Black Race Associated with Higher Percentage of Glaucoma-Associated Diagnosis but Less Glaucoma Knowledge

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Black people in a rural setting are associated with being more likely to have a glaucoma-associated diagnosis, as well as limited knowledge, attitudes, and beliefs about eye care, according to a new study.¹

The prevalence of glaucoma in the U.S. is 3 times higher in Black individuals than White individuals. In fact, following cataracts, glaucoma is the leading cause of blindness in African Americans—but half of those people are unaware of their condition.

“Blindness from glaucoma is about six times more common,” according to the Glaucoma Research Foundation. “In addition to this higher frequency, glaucoma often occurs earlier in life in African Americans—on average, about 10 years earlier than in other ethnic populations.” ²

Individuals with less education, inadequate access to care, no transportation, and lower income are much more likely to develop eye conditions like glaucoma. People of lower income and education levels are also associated with less eye-care visits. With less education and money, people may be in the dark of risks for vision loss and blindness. They also might not be aware of the Alabama Screening and Intervention for Glaucoma and Eye Health Telemedicine, a telemedicine service to prevent vision loss.¹

The new study, presented 127th Annual American Academy of Ophthalmology (AAO) conference in San Francisco, California, sought to find out how race and social factors in a rural population are associated with a glaucoma-associated diagnosis, as well as knowledge, attitude, and beliefs about eye care. The investigators, led by Shaina D. Bolden, BS, of Heersink School of Medicine at University of Alabama at Birmingham, recruited participants from 3 primary care clinics in rural Alabama.

Participants either had to be Black or Hispanic > 40 years old; White > 50 years old; anyone > 18 years old with diabetes; anyone >18 years with a GAD; and anyone >18 years old with a family history of glaucoma. The study included 547 participants with a mean age 58 years. The participant sample included 45.3% Black and 64.7% female. For participants with glaucoma-associated diagnosis, 57.9% of participants were Black and 39.5% were White. Thus, more Black people had the eye disease.

All participants filled out questionnaires about their eye health knowledge, attitudes, and beliefs, analyzed via Fischer’s exact test. The investigators analyzed social determinants of health, insurance coverage, mode of transportation, and employment status.

More participants with glaucoma-associated diagnosis were insured (92%) than participants without glaucoma-associated diagnosis (82%) (P = .03). Also, fewer participants with glaucoma-associated diagnosis drove themselves to the appointment (69.7%) than participants without glaucoma-associated diagnosis (76%) (P = .04). The investigators found no significant association between employment status and glaucoma-associated diagnosis.

Moreover, more White people (39.4%) said that vision loss from glaucoma cannot be restored while only 23% of Black patients believed this (P < .0001).

Answers also varied depending on if an individual had insurance or not. Meanwhile, more patients (92.1%) with glaucoma-associated diagnosis had insurance while 82.2% without glaucoma-associated diagnosis had insurance. Over half of the insured patients (62.1%) said that those at risk for glaucoma should get a dilated eye exam but only 47.8% of the uninsured patients believed this.

Overall, the study found Black participants had a higher prevalence of glaucoma-associated diagnosis but less knowledge about glaucoma.

References

1. ^{Bolden, S, Swain, T, Rhodes L. Association of Race and Social Determinants of Health with Glaucoma and Eye Care Knowledge in a Rural Population. Presented at the 2023 American Academy of Ophthalmology Annual Meeting, November 3 – 6, 2023.}
2. ^{African Americans and Glaucoma. Glaucoma Research Foundation. https://glaucoma.org/african-americans-and-glaucoma/. Accessed November 2023.}