Glaucoma Screening in the Haitian Afro-Caribbean Population of South Florida

Abstract

ObjectiveTo evaluate the presence of clinical signs consistent with suspected glaucoma in Haitian Afro-Caribbean individuals residing in South Florida who do not receive regular eye examinations.DesignRetrospective, cross-sectional study.Methods SETTING: Community health center in the Little Haiti district of Miami, Florida. PATIENT POPULATION: We reviewed medical records and screening forms from five health screenings between October 2011 to October 2013 of 939 Afro-Caribbean individuals older than 18 years, who were never diagnosed with glaucoma or had an eye examination within the last ten years. PROCEDURES: Measurements of distance visual acuity (VA), intraocular eye pressure (IOP), central corneal thickness (CCT), cup-to-disc ratio (CDR), frequency doubling technology (FDT) perimeter visual field (VF).Main Outcome MeasuresProportion of glaucoma suspects, based on IOP greater than or equal to 24 mm Hg or CDR greater than or equal to 0.7 in either eye, and determinants of CDR and IOP.ResultsOne hundred ninety-one (25.5%) of 750 patients were identified as glaucoma suspects. Glaucoma suspects were common in both the youngest and oldest age groups (<40 years, 20.9%; 95% confidence interval [CI], 17.9–23.9; >70 years, 25.0%; 95% CI, 21.8–28.2) and higher in men than women less than 70 years; the reverse was true after 70 years. Among all patients, mean IOP was 19.2±4.5 mmHg, mean CDR was 0.37±0.17, and mean CCT was 532±37.1 µm. In multiple linear stepwise regression analysis, determinates of increased CDR included increasing age (P = 0.004), lack of insurance (P = 0.019), and higher IOP (P<0.001), while increasing CDR (P<0.001) and thicker CCT (P<0.001) were associated with higher IOP.ConclusionsThis first glaucoma survey in a U.S. Haitian Afro-Caribbean population indicates glaucoma suspect status is high across all age groups, and suggests glaucoma monitoring in people less than 40 years of age is indicated in this population.

The Philadelphia Glaucoma Detection and Treatment Project

“…7,34 In the current study, more female than male subjects were included. Although this finding is consistent with findings from a screening program among Haitian Afro-Caribbean individuals, 31 other investigations reported similar rates of glaucoma between the sexes in African Americans, 13 and a recent glaucoma genetic study in Philadelphia reported lower rates of African-American women in the glaucoma group compared with study controls. 35 …”

“…For example, more than 25% Haitian Afro-Caribbean individuals residing in South Florida (aged >18 years) were identified as glaucoma suspects. 31 The Salisbury Eye Evaluation Glaucoma Study reported a glaucoma prevalence of 5.7% among black persons aged 73 and 74 years and 23.2% among those aged >75 years. 14 High rates of glaucoma (11.3%) also were detected among elderly African Americans (aged >80 years) in the Baltimore Eye Survey.…”

Telemedicine for Glaucoma: Guidelines and Recommendations

“…29 However, subsequent studies have suggested that screening in populations at high risk for glaucoma is effective. 30,31 A systematic review of teleglaucoma screening estimated its sensitivity as 83.2% and specificity as 79.0%. 28 Diagnostic consultation.…”

Racial Differences in the Effects of Hormone Therapy on Incident Open-Angle Glaucoma in a Randomized Trial

“…Compared to European-derived counterparts, African-derived populations not only have a higher prevalence and incidence of OAG, [1][2][3] but may also develop the condition a decade or more earlier. 22 In addition, African and African-American women experience menopause at least 6-12 months sooner compared with women of European descent. 23 Given the fundamental racial differences in the risk profiles, it is therefore conceivable that the magnitude of HT effects on OAG might also vary by race.…”