advertisement
Abstract #10027 Published in IGR 5-3
Asian Americans: glaucoma
Law SKInternational Ophthalmology Clinics 2003; 43: 133-149
Certain ethnic subgroups of Asian-Americans appear to have a higher rate of occludable angle and PACG than do whites and blacks. It is important to recognize the different contribution of nonpupillary block mechanism of angle closure, such as anteriorly positioned ciliary processes (as in plateau iris configuration) and lens-induced decrease of anterior chamber angle width. The difference in the combination of mechanisms of angle closure in the Asian-American population would be better understood with wider application of ultrasonic biomicroscopy in evaluating the angular configuration. Because the majority of angle-closure glaucoma in Asian-Americans may be asymptomatic and laser peripheral iridotomy is proven to be an effective prophylactic treatment, examination of the peripheral angle with gonioscopy is crucial for early diagnosis and appropriate treatment. Application of public resources to the at-risk population is considered to be cost-effective in glaucoma care. For angle-closure glaucoma in Asian Americans, the at-risk population is patients older than 40 years, women, hypermetropia, family history of angle closure, and patients of certain ethnic subgroups, such as Chinese, patients from Indochina, and Asian Indians. As eye care professionals, we need to be aware that certain ethnic groups of Asian-Americans may have a lower average IOP than that of whites and blacks. Applying the average IOP for whites or blacks to Asian-Americans in diagnosing glaucoma will miss a significant proportion of Asian-American patients with glaucoma. Glaucoma is defined by the presence of glaucomatous optic neuropathy. Careful evaluation of the optic disc with dilated fundus examination and stereoscopic optic disc photography is a sensitive method of evaluation. Our understanding of primary glaucoma in Asia-Americans is limited. The prevalence and presentation of diseases in US Asians may be different from that in Asians in the East because of the difference in health care structure in terms of accessibility, ophthalmic practice in terms of wider use of laser therapy, and cataract extraction in the USA; possibly such environmental factors as life-style, nutrition, and geographical location; and genetic variation from interracial marriage. Although the multicultural social environment of the USA is certainly different from that in Asia, it may provide a unique opportunity for studying glaucoma among different ethnic groups in a single setting.
Dr. S.K. Law, Jules Stein Eye Institute, 100 Stein Plaza 2-235, Los Angeles, CA 90095, USA
