal treatment outcomes address consequences of glaucoma screening<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Nearly half of diabetic patients with referable glaucoma received treatment<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Few patients progressed to surgery<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Characteristics assessed at screening enabled risk stratification<\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.02.26354782","type":"posted-content","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:10:41Z","timestamp":1780618241000},"source":"Crossref","is-referenced-by-count":0,"title":["Incidence and Predictors of IOP-Lowering Treatment Following Detection of Referable Glaucoma in a Teleretinal Screening Program"],"prefix":"10.64898","author":[{"given":"Kyle","family":"Bolo","sequence":"first","affiliation":[{"name":"Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon J.","family":"Wong","sequence":"additional","affiliation":[{"name":"Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"},{"name":"Department of Ophthalmology, Los Angeles General Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiun L.","family":"Do","sequence":"additional","affiliation":[{"name":"Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"},{"name":"Department of Ophthalmology, Los Angeles General Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose-Luis","family":"Ambite","sequence":"additional","affiliation":[{"name":"Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Marina del Rey, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Li","sequence":"additional","affiliation":[{"name":"Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Marina del Rey, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Kesselman","sequence":"additional","affiliation":[{"name":"Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Marina del Rey, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren P.","family":"Daskivich","sequence":"additional","affiliation":[{"name":"Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"},{"name":"Department of Ophthalmology, Los Angeles General Medical Center, Los Angeles, California"},{"name":"Ophthalmology and Eye Health Programs, Los Angeles County Department of Health Services, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Y.","family":"Xu","sequence":"additional","affiliation":[{"name":"Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026060712300624000_2026.06.02.26354782v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2014.05.013"},{"key":"2026060712300624000_2026.06.02.26354782v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.04.009"},{"key":"2026060712300624000_2026.06.02.26354782v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2020.10.022"},{"key":"2026060712300624000_2026.06.02.26354782v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01289-8"},{"key":"2026060712300624000_2026.06.02.26354782v1.5","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.ophtha.2024.09.032","article-title":"National Experience of Technology-based Eye Care Services: A Comprehensive Ophthalmology Telemedicine Initiative","volume":"132","year":"2025","journal-title":"Ophthalmology"},{"key":"2026060712300624000_2026.06.02.26354782v1.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1991.03470030069026"},{"key":"2026060712300624000_2026.06.02.26354782v1.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.ijg.0000212282.88347.c9"},{"key":"2026060712300624000_2026.06.02.26354782v1.8","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.09-5126"},{"key":"2026060712300624000_2026.06.02.26354782v1.9","doi-asserted-by":"crossref","first-page":"201","DOI":"10.3109\/09286586.2013.789533","article-title":"Outcomes of a vision screening program for underserved populations in the United States","volume":"20","year":"2013","journal-title":"Ophthalmic Epidemiol"},{"key":"2026060712300624000_2026.06.02.26354782v1.10","doi-asserted-by":"crossref","first-page":"e115942","DOI":"10.1371\/journal.pone.0115942","article-title":"Glaucoma screening in the Haitian Afro-Caribbean population of South Florida","volume":"9","year":"2014","journal-title":"PloS One"},{"key":"2026060712300624000_2026.06.02.26354782v1.11","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3109\/09286586.2015.1099683","article-title":"Improving Access to Eye Care among Persons at High-Risk of Glaucoma in Philadelphia--Design and Methodology: The Philadelphia Glaucoma Detection and Treatment Project","volume":"23","year":"2016","journal-title":"Ophthalmic Epidemiol"},{"key":"2026060712300624000_2026.06.02.26354782v1.12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ajo.2017.05.017","article-title":"Optimizing Glaucoma Screening in High-Risk Population: Design and 1-Year Findings of the Screening to Prevent (SToP) Glaucoma Study","volume":"180","author":"SToP Glaucoma Study Group","year":"2017","journal-title":"Am J Ophthalmol"},{"key":"2026060712300624000_2026.06.02.26354782v1.13","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1001\/jama.2022.6290","article-title":"Screening