Undetected Eye Disease Burden High in African American Populations

Nathan Dablania, MS

African American populations are at high risk for undetected eye diseases, suggests new data presented at the Association for Research in Vision and Ophthalmology (ARVO) Virtual Meeting.

A population-based study, led by Nathan Dhablania, MS, of Southern California Eye Institute, extracted data from the African American Eye Disease Study (AFEDS) in order to evaluate factors associated with undetected eye disease in this patient population.

“African Americans, the second largest minority group in the United States, are disproportionally more likely than non-Hispanic whites to have visual impairment,” wrote Dhablania and colleagues. “[They] have a high prevalence of age-related diseases, including type II diabetes and hypertension, and thus are at greater risk of vision loss.”

All patients in the current study resided in or nearby the city of Inglewood in California. They underwent a home interview plus a comprehensive eye examination. Individuals were screened for age-related macular degeneration (AMD), glaucoma, ocular hypertension, diabetic retinopathy, cataract, and refractive error.

The investigators evaluated any patients presenting with an eye disease (n = 3500). Dhablania and team then calculated undetected eye disease prevalence and used chi-square test analyses to evaluate bivariate associations between such diseases and risk factors

“The independent association with undetected eye disease and the predisposing, enabling, need and health behavior characteristics was explored using multiple logistic regression analysis,” they noted. “Standardized β coefficients were used to determine the relative contributory effect of each independent factor on the presence of undetected eye disease.”

The Findings

Of the 3500 individuals eligible for analysis, 26% presented with an undetected eye disease. The most common of these diseases were diabetic retinopathy (75.1%), cataracts (60.8%), refractory error (55.0%), ocular hypertension (33.3%), open angle glaucoma (16.5%), and AMD (7.5%).

Risk factors associated with such diseases were male gender, having less than high school education, and being unemployed or retired (P<.0001). Furthermore, patients of older age were more likely to be associated with undetected eye disease (P<.01).

The investigators also observed that, according to need factors, patients with diabetes and hypertension had a higher prevalence of disease versus those who did not. Similarly, disease prevalence was greater in those who self-reported good, fair, or poor general health and vision compared with patients who reported very good to excellent vision (P<.0001 for all).

The overall major risk factors notably were diabetes mellitus (odd ratio [OR], 4.1; 95% CI, 3.4-4.9), never having had an eye examination (OR, 2.4; 95% CI, 1.6-3.4), a gap of >5 years between eye exams (OR, 2.2; 95% CI, 1.6-3.0), lower educational attainment (OR, 2.0; 95% CI, 1.4-2.9), having poor or very poor general vision (OR, 1.7; 95% CI, 1.4-2.0), and difficulty obtaining glasses (OR, 1.6; 95% CI, 1.3-1.9).

“These findings provide evidence of the significant burden of undetected eye disease among African Americans,” Dhablania and colleagues concluded. “Interventions that address the modifiable risk factors may improve detection of eye disease and decrease the burden of visual impairment in this high-risk minority population.”

The study, “Burden and Predictors of Undetected Eye Disease in Adult African Americans: The African American Eye Disease Study (AFEDS),” was presented at ARVO 2021.