Abstract
PURPOSE: To estimate the burden of and to evaluate the predictors associated with Undetected Eye Disease (UED) in African American adults. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Self-identified African American participants 40 years and older (n = 6347) from thirty contiguous census tracts in Inglewood, California. METHODS: Participants from the African American Eye Disease Study (AFEDS) underwent a complete ophthalmic examination and an in-home-administered questionnaire to assess predisposing, need, enabling, and health behavior predictors associated with UED, including an assessment of ocular conditions such as age-related macular degeneration (AMD), open-angle glaucoma, diabetic retinopathy (DR), visually-significant cataract, and refractive error. Participants with any eye disease (n = 3434) were included in these analyses. UED was defined as having 1 or more eye diseases (AMD, glaucoma, DR, visually-significant cataract-visual acuity in the cataractous less than 20/40, and refractive error) based on the eye examination and self-reporting no known history of any eye disease. The independent associations with UED were explored using multiple logistic regression analysis. MAIN OUTCOMES AND MEASURES: Prevalence of and predisposing, need, enabling, and health behavior predictors of UED. RESULTS: Fifty-four percent (3434 of 6347) of the participants had eye disease. Twenty-two percent (766 of 3434) of them had undetected eye disease. The major risk factors for UED included having diabetes mellitus (OR [95% CI], 3.52 [2.92-4.26], P < .0001), never having had an eye examination (OR [95% CI], 1.75 [1.14-2.65], P < .0001), having had an eye examination more than 5 years ago (OR [95% CI], 1.66 [1.19-2.31], P < .0001), having poor or very poor general vision (OR [95% CI], 1.89 [1.58-2.27], P < .0001), and trouble getting glasses (OR [95% CI], 1.57 [1.28-1.94], P < .0001). CONCLUSIONS: Our data provides evidence of the significant burden of UED among African American individuals. Interventions that address the modifiable risk factors (e.g., trouble getting glasses, never having had an eye examination) may improve detection of eye disease and decrease the burden of VI in this high-risk minority population.