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12-02-2008, 01:19 PM
African-Americans and Glaucoma


Primary open-angle glaucoma (referred to as glaucoma in the rest of this article) affects people of all ages and ethnicities. While glaucoma symptoms vary among black populations in different international regions, glaucoma clearly affects those of African heritage more.
Glaucoma occurs about five times more often in African-Americans, and blindness from glaucoma is about six times more common. In addition to this higher frequency, glaucoma often occurs earlier in life in African-Americans—on average, about 10 years earlier than in other ethnic populations.
Why is there a difference?

The reasons for the higher rate of glaucoma and subsequent blindness among African-Americans are still unknown. However, researchers are becoming more and more certain that African-Americans are genetically more likely to be susceptible to glaucoma, making early detection and treatment all the more important. For example, there may be a greater susceptibility to optic nerve damage, which causes vision loss, for blacks with glaucoma.
In studies such as the Baltimore Eye Survey and the Barbados Eye Study, researchers have been tracking how glaucoma affects different black populations. This information will be invaluable in better understanding the risk factors for blacks, and eventually, in developing more effective treatments and protocols.
Does glaucoma treatment differ?

Although treatment varies for all individuals, the overall goal is to prevent further damage and sight loss from glaucoma. One way that eye doctors seek to meet this goal is to aim for a target eye pressure. In African-Americans, glaucoma generally occurs earlier, often with a greater rate of vision loss. Because of this, an eye doctor may work with a patient to target an eye pressure that may be lower than for other glaucoma patients.
Initial results from the Advanced Glaucoma Intervention Study (AGIS) show that ethnicity may also be a factor in determining the better surgical treatment for glaucoma. Initially expecting both blacks and whites to have similar responses, researchers found that black patients with advanced glaucoma responded better to laser surgery than filtering (cutting) surgery. Now, an eye doctor’s recommendation for surgery may consider the patient’s race in addition to other important aspects of their individual health.
It is important to note, however, that treatments cannot be generalized. Each patient, regardless of race, should continue to be evaluated on the individual state of his or her disease, with a target pressure and treatment plan unique to each patient.
Although much still needs to be learned about why African-Americans are more at risk for glaucoma, one thing is certain. Early diagnosis and treatment is key in preventing vision loss from glaucoma. The Glaucoma Research Foundation recommends that African-Americans get a thorough check for glaucoma every one to two years after age 35. For more information on finding an eye doctor or getting an eye exam, please see the article on Getting Your Eyes Checked (http://www.glaucoma.org/learn/diagnostic_test.html).
Thanks to Joanne Katz, ScD, Professor of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD for contributing to this article. Dr. Katz was a co-investigator of the Baltimore Eye Survey.