Black patients have a significantly higher risk of advanced vision loss after a new diagnosis of primary open-angle glaucoma (POAG) compared to white patients, according to a new study from New York Eye and Ear Infirmary of Mount Sinai (NYEE) .
The book, published on July 25 in Translational vision Science and technology, shows that being of African descent is an independent risk factor for this drastic decline in vision, and should encourage more eye screening in this population for the early detection of glaucoma. This is the first study to use an artificial intelligence algorithm to break down visual field loss in incident glaucoma cases among US-based population groups.
The work is important because glaucoma is the leading cause of blindness in the United States, and primary open-angle glaucoma is the most common type. POAG is the main cause of optic nerve degeneration related to the level of pressure inside the eye, but other factors also contribute to this condition. Patients typically show few or no symptoms until the disease progresses and they experience irreversible vision loss, highlighting the need for early screening and detection of glaucoma in patient groups high risk.
Lead author Louis R. Pasquale, MD, FARVO, vice president of ophthalmology research at the Icahn School of Medicine at Mount Sinai and director of the NYEE Eye and Vision Research Institute, noted that the study had implications considerable.
“This study has huge implications for glaucoma screening in black people, who we already knew were a population at increased risk for glaucoma,” Pasquale said in a statement. “Screening earlier in life could significantly increase the chances of detecting glaucoma and slowing its progression before it reaches one of the advanced patterns shown in our research.”
A team of researchers analyzed nearly 210,000 participants from three population-based databases of nurses and healthcare professionals from the Nurses’ Health Study (enrolled between 1980-2018, and 1989-2019) and the Health Professionals Follow-up Study (enrolled between 1986 and 2018). The participants were over the age of 40 and their data was collected during comprehensive eye exams – none had glaucoma at baseline. They were followed every two years and provided updated information on their lifestyle, diet and health status, including the diagnosis of glaucoma.
In the study group, 1,946 patients developed glaucoma. The researchers analyzed their first visual field loss recording using archetype analysis, a form of artificial intelligence. The algorithm identified 14 archetypes: four representing advanced loss patterns, nine early loss and one without visual field loss.
Black patients made up 1.3% of the study, but had nearly twice the risk of early visual field loss archetypes and six times the risk of advanced field loss archetypes, compared to black patients. white patients. Asian participants, who made up 1.2% of participants, had nearly twice the risk of early visual field loss compared to white patients, but did not have a significantly higher rate of advanced patterns of field loss. visual. Hispanic patients represented 1.1% of the study population and had no increased risk of archetypes compared to white patients; however, the study showed that they were at risk of having an archetype showing initial loss near the center of their visual field. The results were controlled for a number of variables, including socioeconomics, frequency of eye exams, heart disease, diabetes and exercise.
Pasquale noted that the study began decades ago in three cohorts of healthcare professionals that weren’t as diverse as the current numbers — and if the investigators had garnered a greater representation of people of color, the results would probably be even deeper.
“African ancestry is a risk factor for glaucomatous blindness, and this work provides insight into why this might be the case,” he said. “We suspect that the reason blacks showed more advanced loss patterns than whites is that the disease begins one to two decades earlier in the former group compared to the latter group. This underscores the importance of early detection strategies in blacks to identify glaucoma early in order to prevent visual impairment in this population.
According to Pasquale, the next step in this work is to determine the specific risk factors for the different patterns of vision loss observed in patients with glaucoma, including genetic and environmental factors, in order to fully unravel the pathogenesis of primary glaucoma at open corner.
This study was performed with collaborators from Brigham and Women’s Hospital and Massachusetts Eye and Ear. This work was supported by the National Eye Institute, part of the National Institutes of Health.