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Justin Jeffries, Chasidy Singleton, Li Wang; Prevalence and Severity of Open Angle Glaucoma in an Underserved Population in Nashville, Tennessee. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5008.
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Primary open angle glaucoma (OAG) is a devastating yet preventable cause of irreversible vision loss. However, because of the asymptomatic nature of OAG, patients with less access to care may be vulnerable to advanced disease. We performed a retrospective IRB-approved chart review study to estimate the prevalence of OAG and presentation of legal blindness in an urban, underserved population.
Chart review of new patient encounters (from 2006-2011) at Nashville General County Eye Clinic was performed. Data were analyzed by descriptive statistics. Of a total 4700 new patients, 240 had OAG (identified by ICD-9 codes 365.11). Patients were stratified by age, gender, race, and degree of vision loss, with assessment of potential risk factors based on socioeconomic, medical, and environmental influences.
The prevalence of OAG over 5 years in this underserved population was 5.1%, which was statistically significant (p<0.001) compared to the documented U.S. prevalence of 1.86%. Average age was 60 ± 12.5 (range 51 to 68 years). By race, 14.3% identified as Caucasian, 76.8% as African-American, 1.3% Hispanic, and 7.6% of other ethnicities. Females comprised 42.7% and males 57.3%. 35.6% were uninsured, 33.9% on Medicare, 16.3% on Medicaid, 4.2% had commercial insurance, and 10.0% were incarcerated. Medical co-morbidities included hypertension (69.6%), hyperlipidemia (25%), and diabetes (40%). 19% of patients presented with legal blindness (visual acuity < 20/200). Patients under 60 (average 48.7 ± 7.2 years old) with legal blindness was 13.8% of this population, with mean defects and pattern standard deviations of -19 ± 12 and 6.8 ± 3.4 in the right eye and -10.5 ± 10.4 and 4.6 ± 2.7 in the left eye, respectively, on automated visual fields. This group had higher rates of male gender (63.6%), African-American race (81.2%), incarceration (24.2%), lack of insurance (36.4%), prior ocular trauma (33%), tobacco use (51.5%), and illicit drug use (58.5%).
Patients in this underserved, vulnerable population exhibit a higher prevalence of OAG than the general US population. Younger patients with advanced disease and blindness (by acuity and visual field) tended to be uninsured or institutionalized, have multiple medical co-morbidities, and endorse a history of prior ocular trauma, tobacco and illicit drug use.
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