Wilson M Roy, Eezzuduemhoi Deborah R
Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA.
Med Clin North Am. 2005 Jul;89(4):795-804. doi: 10.1016/j.mcna.2005.02.002.
Race- and ethnicity-related differences in prevalence of a number ofophthalmologic disorders have been documented. More importantly, blackand Hispanic Americans share a disproportionate share of morbidity, asmeasured by visual impairment and blindness, when compared with whiteAmericans. The reasons for this health disparity are complex andmultifactorial. If the unequal, individual, and societal burden of avoidable vision lossamong black and Hispanic Americans is to be decreased, it is essential tounderstand the apparent barriers to accessing timely and appropriateophthalmologic monitoring and care for these minority populations. Forthose who do gain access to ophthalmologic care, it is important tounderstand better the determinants leading to different treatment of blackand Hispanic Americans compared with white Americans. Opportunities for decreasing vision-related morbidity caused by cataract,diabetic retinopathy, and glaucoma for these minority groups clearly exist. Strategies for each of these ophthalmologic disorders may differ. Cataract isa reversible cause of visual impairment and removal of cataract improvesquality of life. Cataract surgery should be offered to all who can potentiallybenefit from this treatment. Earlier diagnosis, before the disease hasprogressed to loss of vision, should be a goal in both glaucoma and diabeticretinopathy. Strategies for screening high-risk groups may be particularlyrelevant in this regard. Additionally, with diabetic retinopathy, improvedmanagement of contributing risk factors, such as blood glucose control andblood pressure control, is important. Asian Americans are increasingly becoming a sizable minority group inthe United States. It is projected that by 2070, the Asian population willreach 11% of the total population of the United States. Virtually all of thepopulation-based data relating to ophthalmologic disorders in Asians havebeen performed in Asia. The reported relative proportion of PACG versusPOAG, however, among some Asian populations and of normal-tensionglaucoma versus high-tension glaucoma among the Japanese seems to applyto the United States Asian population. This assertion is based onwidespread clinical impression and analysis of Medicare claims data [56]. Understanding the differences is important for optimal treatment of theseminority populations as the proportion of Asians in the United Statescontinues to grow. The common denominator in all of these diseases is the role of thephysician and patient. Educational programs aimed at the physician tofacilitate cultural competence and at the patient to increase level of knowledgeabout their disease are appropriate and enthusiastically endorsed.
多项眼科疾病患病率的种族和族裔差异已有记录。更重要的是，与美国白人相比，非裔美国人和西班牙裔美国人在视力损害和失明方面的发病率占比过高。这种健康差异的原因复杂且多因素。若要减轻非裔美国人和西班牙裔美国人中可避免视力丧失的不平等、个体和社会负担，必须了解这些少数族裔人群在获得及时、适当的眼科监测和护理方面明显存在的障碍。对于那些确实能获得眼科护理的人，重要的是更好地理解导致非裔美国人和西班牙裔美国人与美国白人接受不同治疗的决定因素。显然存在降低这些少数族裔因白内障、糖尿病视网膜病变和青光眼导致的视力相关发病率的机会。针对每种眼科疾病的策略可能不同。白内障是视力损害的可逆原因，摘除白内障可改善生活质量。应向所有可能从该治疗中获益的人提供白内障手术。在青光眼和糖尿病视网膜病变中，在疾病进展到视力丧失之前进行早期诊断都应是目标。在这方面，针对高危人群的筛查策略可能尤为重要。此外，对于糖尿病视网膜病变，改善血糖控制和血压控制等相关危险因素的管理很重要。亚裔美国人在美国正日益成为一个规模可观的少数族裔群体。预计到2070年，亚裔人口将占美国总人口的11%。几乎所有关于亚洲人眼科疾病的基于人群的数据都是在亚洲进行的。然而，在一些亚洲人群中报告的原发性闭角型青光眼与原发性开角型青光眼的相对比例，以及在日本人中正常眼压性青光眼与高眼压性青光眼的相对比例，似乎也适用于美国亚裔人群。这一论断基于广泛的临床印象和对医疗保险理赔数据的分析[56]。随着美国亚裔人口比例持续增长，了解这些差异对于优化这些少数族裔人群的治疗很重要。所有这些疾病的共同因素是医生和患者所起的作用。旨在提高医生文化能力以及提高患者对自身疾病了解程度的教育项目是合适的，并且得到了积极认可。
