Glaucoma in the black population: a problem of blindness.

Glaucoma is the leading cause of blindness in blacks. Black patients usually present to the ophthalmologist with more extensive optic nerve damage as compared with whites, and the disease process follows a malignant course even after intervention is initiated. Consequent to a greater amount of iris pigmentation, blacks require medications in higher concentrations to receive significant lowering of intraocular pressure. Patients with darker, thicker irides are more prone to have subacute angle-closure glaucoma, which requires gonioscopy and the recognition of subtle details that may be difficult to interpret. If medical therapy fails, the results of noninvasive surgical intervention, such as argon laser trabeculoplasty, and traditional surgical intervention, such as trabeculectomy, have a much lower success rate in the black population when compared with studies of the general population.It is essential that the primary physician be aware of the early signs and risk factors for glaucoma, which are herein outlined in detail. Only through early recognition, proper referral, and aggressive treatment can the incidence of blindness secondary to glaucoma be decreased.