Surgical Undertreatment of Glaucoma in Black Beneficiaries of Medicare

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Abstract
GLAUCOMA IS defined as a multifaceted optic neuropathy that results in permanent visual loss.1 It is the most common cause of blindness in black Americans, and among the leading causes in white Americans.2-4 Currently, more than $1 billion per year is spent on federal assistance to blind glaucoma patients.5 Population-based studies indicate that blacks have a higher prevalence of glaucoma than whites. In the Baltimore Eye Survey, the prevalence of glaucoma increased with age in both races, giving an age-adjusted prevalence of 3.9 per 100 in blacks (3.9%) and 0.6 per 100 in whites (0.6%)—a 6.5-fold difference.6 Across the total population without adjusting for age, the prevalence of glaucoma was 3.3 per 100 in blacks (3.3%) and 0.7 per 100 in whites (0.7%), making the observed prevalence of glaucoma at least 4 times greater in blacks than in whites. In certain populations, the prevalence of glaucoma among blacks is even higher: the St Lucia Eye Study reported an 8.8% prevalence for black residents of that island.7 Not only is glaucoma more common in blacks than in whites, but it also appears to have a more severe course in blacks.8,9