Study Finds American Indian, Native Alaskan Patients Have Highest Rates of Pseudoexfoliation Development

Alongside careful clinical screening of American Indian or Alaska Native patients, including potentially earlier and more frequent exams, the study authors suggested that further research is warranted to elucidate underlying drivers for differences in glaucoma incidence and severity and to understand factors influencing treatment and outcomes in this population. Photo: Henrietta Wang, BOptom, MPH, and Jack Phu, OD, PhD. Click image to enlarge. Researchers at the Spencer Center for Vision Research at Stanford University in Palo Alto, CA, recently investigated the incidence of specific glaucoma subtypes, associated treatment patterns and characteristics of treating clinicians for American Indian or Alaska Native patients compared to patients of other races and ethnicities. Those cohorts comprise approximately 2.6% of the United States population, and previous studies have revealed that these populations are disproportionately affected by a variety of health conditions. The team found that vigilance is warranted to identify pseudoexfoliation and pigmentary glaucoma among both groups.Compared to other races and ethnicities, American Indian or Alaska Native patients have the highest adjusted odds of pseudoexfoliation glaucoma diagnosis and second-highest odds of pigmentary glaucoma. The study also noted that pigmentary glaucoma in American Indian or Alaska Native patients was also more often diagnosed at earlier ages (35 to 44) than among patients of other races and ethnicities.Among the American Academy of Ophthalmology IRIS Registry data from 2011 to 2020, the researchers identified 6,270 American Indian or Alaska Native patients with incident glaucoma (0.34%). Compared with other non-white demographic groups, American Indian or Alaska Native patients were over three times more frequently affected by pseudoexfoliation (4.49% vs. 1.60%) and pigmentary glaucoma (1.37% vs. 0.49%).After adjusting for confounders, American Indian or Alaska Native patients had the highest odds of pseudoexfoliation glaucoma diagnosis (odds ratio: 2.12) compared to other demographic groups and the second-highest odds of pigmentary glaucoma (odds ratio: 1.33). Pigmentary glaucoma was more often diagnosed at younger ages among American Indian or Alaska Native patients. More American Indian or Alaska Native glaucoma patients underwent MIGS (15.2%) compared with patients of other races and ethnicities, with more MIGS procedures performed by a glaucoma specialist (33.9%).“These findings suggest the need for careful screening for pseudoexfoliation and pigmentary glaucoma among these patients, as well as assessment for possible lifestyle modification recommendations such as smoking cessation,” the study authors wrote in their paper, which was published in Ophthalmology Science. “The higher percentage of MIGS and incisional surgery in this study population could suggest more aggressive and severe disease in American Indian or Alaska Native patients at initial presentation, requiring earlier surgical intervention, as well as referral to a glaucoma specialist.”The researchers did note the increased MIGS use, incisional surgery and rates of treatment by a glaucoma specialist among American Indian or Alaska Native patients in the study occurred among patients already diagnosed with glaucoma by a practicing ophthalmologist. Nevertheless, they propose that it is still possible that barriers to care have a greater impact earlier in the patients’ disease course, such as affecting the likelihood of initial diagnosis.“Limited access to care, increased percentage of surgical interventions and increased treatment by glaucoma specialists argue for focused examinations, earlier screenings and appropriate referrals for American Indian or Alaska Native patients,” they noted.Click here for the journal source. Cohen SA, Haque ME, Pershing S, et al. Burden of pseudoexfoliation and pigmentary glaucoma among American Indian or Alaska Native patients. Ophthalmol Sci. November 28, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.