The purpose of this study was to assess racial patterns in the treatment of glaucoma since the 1989 publication of Preferred Practice Patterns on glaucoma by the American Academy of Ophthalmology. Data for this study were derived from the Health Care Financing Administration database for the period from 1991 to 1994. Information on the glaucoma surgical procedures – trabeculectomy and argon laser trabeculoplasty – for hospital inpatient and outpatient services and ambulatory centers was used. Only patients over 65 years of age were included.

Blacks received argon laser trabeculoplasty slightly less frequently as their primary surgical procedure for glaucoma than whites (65% of blacks versus 69% of whites had argon laser trabeculoplasty rather than trabeculectomy). In each age group category (65-74, 75-84, and over 85), black men and women were significantly more likely to receive these surgical procedures compared with whites. The age-sex adjusted rate ratio (black to white) for having a surgical procedure was 2.4 (95% confidence interval=2.11 to 2.16).

Based on prevalence information from the Baltimore Eye Survey, the rate ratio (black to white) would be 4 or higher if one assumes that the same proportion of blacks and whites with glaucoma undergo surgery. Thus, the adjusted observed rate for all blacks (2.95 surgical prodcedures/1000 person years) is 47% below the expected rate (5.52 procedures/1000 person years) based on the observed rate for whites (1.38 procedures/1000 person years).

The authors conclude that, despite programs/guidelines that have been implemented in recent years, surgical undertreatment of glaucoma in elderly blacks still exists. Explanations offered by the authors include lack of public education, societal biases about racial differences in responses to treatment, or overtreatment of whites. Limitations of this study include the lack of clinical data, data on other medical care received for glaucoma, and outcome (blindness) data.