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  • Racial Disparities in Glaucoma Severity and Monitoring

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, October 2022

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    Glaucoma prevalence varies widely by race and ethnicity, and the disease is more common in Blacks and Hispan­ics than in Whites. However, the rate of glaucoma diagnosis in higher-risk populations is lower than expected, suggesting underdiagnosis. Many studies have shown that Black people have earlier onset, greater severity, and poorer visual outcomes of glaucoma, but less is known about racial differenc­es in functional measures of glaucoma severity, progression, or visual field (VF) loss. Halawa et al. used VF and demographic data to explore VF testing frequency and disease severity by race and ethnicity. They found that severe disease at the time of diagnosis was more common in Black, Asian, and Hispanic patients and that Blacks had less frequent monitoring and greater likelihood of progression.

    This retrospective cohort study in­cluded patients who had VF testing at a tertiary eye care center in Boston from 1998 to 2020. Collected data included clinical parameters as well as self-iden­tified race, ethnicity, and preferred language. Outcome measures were VF mean deviation (MD), progression rate, and testing frequency. Multivari­able and longitudinal missed-effects models were used in the analyses.

    Of the 29,891 patients with Hum­phrey VF measurements during the study period, 55.1% were female. With regard to race and ethnicity, 71% self-identified as White or Caucasian, 14% as Black, 7.4% as Asian, and 6.4% as Hispanic. English was the preferred language for 89%. At presentation, the mean VF MD was –9.3 ± 9.7 dB for Blacks, –6.2 ± 7.6 dB for Asians, and –8.3 ± 9.3 dB for Hispanics. For those who identified as White or non-His­panic, it was –5.5 ± 7.3 dB (p < .001) and –6.2 ± 7.8 dB (p < .001), respective­ly. After controlling for age, gender, and English proficiency, disparities in disease severity at presentation were less pronounced, especially for Asians and Hispanics. The frequency of VF testing per person-year was lower for Blacks (1.07 ± 0.53) than for Whites (1.12 ± 0.52, p = .006). Disease progression was 0.43 dB/year faster for Blacks than for Whites (p < .001). VF monitoring occurred more frequently for Hispanics than non-Hispanics (1.18 ± 0.64 vs. 1.11 ± 0.52; p < .001), but there was no significant difference in the rate of disease progression for these cohorts.

    The original article can be found here.