Special section for African-derived persons

Take Home Points

Persons of color, those whose ancestors came from Africa, have a number of important issues that relate to glaucoma. Most importantly, you have three to four times more chance of having open angle glaucoma than other ethnicities, and it develops in your eyes at an earlier age than in others. Second, it is a more aggressive form of glaucoma, leading to vision loss and blindness more often. Third, there are some reasons to believe that even if you take your eye drops as others do that you won’t quite get as much pressure lowering from the same dose. It seems that having more pigment in the eye soaks up the drugs so they work less well. But, they do still work! Finally, many studies show that when we do glaucoma surgery (trabeculectomy), it works somewhat less often in African-derived persons.

So, given all the bad news, what else do we know and how can be overcome this? Well, one approach would be to give up and say that there’s not much one can do and we should just kind of ignore the problem and hope it doesn’t get us. That’s a pretty human thing to do, but, it’s a losing strategy. The answer to having higher rates of prostate and breast cancer is NOT to avoid having PSA blood tests and mammograms. The right answer is to follow the program. And eye doctors need help from you, because it seems, at least at the present time, that we don’t know best how to get the message across to our African-derived patients.

We recently did studies on how patients take their drops for glaucoma and were surprised that our African-derived patients took them less frequently. This would be understandable, since on average African-derived persons have lower incomes, less health insurance, and less access to eye specialists. But, our studies were in persons who were educated, insured, and who got their eye drops for free as part of the study. And yet, when we clocked how well the drops got in, they did worse than other ethnicities. Not only that, but when we tried methods that would remind people to take their drops better, some improved a lot and others not so much. For African-derived patients, in general, the reminders we tried didn’t work as well. This was even true when the doctor was an African-American woman.

This leads us to think that we aren’t as culturally competent at communicating with our patients in ways that help them to prevent vision loss as well as we’d like. Attitudes toward disease must differ a lot among people. The medical community needs help in understanding what might work better than what we’re doing now. I hope that those reading this will make suggestions that can improve our care of glaucoma.

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