April is National Minority Health Month, which began as National Negro Health Week in 1915 when Booker T. Washington proposed the observance to acknowledge the importance of health to economic progress and equity. African-American newspapers, churches, businesses and professional associations played central roles in energizing the movement. Today, the U.S. Office of Minority Health is the lead agency advancing health equity through the theme of “Accelerating Health Equity for the Nation.”
Racial and ethnic minorities suffer disproportionately on many measures of ill health compared to whites and are often victims of disparities that exist outside of the health care system, including disparities in income, education and housing. Much of the health emphasis has been and continues to be rightfully on eliminating disproportionate morbidity from such conditions as heart disease, stroke, cancer, diabetes and infant mortality. However, African-Americans, Hispanic Americans and Native Americans are also burdened, often unknowingly, with increased risks for sight-threatening conditions like glaucoma, diabetic eye disease and hypertensive retinopathy. A survey from Transitions Optical indicated only 44 percent of African-Americans and 34 percent of Hispanic Americans and Native Americans understand their race and ethnicity could place them at increased risk for certain eye conditions.
Glaucoma is a leading cause of vision impairment and blindness. It is a group of diseases that can damage the optic nerve (the bundle of nerve fibers that transmit visual information from the eye to the brain) and lead to permanent vision loss. Blind spots usually begin in the periphery and slowly progress centrally. Glaucoma often has no early symptoms or warning signs and may go unnoticed until it has progressed to permanent vision loss. Anyone can get glaucoma, but African-Americans 40 years of age and older, everyone over the age of 60, especially Hispanics, and those with a family history of glaucoma are particularly vulnerable to this “silent thief of sight.” At least half of the people with glaucoma do not know they have the potentially blinding disease.
Diabetic eye disease is a serious complication of diabetes. It refers to a group of conditions that include diabetic retinopathy, glaucoma and cataract. Diabetic retinopathy — a leading cause of blindness in U.S. adults — results when the small blood vessels in the retina (the light-sensitive tissue in the back of the eye) are damaged by diabetes, causing them to leak fluid or grow abnormally. The risk increases the longer the person has diabetes. Like glaucoma, diabetic retinopathy often has no early symptoms; only about half of the people are aware they have it. Hispanic Americans 50 years of age and older, African-Americans, Native Americans and older adults with diabetes are at high risk for diabetic retinopathy. The number of cases is expected to increase by almost 50 percent by 2030. The greatest increases are expected to occur in Hispanic Americans and African-Americans, with increases of 142 percent and 44 percent, respectively.
Hypertension, or high blood pressure, affects about one-third of the U.S. population and increases the risk of heart disease and stroke. It can also affect the eyes by damaging the blood vessels that supply blood and nourishment to the retina. It can lead to retinal hemorrhages and swelling of the macula and optic nerve. High blood pressure is referred to as the “silent killer,” because it has no warning signs or symptoms, and many people are unaware their blood pressure is elevated beyond normal levels. African-Americans tend to develop high blood pressure more frequently and at an earlier age than Hispanics and whites, and Black women have high blood pressure more than men. The high prevalence of hypertension and the low rate of blood pressure control among African-Americans combine to increase the risk for hypertensive retinopathy.
Early detection, timely treatment and appropriate follow-up can reduce the risk of severe vision loss. People at risk should not wait until a vision problem is noticed before getting a comprehensive dilated eye exam. Anyone with diabetes should get at least an annual dilated eye exam. Eye drops are used to enlarge the pupil so the inside of the eye can be examined to check the health of the back of the eye. Good health practices also include taking medications as prescribed, reaching and maintaining a healthy weight, being physically active, not smoking, and controlling blood sugar, blood pressure and cholesterol levels. As we look to accelerate health equity for the nation, we should not overlook the importance of eye health and remember that vision loss can be prevented in most cases through early diagnosis and treatment and adoption of healthy lifestyles.
Edwin Marshall, OD, MS, MPH, FAAO, FNAP, is professor emeritus of optometry and public health at Indiana University.
