N
Engl J Med 1991 Nov 14;325(20):1412-7
Comment in:
N Engl J Med. 1991 Nov 14;325(20):1440-2.
Racial differences in the cause-specific prevalence of blindness in east
Baltimore.
Sommer A, Tielsch JM, Katz J, Quigley HA, Gottsch JD, Javitt JC, Martone
JF, Royall RM, Witt KA, Ezrine S.
Dana Center for Preventive Ophthalmology, Johns Hopkins School of Hygiene
and Public Health, Baltimore, MD.
BACKGROUND. Bilateral blindness unrelated to simple
refractive error is twice as prevalent among blacks as among whites, although
the difference narrows among the elderly. The reasons for this race- and
age-related pattern are uncertain.
METHODS AND RESULTS. A randomly selected, stratified,
multistage cluster sample of 2395 blacks and 2913 whites 40 years of age
and older in East Baltimore underwent detailed ophthalmic examinations
by a single team. We identified 64 subjects who were blind in both eyes.
The leading causes of blindness were unoperated senile cataract (accounting
for blindness in 27 of the total of 128 eyes), primary open-angle glaucoma
(17 eyes), and age-related macular degeneration (16 eyes). Together, these
three disorders accounted for 47 percent of all blindness in this sample.
Unoperated cataract accounted for 27 percent of all blindness among blacks,
among whom it was four times more common than among whites; whites were
almost 50 percent more likely than blacks to have undergone cataract extraction
before the age of 80 (P less than 0.002). Primary open-angle glaucoma
accounted for 19 percent of all blindness among blacks; it was six times
as frequent among blacks as among whites and began 10 years earlier, on
average. By contrast, age-related macular degeneration resulting in blindness
was limited to whites, among whom it was the leading cause of blindness
(prevalence, 2.7 per 1000; 95 percent confidence interval, 1.2 to 5.4);
it affected 3 percent of all white subjects 80 years of age or older.
CONCLUSIONS. The pattern of blindness in urban Baltimore
appears to be different among blacks and whites. Whites are far more likely
to have age-related macular degeneration, and blacks to have primary open-angle
glaucoma. The high rate of unoperated cataracts among younger blacks and
among elderly subjects of both races suggests that health services are
underused. Half of all blindness in this urban population is probably
preventable or reversible.
PMID: 1922252 [PubMed - indexed for MEDLINE]
N Engl J Med 1991 Nov 14;325(20):1440-2
Comment on:
N Engl J Med. 1991 Nov 14;325(20):1412-7.
N Engl J Med. 1991 Nov 14;325(20):1418-22.
The differential burden of blindness in the United States.
Seddon JM.
Publication Types: Comment; Editorial
PMID: 1922257 [PubMed - indexed for MEDLINE]
