Glaucoma in Black Individuals: How Far Have We Come and Where Do We Go From Here?

center dot PURPOSE: To provide updates on the key scientific discoveries made and sociological theories put forth that have allowed for a better understanding of the disproportionate burden of glaucoma among Black individuals, and to provide insights into future directions for this important field of work. center dot DESIGN: Perspective with a scoping review of the literature. center dot METHODS: Review, synthesis, and critical appraisal of selected literature on the impact of glaucoma in Black Americans. Important studies within and outside of ophthalmology are considered to allow for a greater understanding of the historical, sociopolitical, and encompassing medical contexts surrounding this complex issue. center dot RESULTS: A historical overview of key epidemiologic studies highlights the repeated and unequivocal demonstration of increased risk of glaucoma in Black individuals. To begin to understand this multilayered racial disparity, a historical review of race as a social-legal construct is provided. A careful examination of genetic ancestry is considered as a partial means by which increased glaucoma risk is conferred among Black individuals. The growing body of work examining social determinants as an important driver for racial disparities in glaucoma is also reviewed. Finally, the pitfalls and dangers of race based medicine are highlighted through illustrative cases before providing insights to future directions. center dot CONCLUSIONS: Though our understanding of the disparities in glaucoma in Black individuals has grown over the past decades, gaps persist, particularly because of deficient data driven by a lack of studies in this disproportionately burdened group. Though the use of race as a variable may become increasingly less relevant with the rise of precision medicine, it remains a crucial though flawed concept that continues to be our best means by which to measure, investigate, and intervene upon these disparities in our efforts to achieve health equity. (Am J Ophthalmol 2024;259: 96-101. (c) 2023 Published by Elsevier Inc.)