GLAUCOMA: WHY THERE IS A HIGHER RATE OF BLINDNESS IN BLACK PEOPLE (AFRICANS AND DIASPORA)

 

Ever heard of Glaucoma? chances are you have if you have ever visited an Optometrist or an Ophthalmologist. One of the most important questions we ask you is, "Have you ever been told that you have glaucoma by an eye doctor?  and "Does any member of your family has or had glaucoma?  

What is Glaucoma? In layman's terms, it is when the pressure inside the eye is too high it causes damage to the visual nerve (The nerve connecting the eye to the brain) it is much more complicated, but I will keep it as simple as possible. 

What causes glaucoma?

Why is this second cause of irreversible blindness in the world cause more blindness in the African and African diaspora communities ( African diaspora includes African-Americans, Caribbean people of African descent, and all across the Americas, Asia, and Europe) than other groups? 

First, you have to understand that there are different types of glaucoma, The three common types are Angle-closure, Open-angle, and Normal-pressure. Angle-closure glaucoma often comes with the symptom of pain. Open-angle and Normal pressure (Tension) do not often cause any pain

Unfortunately, the types that come with no symptoms until it is advanced cause blindness in more Africans and African descendants the most. But why is our community more at risk? And the key to preventing blindness from glaucoma is early detection and diagnosis. If Open-angle and Normal pressure (Tension) glaucomas which often have no symptoms until much more advanced are diagnosed early, it can be well managed. So it is safe to say that Africans and their diaspora are often diagnosed late and misdiagnosed because of a couple of reasons.

1. Africans and their descendants have thinner corneas. We know that the measurement of eye pressure (Intraocular pressure) is one of the important factors in diagnosing glaucoma. To measure eye pressure the cornea (The clear part of the eye's protective covering) plays an important role in accurately measuring eye pressure. People with thinner corneas have their actual cornea pressures underestimated. For many years before 2002 measuring the cornea thickness (CCT) which can be done using a pachymeter- a simple medical device was not part of the protocol in diagnosing glaucoma. This means early detection was often missed in our community, And so people in our community are likely to come in for an eye exam with advanced glaucoma. With glaucoma early detection is key!

2. Africans and their descendants have larger optic nerves (The nerve connecting the eye to the brain) and people with large optic nerves are often misdiagnosed with glaucoma. The two reasons above are probably the reason why there is more blindness from glaucoma in our community than in other groups. 

3. Another factor could be that most people don't routinely visit the eye doctor until they have a problem. I cannot tell you how many times I have seen a patient with advanced glaucoma who was visiting an eye clinic for the first time.

Of course, there are other risk factors for glaucoma which occur in other ethnic groups too like:

• Elevated Eye pressure
• Family history
• Age
• Medical conditions like Diabetes, High blood pressure, Heart condition, Sickle cell anemic
• High nearsightedness
• Corticosteroid use (especially eye drops)

Some symptoms of Open-angle glaucoma which are usually noticed in late stages are:

• Patchy blind spots in your side (Peripheral) and central vision
• Tunnel vision in the advanced stage

To reduce blindness in the African/African descendants community, a regular eye exam is advised especially from age 40. I often tell my patients, to make it a birthday present for themselves. Have an eye exam on your birthday, that way, you will always remember.

I will never forget the case of a 37-year-old I saw a couple of years ago. Breaking the news to her that she had glaucoma broke my heart and hers. when she returned on a follow-up visit, she had lost so much weight from worrying about the cost of medications. Unfortunately, her health insurance did not cover the cost of medications. Glaucoma eye drops are very expensive and while there is government assistance for people 65 years and over, non-pensioned people do not have that luxury except they have good insurance.

In Trinidad and Tobago though people fare better because there is universal health insurance and Glaucoma falls under chronic diseases therefore glaucoma medications are essentially covered by Government.  Although they are not always available and you have to pay out of pocket, which is often reimbursed.

What can save us and our community from this blinding eye condition is to have regular eye exams by qualified Optometrists and Ophthalmologists.