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Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (1 December 2022) | Viewed by 11342

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Special Issue Editors

Dr. Brent Siesky

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Guest Editor

Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Interests: racial disparities; gender studies; ocular blood flow; imaging; ocular physiology; glaucoma; ocular medications; retinal disease

Prof. Dr. Alon Harris

E-Mail Website
Guest Editor

Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, 1468 Madison Avenue, Annenberg 22-86, New York, NY 10029, USA
Interests: ophthalmology; physiology; glaucoma; ocular blood flow; imaging; mathematical modeling; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Disparities in eye disease represent significant challenges to patients, communities, and clinicians’ efforts to prevent vision loss and preserve the quality of life. Risk factors for eye disease and subsequent management approaches differ both individually and between race and gender categories. In some ocular pathologies such as glaucoma, racial disparities exist in almost every aspect of the disease process and management. Specifically compared to their European Descent (ED) counterparts, African descent (AD) populations have been shown to have earlier disease onset, more rapid glaucomatous progression, worse disease severity, and greater visual function loss as well as higher intraocular pressure compared to ED populations. Asian and Latin American descent populations have been reported to have average prevalence rates of glaucoma that are greater than ED but less than AD, while the prevalence in Middle Eastern populations is estimated to be similar to Asian populations. Pilot data have suggested a stronger ocular vascular component may be involved in the disease process in persons of AD possibly accounting for some of the elevated disease disparities observed. In other eye diseases such as age-related macular degeneration (AMD) and diabetic retinopathy (DR), the physiological mechanisms involved and outcome differentials across racial groups are less-well established. Educating clinicians on risk modifiers, including genetic and racial influence, is important when considering individually tailored clinical management and the goal of reducing disease disparities. The application of mathematical modeling and artificial intelligence to clinical data inclusive of race, gender, and other demographic factors may further help identify bias and provide pathways to reduce disease disparities and improve patient outcomes.

The present Special Issue aims to highlight risk factors and management approaches to preserve vision with an emphasis on identifying and understanding disparities of eye disease. By increasing awareness of differential risk factors, bias, and clinically focused management approaches we can reduce disparities of outcomes and the quality of care for all individuals.

Dr. Brent Siesky
Dr. Alon Harris
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Disparities
Eye Disease
Risk Factors
African Descent
Minorities
Predictors
Disease management

Published Papers (6 papers)

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Research

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11 pages, 254 KiB

Open AccessArticle

Heterogeneity of Ocular Hemodynamic Biomarkers among Open Angle Glaucoma Patients of African and European Descent

by Brent Siesky, Alon Harris, Alice Verticchio Vercellin, Julia Arciero, Brendan Fry, George Eckert, Giovanna Guidoboni, Francesco Oddone and Gal Antman

J. Clin. Med. 2023, 12(4), 1287; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12041287 - 06 Feb 2023

Viewed by 1245

Abstract

This study investigated the heterogeneity of ocular hemodynamic biomarkers in early open angle glaucoma (OAG) patients and healthy controls of African (AD) and European descent (ED). Sixty OAG patients (38 ED, 22 AD) and 65 healthy controls (47 ED, 18 AD) participated in a prospective, cross-sectional study assessing: intraocular pressure (IOP), blood pressure (BP), ocular perfusion pressure (OPP), visual field (VF) and vascular densities (VD) via optical coherence tomography angiography (OCTA). Comparisons between outcomes were adjusted for age, diabetes status and BP. VF, IOP, BP and OPP were not significantly different between OAG subgroups or controls. Multiple VD biomarkers were significantly lower in OAG patients of ED (p < 0.05) while central macular VD was lower in OAG patients of AD vs. OAG patients of ED (p = 0.024). Macular and parafoveal thickness were significantly lower in AD OAG patients compared to those of ED (p = 0.006–0.049). OAG patients of AD had a negative correlation between IOP and VF index (r = −0.86) while ED patients had a slightly positive relationship (r = 0.26); difference between groups (p < 0.001). Age-adjusted OCTA biomarkers exhibit significant variation in early OAG patients of AD and ED. Full article

(This article belongs to the Special Issue Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases)

9 pages, 2213 KiB

Open AccessArticle

A Prospective Analysis of the Simplified Student Sight Savers Program on Open-Angle Glaucoma Cost Burden in Underserved Communities

by Justin T. Bradshaw, Telyn Peterson, Lawsen M. Parker, Zeke Richards, Chad J. Skidmore, Kevin Brighton, Maxton W. Muir, Alexandra Moody, Andrew Collyer, Isain Zapata, Amanda E. Brooks and Marcos Reyes

J. Clin. Med. 2022, 11(10), 2903; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11102903 - 20 May 2022

Cited by 2 | Viewed by 1439

Abstract

(1) Background: Glaucoma is a leading cause of irreversible blindness worldwide. Unfortunately, no noticeable symptoms exist until mid- to late-stage glaucoma, leading to substantial costs to the patient and the healthcare system. (2) Methods: The Student Sight Savers Program, an initiative started at Johns Hopkins University, was designed to meet the needs of community screening for glaucoma. Several medical students at the Rocky Vista University in Saint George, Utah, were trained, and screened patients at local fairs and gathering places using a modified version of this program. Patients found to have elevated pressure (>21 mmHg) or other ocular abnormalities were referred for an ophthalmological examination. (3) Results: Individuals from medically underserved areas/populations (MUA/Ps) were nearly three times as likely to have elevated intraocular pressure as individuals not in underserved areas (p = 0.0141). A further analysis demonstrates that medical students can help reduce medical costs for patients and the healthcare system by providing referrals to ophthalmologists and reaching populations that are not usually screened for glaucoma. (4) Conclusions: Allowing medical students to perform community-based glaucoma screening events in MUA/Ps using handheld tonometers may decrease the cost burden associated with late diagnosis, and raise awareness about glaucoma, especially in underserved populations. Full article