for Glaucoma in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force","volume":"327","year":"2022","journal-title":"JAMA"},{"key":"2026060712300624000_2026.06.02.26354782v1.14","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1016\/j.ophtha.2016.04.031","article-title":"The Philadelphia Glaucoma Detection and Treatment Project: Detection Rates and Initial Management","volume":"123","year":"2016","journal-title":"Ophthalmology"},{"key":"2026060712300624000_2026.06.02.26354782v1.15","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/IJG.0000000000002035","article-title":"Outcomes and Revenue Generation of a Community-based Screening at a Center in the United States: The SToP Glaucoma Program","volume":"31","author":"SToP Glaucoma Study Group","year":"2022","journal-title":"J Glaucoma"},{"key":"2026060712300624000_2026.06.02.26354782v1.16","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1001\/jamainternmed.2017.0204","article-title":"Implementation and Evaluation of a Large-Scale Teleretinal Diabetic Retinopathy Screening Program in the Los Angeles County Department of Health Services","volume":"177","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2026060712300624000_2026.06.02.26354782v1.17","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.ogla.2022.10.007","article-title":"Effectiveness of Glaucoma Screening and Factors Associated with Follow-up Adherence among Glaucoma Suspects in a Safety-Net Teleretinal Screening Program","volume":"6","year":"2023","journal-title":"Ophthalmol Glaucoma"},{"key":"2026060712300624000_2026.06.02.26354782v1.18","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2018-313451"},{"key":"2026060712300624000_2026.06.02.26354782v1.19","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/IJG.0000000000002521","article-title":"Glaucoma Screening and Referral Risk Factors in a High-Risk Population: Follow-Up Study of the Manhattan Vision Screening Study","volume":"34","year":"2025","journal-title":"J Glaucoma"},{"key":"2026060712300624000_2026.06.02.26354782v1.20","doi-asserted-by":"crossref","unstructured":"Fujita A , Zebardast N , Friedman DS , IRIS\u00ae Registry Analytic Center Consortium. Comparison of glaucoma surgery incidence and outcomes in pigmentary and primary open-angle glaucoma: IRIS\u00ae Registry analysis. Ophthalmology 2026:S0161\u20136420(26)00296\u20134.","DOI":"10.1016\/j.ophtha.2026.04.026"},{"key":"2026060712300624000_2026.06.02.26354782v1.21","unstructured":"Yoo K , Wu L , James A , Lung K , Camp A , Bolo K , Xu BY . Risk-Stratified Monitoring of Open Angle Glaucoma Suspects Based on Diagnostic Conversion Risk. Am J Ophthalmol. In Press."},{"key":"2026060712300624000_2026.06.02.26354782v1.22","first-page":"1","article-title":"Assessment of Cumulative Incidence and Severity of Primary Open-Angle Glaucoma Among Participants in the Ocular Hypertension Treatment Study After 20 Years of Follow-up","volume":"139","author":"Ocular Hypertension Study Group","year":"2021","journal-title":"JAMA Ophthalmol"},{"key":"2026060712300624000_2026.06.02.26354782v1.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2012.02.024"},{"key":"2026060712300624000_2026.06.02.26354782v1.24","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1080\/02713683.2021.1924384","article-title":"Visual Acuity in Glaucomatous Eyes Correlates Better with Visual Field Parameters than with OCT Parameters","volume":"46","year":"2021","journal-title":"Curr Eye Res"},{"key":"2026060712300624000_2026.06.02.26354782v1.25","doi-asserted-by":"publisher","DOI":"10.1097\/ijg.0000000000001794"},{"key":"2026060712300624000_2026.06.02.26354782v1.26","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/IJG.0000000000001795","article-title":"Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology","volume":"30","year":"2021","journal-title":"J Glaucoma"},{"key":"2026060712300624000_2026.06.02.26354782v1.27","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/IJG.0000000000001812","article-title":"Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT): Baseline Methodology for Implementing and Assessing a Community-Based Program","volume":"30","year":"2021","journal-title":"J Glaucoma"},{"key":"2026060712300624000_2026.06.02.26354782v1.28","doi-asserted-by":"crossref","first-page":"101008","DOI":"10.1016\/j.xops.2025.101008","article-title":"Comparison of RETFound and a Supervised Convolutional Neural Network for Detection of Referable Glaucoma from Fundus Photographs","volume":"6","year":"2026","journal-title":"Ophthalmol Sci"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.06.02.26354782","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T19:30:16Z","timestamp":1780860616000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.06.02.26354782"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":28,"URL":"https:\/\/doi.org\/10.64898\/2026.06.02.26354782","relation":{},"subject":[],"published":{"date-parts":[[2026,6,4]]},"subtype":"preprint"}}