Eyesight: at what price? Hopkins study finds high blindness rate

In the shadow of the world-renowned Wilmer Eye Institute, citizens of East Baltimore are going blind at a disproportionately high rate because many are not receiving treatments capable of saving their sight, doctors said yesterday.

Johns Hopkins doctors studying 5,308 people living a short distance from the center found that half of all cases of blindness were preventable or reversible -- and that, overall, blacks were twice as likely to remain blind as were whites.


But black or white, many people with glaucoma had never taken advantage of surgery that could have prevented the loss of sight, while many with cataracts had not undergone a one-hour operation that can make a blind person see.

"I think this is terrible," said Dr. Alfred Sommer, dean of the Johns Hopkins School of Hygiene and Public Health, adding that the hospital and medical school recently launched "outreach" programs aimed at educating the public about sight-saving treatments.


"We recognize that we have an obligation to this community -- not just in the ethical sense, but our students also need to be educated about the real problems of the real world," Dr. Sommer said.

The findings, described in today's New England Journal of Medicine, stem from a four-year study of blindness among a sample population of 5,308 adults in East Baltimore.

The study was done under the auspices of Hopkins' Dana Center for Preventive Ophthalmology.

While the researchers have not fully analyzed the reasons why so many eye problems have gone untreated, Dr. Sommer said it is clear that many younger patients lacked financial means: They were too poor to have private health insurance and not poor enough to qualify for Medicaid.

But the majority of patients were over 65, meaning they qualified for Medicare regardless of financial means.

In another study, researchers from Georgetown University speculated that many poor blacks on Medicare missed the opportunity for sight-saving glaucoma surgery because they could not afford co-payments and the supplemental insurance, which can run into several hundred dollars a year.

Emphasizing that he could only speculate, Dr. Sommer said some elderly people may forsake treatment out of the belief that blindness is an inevitable part of aging.

Dr. James M. Tielsch, associate professor of ophthalmology at Johns Hopkins, said he was startled to find that 8 percent of the people over the age of 80 were blind in both eyes. "It's enormous," he said.


"This kind of prevalence for a preventable disease is very, very high."

Some key findings:

* When compared with whites, blacks were 6.6 times more likely to go blind from primary open-angle glaucoma, a condition in which the fluid pressure inside the eye increases and gradually damages the optic nerve.

Previous research has shown that blacks are four times as likely to develop the disease, but the new figure suggests that blacks are also less likely to receive preventive treatment.

* Blacks were also more than five times as likely to remain blind from cataracts, a condition in which vision becomes cloudy as the lens loses its transparency.

Cataracts were the leading cause of blindness among blacks.


* Another disease, age-related macular degeneration, was the leading cause of blindness among whites but did not occur at all among blacks in the study group.

People afflicted with this disorder lose an ever-widening portion of their central vision.

So much untreated eye disease is particularly disturbing in light of the tremendous strides in ophthalmology that have been made over the last 10 to 15 years, said Dr. Tielsch.

Cataract surgery, for instance, is performed on about 1.2 million people each year -- restoring sight to people who once had to live with a progressive loss of vision.

While cataract surgery may be performed after a person has become blind, glaucoma surgery must be done before the disease has destroyed a large part of the optic nerve.

"The problem is that the person is unaware [of glaucoma] until 90 percent of the optic nerve is destroyed," Dr. Sommer said.


Comprehensive eye examinations, in which a doctor peers through a dilated pupil, is the only way to identify glaucoma in time to preserve someone's sight.

Dr. Sommer said people at high risk for glaucoma -- blacks over age 35 and whites over 65 -- should get complete eye exams every year or two.