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Editors Selection IGR 16-4

Epidemiology: Glaucoma in Asian Americans

Comment by Shan Lin on:

27923 Differences in Rates of Glaucoma among Asian Americans and Other Racial Groups, and among Various Asian Ethnic Groups, Stein JD; Kim DS; Niziol LM et al., Ophthalmology, 2011; 118: 1031-1037

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The study by Stein et al. (2) reports the rates of glaucoma for various Asian American and other racial groups, based on retrospective review of data from a managed care network database. Over two million patients were included in this survey. Prevalence and incidence rat es of primary open-angle, normaltension, and angle-closure glaucoma were significantly higher among the Asian Americans than among non-Hispanic whites. Normal-tension and angle-closure glaucoma rates were highest in Asian Americans as compared to non-Hispanic whites, Hispanics, and African Americans. Normal-tension glaucoma was particularly high in Japanese Americans, and angle-closure glaucoma was most prominent in those of Chinese and Vietnamese ancestry. One limitation of such a study design is the inability to verify diagnoses, particularly normal-tension and angle-closure glaucoma. The former is optimally assessed with a diurnal curve and multiple visits prior to diagnosis. Also many cases of NTG are often 'checked off' as POAG when coding. In the case of angle-closure glaucoma, gonioscopy is a necessary diagnostic procedure, but studies have shown that this test is often neglected which calls into question the validity of this diagnosis when considered on such a large scale. However, given such shortcomings, this study with its large numbers and striking findings provides strong support to further recommend that Asian Americans should be screened carefully for glaucoma, particularly for normal-tension and angle-closure subtypes.

Asian Americans should be screened carefully for glaucoma, particularly for normal tension and angle closure subtypes

Furthermore, there is compelling evidence for understanding the racial background of an individual glaucoma patient, since each ethnic group can possess its own unique spectrum of glaucomatous disease. Results are in accordance with prior studies in the individual racial groups and are clinically relevant given the rapid rise of Asian American populations in the U.S.

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