Social Determinants of Glaucoma Risk and Vision‑Related Quality of Life in Rural Nigeria

Background: Glaucoma is a leading cause of irreversible blindness. Late presentation is common in sub‑Saharan Africa; however, most data on social determinants of glaucoma risk originate from high‑income countries. We explored how socioeconomic status (SES) and barriers to care affect intraocular pressure (IOP) and vision‑related quality of life (VR‑QOL) in Imo State, Nigeria.

Objectives: To assess relationships between SES, barriers to care, visual functioning, and glaucoma risk in rural Nigeria.

Methods: Thirty‑six adults at risk for glaucoma were recruited during a free outreach in South‑East Nigeria. SES, VR‑QOL, and barriers‑to‑care questionnaires were administered. Participants received medical exams with IOP measurement.

Findings: Transportation source was the most consistent SES predictor of outcomes. Participants with more sophisticated transportation sources had lower IOP (r = −0.71 [95% CI: −0.92 to −0.17], P = 0.019, n = 11) and faced fewer barriers to care (r = 0.37 [95% CI: 0.04 to 0.63], P = 0.026, n = 36). Patients with fewer barriers presented with lower IOP (r = −0.72 [95% CI: −0.92 to −0.18], P = 0.018, n = 11) but longer intervals since their last doctor’s visit (r = 0.35 [95% CI: 0.01 to 0.62], P = 0.036). Longer intervals since the prior doctor’s visit correlated with worse VR‑QOL in reading medicine and food labels (r = −0.39 [95% CI: −0.65 to −0.07], P = 0.017, n = 36). Female participants reported greater cost‑related, distance‑related, and overall barriers to care (r = −0.44 [95% CI: −0.67 to −0.11], P = 0.008).

Conclusions: Transportation limitations and female sex were associated with greater clinical and functional burden. While fewer barriers correlated with lower IOP, longer gaps in care and poorer VR‑QOL suggest persistent deficits in glaucoma awareness. Improving transportation access and community health education may support earlier detection and reduce glaucoma burden in rural Nigeria.