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Eye Disease in Black & African American Communities
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African Americans have particular susceptibility to certain eye diseases and health conditions that can cause those diseases. Chief among them is glaucoma.
Glaucoma is the primary cause of blindness in Black people. This is because people of African descent have different genetic mutations and organic structures from people of white descent.
Additionally, Black Americans are subject to different socioeconomic factors and lifestyle risks than white people, which contribute to higher rates of eye disease.
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Eye Diseases & the African American Community
Among all ethnic groups, Black Americans suffer the most from glaucoma and other eye diseases.
In 2011, the Glaucoma Research Foundation found that glaucoma is the primary cause of blindness among African Americans. They are 15 times more likely to experience a loss of vision caused by glaucoma than white Americans. However, as many as 16 percent of Black Americans do not know about glaucoma, how to avoid it, and how to seek treatment for it.
Hypertension and diabetes are two other conditions that also affect eyesight, and they are similarly widespread in African American communities across the country. The Miami Herald estimates that 18.7 percent of Black Americans over the age of 20 have diabetes, and the American Heart Association calculated that over 40 percent of Black people have high blood pressure. The result of this is that African Americans have a higher chance of eye diseases and overall loss of vision.
One reason for these high instances is that many African Americans are not made aware that these vision problems can be treated or even reversed, largely due to substandard education policies and lack of health care access in Black-majority areas. Many Black communities also struggle with unhealthy lifestyles that contribute to the development of eye diseases, again a result of limited educational opportunities and health care.
The Leading Cause of Blindness
Data from 2012 has found that over half a million Americans diagnosed with glaucoma are African American, making that condition the leading cause of irreversible blindness among Black people.
As far back as 1991, the Baltimore Eye Survey, published in the American Journal of Epidemiology, showed that African Americans were as much as four times more likely to have a diagnosis of glaucoma compared to white Americans. Additionally, the disease tended to develop at an earlier age in Black people. In most cases, patients were unaware that they had glaucoma or what glaucoma even was.
This has led to many questions about why Black Americans are more susceptible to glaucoma compared to other minority groups. There is no consensus among researchers, but in addition to sociocultural factors, many scientists believe that there are genetic differences in Black people that increase the likelihood of developing an eye disease. One such example is that the anatomic structure of the optic nerve in African Americans is different to the structure found in non-Hispanic white people.
Notwithstanding the root causes, glaucoma remains a common problem in the African American population. It is more difficult to treat; it tends to be more severe at the time of diagnosis; and ultimately, it results in higher incidences of vision loss.
Why Does Race Matter?
Review of Optometry looked at evidence that suggests that Black people do not respond to medical and surgical treatment for glaucoma at a rate comparable to that of white Americans. One possible reason for this is that the chemical compounds in medications for glaucoma bind to the heavy ocular melanin found in African Americans. Thus, these drugs may need to be administered in a higher concentration to Black people, so they can experience the same effects that white Americans derive from normal doses.
Another reason is that Black people have thinner corneas than white people, which can cause doctors to underestimate the intraocular pressure. This can lead to delayed diagnosis and treatment.
Across the U.S., hypertension and hypertensive retinopathy — both conditions that can affect eyesight — are more prevalent in Black Americans than in white Americans. They show up at a much earlier age, and they typically present with more complications in Black people than in white people, often with an increased risk of mortality.
Lifestyle Improvements
Lifestyle changes can have positive effects against the spread of eye diseases, including switching to a diet that is low in sodium, sugar, and red meat. Also, reducing total and saturated fats and cholesterol will lead to significantly lower blood pressure, which will decrease the risk of complications from hypertension, such as vision loss due to glaucoma.
Additionally, regular eye exams will also present the best defense against glaucoma and other eye problems that can reduce vision. Most patients are advised to get tested for glaucoma as they approach their 40th birthday since the condition is age-related, and the diagnosis has to be made over a period of time.
Other factors should also be taken into consideration, like a family history of high blood pressure, lifestyle habits, other vision problems, and related medical conditions. A Black patient with one or more of these risk factors should get a comprehensive eye exam as soon as possible.