(This article belongs to the Special Issue Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases)

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12 pages, 851 KiB

Open AccessArticle

Exfoliation Syndrome in Baja Verapaz Guatemala: A Cross-Sectional Study and Review of the Literature

by Chase Paulson, Samuel C. Thomas, Orlando Gonzalez, Samuel Taylor, Cole Swiston, Jennifer S. Herrick, Lori McCoy, Karen Curtin, Craig J. Chaya, Brian C. Stagg and Barbara M. Wirostko

J. Clin. Med. 2022, 11(7), 1795; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11071795 - 24 Mar 2022

Cited by 4 | Viewed by 1672

Abstract

There are little epidemiologic data on exfoliation syndrome (XFS) or exfoliation glaucoma (XFG) in Guatemala, especially in the underserved Baja Verapaz region. This observational study assessing XFS/XFG and demographic factors of this region aims to better understand unique exogenous and endogenous risk factors associated with XFS/XFG in Guatemala. During Moran Eye Center’s global outreach medical eye camps from 2016–2017, 181 patients age 15 years and older presented for complete eye exams. These individuals were screened for eye disease and evaluated for possible surgical interventions that could occur during the camps to improve eyesight. During the dilated exams, XFS was noted as missing or present. Of those 181, 10 had insufficient data and 18 lacked a definitive diagnosis of XFS or XFG, resulting in 153 evaluable patients; 46 XFS and 9 XFG were identified. Age, gender, hometown, ancestry (languages spoken by parents and grandparents), past medical history, family medical history, and occupational data (only 2017 trip) were obtained for each patient. The most common occupations of these individuals were farming and housekeeping. Higher rates of XFS/XFG were noted in individuals of rural compared to urban settings and Mayan speaking people compared with Spanish speakers. Based on this subset of patients, with various ocular pathologies being evaluated during medical eye outreach camps, the prevalence of XFS/XFG appeared to be 36%, a high prevalence compared to other world populations. Location and higher altitude, along with a farming occupation, may contribute to XFS development and subsequent progression to XFG. To our knowledge, this is the largest study looking at the epidemiology of XFS/XFG in the Baja Verapaz region of Guatemala for those over the age of 15 years seeking eye exams and interventions. Full article

(This article belongs to the Special Issue Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases)

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Review

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12 pages, 508 KiB

Open AccessReview

High Myopia Prevalence across Racial Groups in the United States: A Systematic Scoping Review

by Bryana Banashefski, Michelle K. Rhee and Gareth M. C. Lema

J. Clin. Med. 2023, 12(8), 3045; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12083045 - 21 Apr 2023

Cited by 2 | Viewed by 1709

Abstract

High myopia is a significant public health issue globally and in the United States (US), where it affects ~4% of the population or 13 million people. This is a potentially blinding condition, but complications can be prevented with early intervention in childhood. Several countries have developed robust data on high myopia, but the United States' data on high myopia remains lacking. Further, underrepresented populations are at particular risk of complications due to reduced access to optometric and ophthalmic care. We performed a systematic scoping review of population-based studies that investigated the prevalence of high myopia across racial and ethnic groups in the US to identify the impact of high myopia on underrepresented communities. Only four studies were identified that met inclusion criteria, which highlights the need to further investigate the topic in the United States. The prevalence of high myopia ranged from a low of 1.8% among Hispanic populations to a high of 11.8% among Chinese populations. Our study demonstrated a paucity of high myopia data in the United States and variable rates of high myopia depending on the time and location of each study. More complete prevalence data will help identify opportunities for community-based interventions to prevent debilitating and blinding complications of high myopia. Full article

(This article belongs to the Special Issue Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases)

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13 pages, 314 KiB

Open AccessReview

Social Determinants of Health and Impact on Screening, Prevalence, and Management of Diabetic Retinopathy in Adults: A Narrative Review

by Dhruva Patel, Ajaykarthik Ananthakrishnan, Tyger Lin, Roomasa Channa, T. Y. Alvin Liu and Risa M. Wolf

J. Clin. Med. 2022, 11(23), 7120; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11237120 - 30 Nov 2022

Cited by 7 | Viewed by 2224

Abstract

Diabetic retinal disease (DRD) is the leading cause of blindness among working-aged individuals with diabetes. In the United States, underserved and minority populations are disproportionately affected by diabetic retinopathy and other diabetes-related health outcomes. In this narrative review, we describe racial disparities in the prevalence and screening of diabetic retinopathy, as well as the wide-range of disparities associated with social determinants of health (SDOH), which include socioeconomic status, geography, health-care access, and education. Full article

(This article belongs to the Special Issue Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases)

8 pages, 822 KiB

Open AccessReview

Geographical Variability in CYP1B1 Mutations in Primary Congenital Glaucoma

by Manali Shah, Rachida Bouhenni and Imaan Benmerzouga

J. Clin. Med. 2022, 11(7), 2048; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11072048 - 06 Apr 2022

Cited by 7 | Viewed by 1964

Abstract

Primary congenital glaucoma (PCG) is a rare type of glaucoma that is inherited in an autosomal recessive manner. PCG can lead to blindness if not detected early in children aged 3 or younger. PCG varies in presentation among various populations, where disease presentation and disease severity vary by mutation. The most common gene implicated in PCG is cytochrome p450 1B1 (CYP1B1). Here, we sought to review the literature for mutations in CYP1B1 and their presentation among different populations. Areas of interest include recent findings on disease presentation and potential implications on our understanding of PCG pathophysiology. Full article

(This article belongs to the Special Issue Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases)

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