As decided in a landmark 1973 Supreme Court case (Estelle v. Gamble), people who are incarcerated in the United States have a right to access medical care. Anything less amounts to a violation of the Eighth Amendment, which bars “cruel and unusual punishment,” according to the ruling.1 But eye care for people living in incarceration is waning, in particular with regards to glaucoma treatment, according to a research team based in Chicago. 2 Their study shows that, even though administration of medications and appointment attendance is controlled in prison, substantial medication and follow-up non-adherence exists among these patients.2

The data comes from the investigators’ 375 visits to 82 male patients between 20 and 75 years old. Primary open-angle glaucoma was diagnosed in 32.9% of them.2 Another 32.3% were deemed glaucoma suspects.2 Overall, 59 patients (73.2%) were treated medically with up to four topical agents.2 Of those treated, 70% reported non-adherence during at least one visit, especially if they were given multiple medications. Only 26.6% of return office visits occurred within the recommended follow-up time frame.2 Furthermore, 93 patients weren’t seen until more than a month after their recommended follow-up.2

During the course of the study, the 14 eyes were treated with 19 office procedures (including laser peripheral iridotomy and laser trabeculoplasty). Additionally, 17 incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant and trabeculectomy.2

Glaucoma care for incarcerated people is under-represented in the literature, and managing their treatment is a unique challenge, the researchers explain.2

1. Dimitrakopoulos I. Individual rights and liberties under the U.S. Constitution: the case law of the U.S. Supreme Court. 2007; Leiden: Koninklijke Brill. p. 312.

2. Kanu L, Jang I, Oh D, et al. Glaucoma care of prison inmates at an academic hospital. Jama Ophthalmol. February 20, 2020. [Epub ahead of print].