Black Men Are More Prone to Open Angle Glaucoma Than Black Women
Male sex is a risk factor for primary open-angle glaucoma (POAG), making black men more prone to developing this condition than black women. 1
Epidemiology and Risk Factors
Primary open-angle glaucoma is a significant public health problem affecting approximately 76 million people worldwide as of 2020, with projections showing an increase to 79.8 million by 2040 1. The condition disproportionately affects individuals of African descent:
- African Americans have approximately three times higher prevalence of open-angle glaucoma compared to non-Hispanic whites in the United States 1
- Glaucoma is the leading cause of blindness in African Americans 1, 2
- The prevalence is even higher in Afro-Caribbeans compared to African Americans 1
Key Risk Factors for POAG
Multiple guidelines have identified specific risk factors for primary open-angle glaucoma, with male sex being consistently listed among them:
- Male sex 1
- Elevated intraocular pressure (IOP) 1
- Older age 1
- African race or Latino/Hispanic ethnicity 1
- Family history of glaucoma 1
- Thin central cornea 1
- Low ocular perfusion pressure 1
- Type 2 diabetes mellitus 1
- Myopia 1
- Large cup-to-disc ratio 1
Sex Differences in POAG
The 2021 Primary Open-Angle Glaucoma Preferred Practice Pattern specifically identifies male sex as a risk factor for POAG 1. This finding is consistent across multiple studies and guidelines:
- The Baltimore Eye Survey found no significant difference in POAG rates between men and women within racial groups, but did confirm the substantially higher overall prevalence in blacks compared to whites 3
- However, more recent and comprehensive guidelines have identified male sex as a risk factor 1
- The Barbados Eye Study, which focused specifically on a black population, found that older men were most likely to have open-angle glaucoma 4
Clinical Implications
Understanding that black men are at higher risk for POAG than black women has important clinical implications:
- Screening should be prioritized for black men, particularly those over 40 years of age 5
- Earlier and more aggressive intervention may be warranted in this high-risk population
- Black patients often present with more extensive optic nerve damage compared to whites, and the disease typically follows a more aggressive course 2
- Black patients may require medications in higher concentrations to achieve significant lowering of intraocular pressure 2
- Surgical interventions such as laser trabeculoplasty and trabeculectomy have lower success rates in black populations 2
Prevention and Management Considerations
Given the higher risk profile of black men for POAG:
- Regular comprehensive eye examinations are crucial for early detection
- Aggressive IOP management is essential, as studies have demonstrated that reducing IOP decreases the risk of visual field progression 1
- Target IOP should be set lower to prevent further optic nerve damage 1
- Patient education about the importance of medication adherence is critical
- Awareness of potential treatment challenges in this population is important, as blacks may be less responsive to both drug and surgical treatments 6
Early identification and intervention are particularly important for black men to prevent irreversible vision loss from this sight-threatening condition.