The Changing Face of Eye Care

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by Kelly Waterhouse

The Canadian cultural landscape is evolving into the diverse mosaic it is intended to be and for eyecare professionals (ECPs) that means it is important to educate patients on the genetic implications of certain eye health concerns, some of which are more prevalent to ethnicity-specific groups.

Keith Gordon, Vice President of Research for the Canadian National Institute for the Blind (CNIB), says it is important for patients to understand their genetic heredity in eye health, including how it relates to their ethnic ancestry.

“Many eye diseases have genetic origins and if your parents or siblings have the disease, you will be at a higher risk of acquiring the disease yourself. In particular, glaucoma and age-related macular degeneration (AMD) have been shown to be genetically linked while genetic factors have also been shown to be involved in diabetic retinopathy,” Gordon said.

He adds, “In addition to your family history, your ethnic background will also affect your risk of developing many eye diseases. People of East Asian origin (Chinese/Japanese) are at a higher risk of developing a form of glaucoma called narrow angle glaucoma as are people of Inuit heritage, while First Nations
people and people from South Asia (India, Pakistan, Sri Lanka) have a higher risk of developing diabetic retinopathy.”

In the case of glaucoma, Gordon explains that it is the anatomy of the eye that predisposes the nature of the glaucoma, should the disease occur.

For East Asian people, this puts them at a greater risk of narrow angle glaucoma, also known as closed-angle glaucoma, than the general population.

“If the eye tends to be more narrow then the angle between the iris and drainage is more narrow, simply because they have narrower eyes,” Gordon said. “People of East Asian descent have narrower eyes. It’s strictly a matter of their anatomy-ethnicity.”

According to research through the CNIB, people of African descent have up to eight times the risk of experiencing open-angle glaucoma, also known as wide-angle glaucoma, than the general population. People of Hispanic ethnicity are also at a greater risk. Caucasians are also at risk for this form of glaucoma, but are
more likely to develop AMD than any other ethnic groups.

Everyone with diabetes is at risk of developing diabetic retinopathy, the CNIB website states, but there are certain factors that increase this risk. Some of the risk factors cannot be controlled, including ethnicity.

“The risk of diabetic retinopathy is higher in people of Aboriginal, Latin American, Asian, South Asian and African origins,” Gordon said.

The Canadian Diabetes Association Clinical Practice Guidelines confirms: “Aboriginal peoples living in Canada are among the highest risk populations for
diabetes and related complications.”

Their research states that Aboriginal Canadians are three to five times more likely than the general population to develop type 2 diabetes and are, therefore, at a much higher risk of developing vision problems related to diabetes.

Supporting that statement, the Public Health Agency of Canada’s report, Diabetes in Canada: Facts and Figures From A Public Health Perspective, researched diabetes amongst First Nations, Inuit and Metis populations.

Recognizing that the prevalence of diabetes varies between these cultural groups, according to its unique characteristics, the report states that the socio-cultural, biological, environmental and lifestyle changes seen in the First Nations, Inuit and Métis populations in the last half century have contributed significantly to increased rates of diabetes and its complications. Complications of diabetes are also more frequently seen among the Aboriginal population than in the non-Aboriginal population.

“Thirty to 40 per cent of diabetic Canadian Aboriginal peoples have diabetic retinopathy, three times as high as the Canadian population,” Gordon states.

Gordon points out that patient education is key to creating awareness, offering early detection and encouraging preventative measures when it comes to eye health. Patients need to understand how their genetics and ethnicity impact their risks for certain diseases. Communication is essential.

“If you don’t know there is glaucoma in the family and your not aware of the ethnic implications, you don’t know what to look for,” Gordon said. “The good news is that early detection and treatment of these diseases can minimize serious vision loss.”

Canada’s cultural mosaic is a landscape that celebrates ethnic diversity. As communities evolve and grow, there are new opportunities for ECPs to work with patients and change the future of eye health for generations of Canadians to come.

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