A Single-Center Case-Control Study of Glaucoma Severity on Initial Presentation in Haitian Americans.

Abstract

Purpose: To assess relative glaucoma severity between Haitians and non-Haitians upon presentation to a tertiary referral practice using a retrospective case-control design.

Patients and methods: All Haitian descent patients were age- and zip code-matched with non-Haitian Hispanic American controls from a tertiary glaucoma service in a 1:1 ratio. Clinical and social vulnerability characteristics were analyzed for differences in functional and structural glaucoma deficits. Those who did not return after 1 year were considered lost to follow-up. Outcome measures included a comparison of blindness, glaucoma severity [visual field and retinal nerve fiber layer (RNFL) loss], and follow-up rates between groups.

Results: At presentation, 95 Haitians had worse average mean deviation (MD) than controls in the better (-9.4 ± 9.8 vs -5.1 ± 6.4 dB, p < 0.02) and worse eyes (-12.7 ± 10.0 vs -7.3 ± 7.0 dB, p < 0.01). Haitians also had a greater percentage of functional blindness (22.4% vs 4.1%, p < 0.02) in the worse eye. RNFL thickness and loss to follow-up were similar between groups. Haitians were also less likely to have had a glaucoma surgery or laser prior to presentation than controls (p ≤ 0.009). In multivariable models, Haitian descent was associated with worse MD in the worse eye. Worse neighborhood area deprivation indices were associated with higher likelihood of loss to follow-up, but Haitian descent was not.

Conclusion: Haitians had greater vision loss than controls despite similar exam findings. Higher burden of blindness and fewer prior procedures upon presentation may indicate a care disparity. Haitian patients may benefit from greater surveillance or earlier treatment for glaucoma.