Study investigates disparities in glaucoma care affecting persons of African descent
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A literature review shed light on the disparities in prevalence, treatment outcomes, adherence to therapy and access to care between persons of African descent and European descent affected by open-angle glaucoma.
Open-angle glaucoma (OAG) is disproportionally more prevalent in persons of African descent, who also tend to have a more severe course of the disease. This finding could be potentially explained by structural and/or vascular differences within eye tissues, but the mechanisms behind disparities are probably more complex and remain poorly understood, the authors wrote. Through PubMed, Embase, Ovid, Scopus and Trip searches conducted up to Dec. 1, 2021, they tried to identify the answers and gaps in research so far.
Several studies, including the Baltimore Eye Survey and the Ocular Hypertension Treatment Study, suggested that medical therapy is less effective in patients of African descent (AD). Prostaglandin analogues were found to be more effective and beta-adrenergic antagonists less effective in persons of AD as compared with those of European descent (ED). No comparative data on ROCK inhibitors are yet available. Among surgical interventions, data show that trabeculectomy has a higher rate of surgical failure in AD. This may be due to the greater number of macrophages and fibroblasts contained in the conjunctiva of persons of AD, leading to excessive wound healing. Other surgical options, such as Ex-Press shunt implantation (Alcon), viscocanalostomy and canaloplasty, may be promising, but comparative data are lacking, while laser trabeculoplasty appears to be at least as beneficial in those of AD as compared with those of ED.
Limited access to therapy, irregular supplies and poor adherence to therapy especially affect communities of AD. “Barriers to care in OAG patients of AD may include lack of knowledge about glaucoma, utilization issues, insurance status, transportation, prescription cost, and issues related to doctor-patient communication and relationships,” the authors wrote.
Finally, poor representation of AD populations in glaucoma clinical trials was noted.
“This may help explain racial disparities in treatment outcomes as new drugs are often not well tested in minority populations,” the authors wrote. “Overall, data suggest the need for properly designed prospective trials with AD populations as a primary focus to identify the potential mechanisms driving disparities in treatment and address overall potential bias in glaucoma management.”
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