The literature surrounding open angle glaucoma (OAG) treatment for patients of African descent is insufficient to inform treatment decisions, according to research published in the Journal of Glaucoma

“Increased risk may be related to bias in treatment approach, limited access, lack of therapeutic choice, lower chronic medication adherence, and overall bias in glaucoma studies that focus on [populations of European descent] as the primary treatment population,” the investigators report.

This literature review aimed to document overall treatment outcomes for patients with open-angle glaucoma who are Black. Researchers searched article abstracts, articles, and related research published in English up until December 2021 for key words related to OAG, OAG treatment and race/ethnicity. Outcome measures included differences in reactions to therapies, adherence patterns, and access to care across races. 


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Treatments found included topical drug therapies, surgical interventions, trabeculectomy, laser trabeculectomy, implantable shunts, viscocanalostomy and canaloplasty, and alternative surgical options. While the research on race disparities in reaction to topical drug therapies is limited and inconsistent, prostaglandin analogues have been found to be slightly more effective in Black populations compared with White populations, while the opposite was true for beta-adrenergic receptors. While laser trabeculoplasty can effectively reduce intraocular pressures (IOP) in patients who are Black, this group also has a higher risk of trabeculectomy failure, the report shows. The study shows no differences in outcomes for shunt implantation, viscocanalostomy, and canaloplasty.    

Participants who are Black showed reduced adherence, being 3 times more likely to have less than 80% adherence in some studies. They also showed reduced access to care across studies, with 1 study that looked at utilization of eye care services through Medicaid that showed patients with African heritage were 67% as likely to seek help as those with European heritage.

The data surrounding race disparities is insufficient within the current literature, the study says. Many studies include race as a secondary outcome and suggest more studies with a primary focus on conclusive results.

Reference

Siesky B, Harris A, Belamkar A, et al. Glaucoma treatment outcomes in open angle glaucoma patients of African descent. J Glaucoma. 2022;31(7):479-487. doi:10.1097/IJG.0000000000002027