Glaucoma is the leading cause of irreversible blindness in the U.S., with primary open-angle glaucoma (POAG) the most common form. Research has shown that people of color bear the greatest burden of POAG, particularly African Americans. Now, research from Mount Sinai’s New York Eye and Ear Infirmary (NYEE) reveals just how great African Americans’ disease burden actually is.*

What the researchers did

Funded by the National Institutes of Health’s National Eye Institute, researchers from NYEE, in conjunction with Brigham and Women’s Hospital and Massachusetts Eye and Ear, analyzed several large databases of healthcare professionals for glaucoma development.

• Close to 210,000 healthcare professionals were analyzed. 
• Two databases of participants were the Nurses’ Health Study, enrolled from 1980-2018 and 1989-2019.
• The third database was the Health Professionals Follow-up Study, from 1986-2018.

All participants were over 40 years of age and glaucoma-free at enrollment. Every two years, participants received eye exams, and submitted lifestyle and health history updates, including any glaucoma diagnosis.

What they found

The study, published in Translational Vision Science and Technology, was the first to use artificial intelligence (AI) to analyze vision loss in new glaucoma cases among U.S. racial/ethnic populations. The findings showed that:

• 1,946 participants developed glaucoma
• The AI computer program was able to analyze patients’ earliest recorded instance of visual field loss.
• 14 different disease patterns emerged: 
  • 9 representing early visual field loss, 
  • 4 indicating advanced loss, and 
  • 1 showing no loss.

Broken down by race:

• Black participants, comprising just 1.3% of the study population, had twice the risk of early visual field loss, and six times the risk of advanced visual field loss, as their White counterparts.
• Asian participants, at 1.2% of the study population, also had twice the risk of early visual loss as Whites but not the alarming increase in risk of advanced loss as Black patients.
• Hispanic participants, making up 1.1% of the study population, didn’t show any increased risk of visual loss compared to Whites, though were at higher risk of early near-central vision loss.

The researchers factored in a number of potential influences when determining significance of the results, such as income, education, eye exam frequency, heart disease, and exercise.

What it means

Glaucoma is often asymptomatic until vision loss starts to occur, highlighting the importance of screening and early detection for high-risk populations, like African Americans. 

“This study has tremendous implications for glaucoma screening of Blacks, who we already knew were a population at increased risk of glaucoma,” stated senior author Louis R. Pasquale, M.D., FARVO, who directs NYEE’s Eye and Vision Research Institute and is deputy chair for ophthalmology research at Mount Sinai’s Icahn School of Medicine. “Screening earlier in life could significantly increase the chance of detecting glaucoma and slowing down progression before it reaches one of the advanced patterns shown in our research.”

Pasquale noted that if the three groups were more representative of today’s diverse population, the results would have been even more significant, emphasizing that “African descent is a risk factor for glaucoma blindness.” He suspects this is because glaucoma begins 10-20 years earlier in Blacks than in Whites. The researchers next want to determine risk factors for the different glaucoma patterns observed to better understand how POAG develops.

POAG prevalence is expected to rise more than 50% by 2040, from roughly 53 million to 80 million individuals, mainly those of African and Asian descent. Researchers say it’s also important for key stakeholders to create diverse study populations for clinical trials involving potential treatments.

*Staff. (2022, July 26). Black Patients Found Six Times More Likely to Have Advanced Vision Loss After Glaucoma Diagnosis Than White Patients, New Study Shows. Vision Monday. https://www.visionmonday.com/eyecare/eye-health/article/black-patients-found-six-times-more-likely-to-have-advanced-vision-loss-after-glaucoma-diagnosis-than-white-patients-new-study-shows