Disparities in some ocular disease linked to race
Click Here to Manage Email Alerts
Black individuals may be at greater risk for developing certain eye diseases that can threaten vision, including glaucoma, which typically strikes this patient population 10 years earlier than other ethnicities.
“This is a staggering statistic that has negative implications on one’s quality of life,” Darryl Glover, OD, a private practitioner from Durham, N.C., said.
According to Glover, these disparities are a result of social determinants and lack of representation in research and clinical trials.
“Systemic racism is a key social determinant, as it creates inequities in access to health care facilities and obstacles for insurance coverage, income, education and housing,” he said. “In research and clinical trials, it is imperative to collect data across all diverse populations to help prevent disparities and produce better health outcomes.”
Glover believes that eye care professionals can help reverse this trend by encouraging earlier and more frequent examinations for Black patients.
“Being that Black patients do not get eye exams as early or frequently, this increases risk for or prevalence of conditions like glaucoma and diabetic or hypertensive retinopathy going undetected,” he said. “This puts Black patients in a disadvantaged position by setting off a cascade of events that negatively impact how they function in life. Overall, we need to see all walks of life earlier and more frequently, especially in the Black community.”
Glover also stressed the importance of health care providers working together when caring for patients with chronic health conditions.
“As eye care professionals, we are the gatekeepers into the health care system, so we tend to see ocular manifestations from various systemic conditions, such as autoimmune disorders, vascular-related conditions and more,” he said. “We can streamline patient care by leveraging innovation, educating patients on the importance of holistic care and integrating electronic health systems to provide better continuity of care.”
According to data from the Salisbury Eye Evaluation (SEE) study, Black individuals are four times more likely to develop a cortical cataract, which affects the outer layer of the lens of the eye (Storey et al.). Patients with diabetes and high blood pressure are at a higher risk for cortical cataracts as well.
This study also found that the incidence of cortical opacity was higher in Black individuals (6.9%) than white individuals (3.0%), as was the rate of progression of cortical opacity (38.4% vs. 22.8%).
However, according to the study, Black individuals have half the risk of nuclear cataracts compared with white individuals.
Diabetes affects 11.7% of non-Hispanic Black Americans compared with 7.5% of non-Hispanic white Americans, according to the American Diabetes Association. In addition, the SEE study found that Black individuals had a fourfold risk for vision loss from diabetic retinopathy (DR) compared with white individuals.
Using data from the SEE study, researchers have reported that diabetic retinopathy causes 17% of vision loss in Black individuals — more than double the vision loss DR causes in non-Hispanic white population (8%).
“In the U.S., African Americans not only have a high prevalence of type 2 diabetes, but they also seem to be at high risk for consequent microvascular disease, including nephropathy and retinopathy,” study authors wrote.
The prevalence of glaucoma is about five times higher in Black individuals than white individuals, and Black patients are six times more likely to go blind as a result of the disease. Black patients also tend to develop glaucoma approximately 10 years earlier than other populations.
Further, Black individuals who have a family history of glaucoma have a 20% higher risk for developing the disease than those who do not. Although additional research is needed to identify factors that lead to a higher risk for glaucoma in Black individuals, possible contributors include tendency to have thinner corneas and larger cup-to-disc ratios.
Autoimmune conditions — many of which have ocular complications — are generally more prevalent or more severe in Black individuals. Examples include:
- Approximately 10% of Americans have eczema. Although Black individuals do not have a higher incidence of eczema, they tend to have a more severe form of the disease.
- Nearly 90% of those diagnosed with lupus are women, and the disease is two to three times more prevalent in Black women than white women.
- Rheumatoid arthritis is more prevalent among Black individuals than white, Asian and Hispanic individuals.
Patients with eczema, lupus and rheumatoid arthritis may be more likely to develop dry eye syndrome as a result of inflammation and may be at higher risk for other eye conditions. For example, eczema can increase the risk for conjunctivitis and keratitis, while rheumatoid arthritis can increase a person’s risk for developing uveitis and glaucoma.
“As eye care professionals, we serve as the gatekeepers into the health care system,” Glover said. “This gives us the opportunity to set a strong foundation to the health care industry on how to serve diverse populations and backgrounds. If we, as an industry, model inclusive care, establish trust with our patients and work together to remove social determinants from health care as a whole, we will create a happier and healthier world.”
References:
- American Diabetes Association. Statistics about diabetes. https://www.diabetes.org/about-us/statistics/about-diabetes. Updated Feb. 24, 2022. Accessed June 3, 2022.
- Barsegian A, et al. Int J Clin Endocrinol Metab. 2017;doi:10.17352/ijcem.000027.
- Culpepper L. Glaucoma risk higher in the African American population. https://www.allaboutvision.com/conditions/glaucoma-african-american-prevalence/. Updated March 15, 2022. Accessed June 3, 2022.
- Glaucoma Research Foundation. African Americans and glaucoma. https://glaucoma.org/african-americans-and-glaucoma/. Reviewed Feb. 28, 2022. Accessed June 3, 2022.
- Glover K, et al. Front Immunol. 2021;doi:10.3389/fimmu.2021.744396.
- Lupus Foundation of America. Lupus facts and statistics. https://www.lupus.org/resources/lupus-facts-and-statistics. Accessed June 3, 2022.
- National Eczema Association. Eczema stats. https://nationaleczema.org/research/eczema-facts/. Accessed June 3, 2022.
- Spraybary A. The effect rheumatoid arthritis has on your eyes. https://www.allaboutvision.com/conditions/related/rheumatoid-arthritis-eyes/. Published Dec. 15, 2021. Accessed June 2, 2022.
- Storey P, et al. Invest Ophthalmol Vis Sci. 2013;doi:10.1167/iovs.12-11412.
- Xu Y, et al. J Clin Med. 2021;doi:10.3390/jcm10153289.
For more information:
Darryl Glover, OD, practices in Durham, N.C. He can be reached at Darryl.Glover@myeyedr.com.
Collapse
Read more about
Click Here to Manage Email Alerts