Black and white patients had similar rates of glaucoma progression in this study. Photo: Getty Images. 

The 11-year findings from the African Descent and Glaucoma Evaluation Study (ADAGES) (n=516 OAG eyes) provided further evidence that healthcare and socioeconomic disparities are a key reason for the poorer outcomes Black patients are more likely to experience.

The authors reported that, in a research setting with similar access to care and care delivery, rates of progression were similar between Black and white patients, despite the relatively worse initial status of the former. Black subjects in the study were significantly younger than white patients (59.7 vs. 66.9), significantly less likely to undergo trabeculectomies (29.5% vs. 50%) and had significantly higher treated mean IOP (14.9mm Hg vs. 14.0mm Hg).

While increased visual field variability has been proposed as a possible reason for previously reported outcome differences (due to the fact that variability can delay progression detection and make it seem as if the disease is progressing at a slower rate), the authors of the present study wrote that when matched for specificity, “increased variability alone was not sufficient to explain the differences between groups.”

Additionally, though previous studies have reported more rapid progression among Black patients, the authors wrote, “During study follow-up when all participants were treated and monitored closely, such potential faster rates were not observed and both groups progressed at statistically similar rates.” They pointed out that these previous population-based studies were conducted “in an environment where socioeconomic disparities and differences in access to treatment may have adversely affected individuals of Black race.”

Overall, the authors noted that their findings “suggest that despite a more aggressive disease at presentation among Black race individuals […] treatment in this study was able to equalize the rates of progressive functional loss between racial groups.”

Melchior B, Valenzuela IA, De Moraes CG, et al. Glaucomatous visual field progression in the African Descent and Glaucoma Evaluation Study (ADAGES): eleven years of follow-up. Am J Ophthalmol. February 13, 2022. [Epub ahead of print].