ROLE OF ETHNICITY IN GLAUCOMA

 

Glaucoma is globally more prevalent among the Black population, compared with white patients, develops 10 years earlier on average, and is 15 times more likely to cause visual impairment. The outcomes of medical and surgical treatment for glaucoma are worse for black than white populations.

An observational study was performed in the UK to assess whether patients from minority ethnic groups have different perceptions about the quality-of-life (QOL) outcomes that matter most to them.

The study involved 511 patients diagnosed with primary open-angle glaucoma and ocular hypertension.

The self-reported priorities for health outcomes among the responders was divided into:

(1) vision, (2) drop freedom, (3) intraocular pressure (IOP), and (4) one-time treatment.

For White patients, the priority for QOL was good vision.

However, for Black/Black British patients the priority was drop freedom, followed by control of IOP and finally the possibility of one-time treatment.  

For Asian/Asian British patients, the priority was control of IOP. This was almost the same as the priority for vision.

Other ethnic minority groups also had higher odds ratios (ORs) for prioritizing health outcomes other than vision alone: 4.50 (1.03 to 19.63, p=0.045) for drop freedom and 5.37 (1.47 to 19.60, p=0.011) for IOP.

The study showed that ethnicity is strongly associated with differing perceptions regarding health outcomes and QOL priority. Therefore, an individualized and ethnically inclusive approach is needed when selecting and evaluating treatments in clinical and research settings.

Certain important implications from this study include the fact that the patient’s priority for care may not be the same as the treating physician. A large number of patients in this study regarded freedom from drops as the most important priority. This implies that minimally-invasive glaucoma surgeries (MIGS) and laser procedures such as selective laser trabeculoplasty (SLT) could be a useful approach in making the patient drop-free. Therefore, non-white patients could be more perceptive for such procedures.

It also shows that black patients may not use their eye drops regularly, causing detrimental outcomes.

Furthermore, QoL outcomes from studies which predominantly recruit certain ethnic groups may not be generalizable to other ethnic groups. This requires a tailored-approach to perform QOL studies.

In conclusion, ethnicity plays a major role in the occurrence of glaucoma, the management profile, and the perceptions of patients across various ethnicities.

REFERENCE:

Safitri A, Konstantakopoulou E, Gazzard G, et al. Priorities for health outcomes in glaucoma in an ethnically diverse UK cohort: an observational study. BMJ Open 2024;14:e081998. doi:10.1136/ bmjopen-2023-081998