Frequency of glaucoma monitoring affects outcomes in Black individuals
Despite greater severity at presentation, Black patients had less frequent glaucoma monitoring and greater progression of disease compared with white patients, according to a study in the American Journal of Ophthalmology.
Further, a lack of proficiency in English language affected the development and severity of glaucoma in non-English speaking Asian and Hispanic individuals.
“These findings suggest that groups with worse glaucoma at baseline are in need of more frequent monitoring in order to prevent disease progression,” Omar A. Halawa, BA, of the department of ophthalmology at Massachusetts Eye and Ear in Boston, and colleagues wrote. “Black/African American patients in our study were likely under-monitored and undertreated, as has been found in previous studies, resulting in worse disease severity over time.”
In a retrospective cohort study, Halawa and colleagues obtained visual field (VF) test measurements from 29,891 individuals between 1998 and 2021 from an academic eye care center in Boston. Participants self-reported race, ethnicity and preferred language. More than 50% were women, and 71% identified as white, 14% as Black/African American, 7.4% as Asian and 6.4% as Hispanic.
According to the study, Black/African American individuals had greater glaucoma severity at baseline, but low VF test frequency/person-years (1.07 ± 0.53) compared with white individuals (1.12 ± 0.52, P = .006), as well as advanced VF progression (–0.43 dB/year; 95% CI, –0.67 to –0.28; P < .001).
Conversely, Hispanic patients had a higher VF frequency compared with non-Hispanic patients (1.18 ± 0.64 vs. 1.11 ± 0.52, P < .001) but no difference in VF progression.
Language preference also had an impact on baseline glaucoma severity. Although Asian and Hispanic individuals underwent more frequent VF testing compared with Black/African Americans, those who did not speak English were older at their first visit and had more advanced VF loss compared with primarily English speakers.
The authors acknowledge that because the study data was obtained from a single source, the findings may not be generalizable to the U.S. population.
“The causes of early and more severe glaucoma in some populations remain unknown, and further work is needed to understand the factors leading to disparities in the frequency of VF tests, including the roles of structural racism and socioeconomic status in mediating these associations,” Halawa and colleagues concluded.
Perspective
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The “silent” nature of glaucoma presents a myriad of challenges, impacting management of this sight- threatening disease from diagnosis to compliance to identifying progression.
Halawa and colleagues determined that race, ethnicity and language preference also contribute to these treatment challenges by recognizing differences in age and glaucoma severity at initial diagnosis. Their findings showed that while Black/African American, Asian and Hispanic patients presented for examination at a younger age, Black/African Americans had less frequent glaucoma monitoring and greater progression of disease. They also found that non-English speaking patients presented at an older age and with greater glaucoma severity.
This retrospective cohort study further recognized compounding factors that hinder patient care and raises further questions about how we can improve outcomes for each and every glaucoma patient. There is no question that we, as providers, need to find ways to effectively communicate with our patients, educate the community and lessen any disparity of glaucoma treatment and management that may be created by structural racism or socioeconomic status.
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