Treating Glaucoma in Black Patients
The Glaucoma Research Foundation notes that while glaucoma treatment is different for everyone, the goal of treatment is to prevent vision loss in every patient. In an African American patient, this means that an optometrist might identify eye pressure that is lower than in other patients who have glaucoma.
Regardless of race, each patient should receive unique evaluations based on the state of their disease and the degree of loss of vision.
Differences in Black Populations
It should be noted that African American communities across the country are quite diverse, to the point that not all Black groups and populations have the same rate of the condition.
Black people living in the Caribbean (or people of Black Caribbean descent), for example, display different prevalence levels of glaucoma, possibly due to having a different lifestyle than Black people in the United States. People of East African descent living in the United States also show slightly different presentations of glaucoma. Again, this may be due to environmental and lifestyle differences from traditionally (and majority) Black Americans.
Researchers are looking into the factors that determine the risk of developing glaucoma across different Black communities and populations. The hope is that an examination of all the known risk factors will help narrow down what triggers the development of glaucoma, when it starts to form, and what the best line of treatment will be.
This kind of intensive tracking helps doctors “learn a lot about the course of the disease,” especially because white Americans have a lower incidence of glaucoma, so data is not as widely available.
Other research has looked at whether there is a higher incidence of genetic mutations in specific genes in people of African descent, which might be why there is a correspondingly higher rate of eye diseases in that population. This, combined with nongenetic factors like environment and lifestyle, suggests why eye diseases occur more frequently and earlier in various African (American) populations.
Socioeconomic Factors
The Baltimore Eye Survey further found that people who received less than 12 years of education had a greater chance of developing visual impairment than those who completed a K-12 program. Similarly, people with higher incomes enjoyed a lower rate of visual impairment and disease-related vision loss compared to people with lower incomes.
Stemming from this, having health insurance will also affect access to care. As the Population Research and Policy Journal explains, Black Americans are twice as likely to have no insurance than their white counterparts.
Without medical insurance, they are less likely to go to a doctor when their vision starts to deteriorate. They are also less likely to get surgery for their eye diseases, which explains this degree of higher prevalence of glaucoma and blindness in this population.
Additionally, the Advanced Glaucoma Intervention Study discovered that Black people react differently to glaucoma surgery than white people. Black people who had advanced glaucoma at the time of their surgery had better responses to laser surgery than trabeculectomy. White patients, on the other hand, did better with trabeculectomy.
It may be the case that there is an explanation for this difference that is not based on race, but doctors advise that the difference does address the reality that race should be taken into consideration when planning glaucoma treatments.
References
- African Americans and Glaucoma. Glaucoma Research Foundation.
- Don’t Buy The Lie: Black Americans Are Especially Vulnerable to Coronavirus | Opinion. (March 2020). The Miami Herald.
- High Blood Pressure and African Americans. (March 2016). American Heart Foundations.
- Implicit Bias and Racial Disparities in Health Care. American Bar Association.
- Southern Diet Blamed for High Rates of Hypertension Among Black Americans. (October 2018). NPR.
- A Population-Based Evaluation of Glaucoma Screening: The Baltimore Eye Survey. (November 1991). American Journal of Epidemiology.
- Differences in Optic Nerve Structure Between Individuals of Predominantly African And European Ancestry: Implications for Disease Detection and Pathogenesis. (March 2008). Clinical Ophthalmology.
- What’s Race Got to Do With It? (June 2009). Review of Optometry.
- Prevalence of Complications and Response to Different Treatments of Hypertension in African Americans and White Americans in the U.S. (November 1993). Clinical and Experimental Hypertension.
- Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. DASH-Sodium Collaborative Research Group. (January 2001). New England Journal of Medicine.
- High Glaucoma Prevalence in Blacks Leaves Questions About Treatment. (November 2003). Healio.
- The African Caribbean Eye Survey: Risk Factors for Glaucoma in a Sample of African Caribbean People living in London. (1994). Eye (London).
- Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course. (October 2016). Population Research and Policy Review.
- The Advanced Glaucoma Intervention Study (AGIS): 7. The Relationship Between Control Of Intraocular Pressure And Visual Field Deterioration. (October 2000). American Journal of Ophthalmology.
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