GLAUCOMA CATARACT-003

Diet and exercise, along with following the doctor’s orders can help prevent many of the conditions associated with the development of glaucoma and cataracts. (Courtesy photo)

For generations, a belief has existed among African Americans that gradual loss of eye sight was both normal and natural.  The culprits in most cases, cataracts and glaucoma, have come to be associated with growing older in the same manner as developing arthritis, though both are largely preventable and, like many degenerative conditions, attack Blacks disproportionately, due to poor fitness.

Cataracts and glaucoma are the leading causes of blindness in the Black community with the diseases striking earlier and progressing quicker among Black women than any other population. Half of those with glaucoma don’t know they have it.

Cataracts are characterized by progressive damage to the optic nerve that tends to begin with the loss of side or peripheral vision, then gradually the loss of central vision, until the total sight is compromised.  Cataracts develop as a result of clouding in the lens of the eye that affects clear vision. There is often pressure felt in the eye with cataracts that many believe is linked to an onset of glaucoma, where fluid inside the eye does not drain properly from a buildup of that pressure inside the eye.

In both conditions, people with diabetes type 1 or 2 are at very high risk for their development and more likely to develop them at younger ages. In fact, high levels of blood sugar (hypoglycemia) are significantly related to cataract development, as are hypertension and prolonged steroid use (for treating conditions like asthma).

Researchers, including Carla J. Siegfried and David C. Beebe, have worked since 2011 to more succinctly position the oxygen flow (oxygen metabolism) and pressure in the optic nerve to the development of cataracts and glaucoma. Their findings have helped unlock race-based differences in development and progression.

“Our findings suggest there may be physiologic differences in oxygen metabolism between African Americans and Caucasians,” said Siegfried.  “Glaucoma often affects African Americans at a younger age, and when we used statistical methods to adjust for differences in age, the difference in oxygen levels between African Americans and Caucasians became more significant. Then, when we controlled for racial differences, we found that increased age became an important indicator of elevated oxygen levels in certain locations in the front part of the eye.”

While glaucoma is usually, but not always, associated with elevated pressure in the eye (intraocular pressure), elevated eye pressure that leads to damage of the optic nerve is believed to be caused by poor regulation of blood flow – as seen in hypertension and diabetes patients. Glaucoma occurs about five times more often in African Americans; blindness from glaucoma is about six times more common. In addition to this higher frequency, glaucoma often occurs earlier in life in African Americans — on average, about 10 years earlier than in other ethnic populations.

Yolanda Yancy has lived with glaucoma for nearly three years.  Despite the slow dissipation of her sight, Yancy said she ignored the warning signs because she believed they were simply indicators of aging.  Now, at 56, her sight in both eyes has deteriorated to a point where surgery is necessary.

“African Americans may be sick of hearing that they develop conditions quicker, have progression rates that are higher, or have complications or death from diseases that others are successfully treated for, but that reality is there,” said Yancy, whose glaucoma was the result of untreated hypertension and early diabetes.  “My condition is based almost entirely on me not eating right and not exercising.”

Yancy, a Cheverly, Md. resident, said that even after her initial diagnosis, she found it difficult to stick to the physician’s regiment that included controlling her diet, exercising, and taking medications on time, every day.

“All the studies in the world and all the Obamacare on the planet will not help us to live better if we don’t stick to the basics of eating and exercising properly. I went from taking eye drops, to pills and now have to have surgery to keep from going totally blind,” Yancy said.  “The tragedy in this is that no matter what I do to stop it now, my sight will never go back to the way it was.  I take the blame.  If I can help someone keep from going through this, I want to help.”

In studies such as the Baltimore Eye Survey and the Barbados Eye Study, researchers have investigated how glaucoma affects different Black populations, globally and found that with such a prevalence among Blacks, grouping based on race may help physicians better understand the risk factors for African Americans, and eventually, in developing more effective treatments.

According to the Baltimore Eye Study, primary open angle glaucoma (OAG), the most common form of glaucoma in the US, impacts an estimated 2.2 million Americans over age 40.  OAG is three times more prevalent among African Americans in the United States than among Caucasians and similarly impacts Black West Indian populations in St. Lucia and Barbados at rates of 8.8 percent and 6.6 percent, respectively.

While the prevalence of glaucoma in African Americans in the United States is three to four times that of Caucasian patients, African Americans are six to 10 times more likely to go blind from glaucoma when compared to their Caucasian counterparts. In addition, the Baltimore Eye study found that African Americans appeared to develop glaucoma 10 years earlier than their White counterparts, leading researchers to debate the inherent increased susceptibility to disease or development based on socioeconomic factors.

“There is significant proof that access to physicians and poor follow-up impede diagnosis and treatment or late diagnosis among minority patients, but there are also factors that the medical community may never fully understand when it comes to how stress and hypertension react in the body,” said Hasin Abdullah, a holistic practitioner in Southeast, D.C.

“It is not to dismiss the fact that too many of us are overweight, but malnourished – meaning the junk we consume is literally going into our systems and consuming us – we are strapped as Black people with stressors that make us sleep deprived, depressed, anxious, and sometimes resistant to Western medicine,” Abdullah said.

Suggesting that Blacks return to a holistic approach in improving their overall health, Abdullah said that water intake, proper sleep and hygiene, and the elimination of sugary and salty processed foods would go a long way in improving the diabetes and hypertension numbers, and subsequently impact the prevalence of glaucoma and cataracts among Black women.

“We have to get those screenings as African Americans, and then act responsibly in following the doctors’ orders.  Changing our living habits is critical to our health,” Abdullah said.