Burden of Pseudoexfoliation and Pigmentary Glaucoma among American Indian or Alaska Native Patients.

Objective: To evaluate differences in glaucoma subtype, patient characteristics, and treatment among American Indian or Alaska Native patients compared with other demographic groups. Design: Retrospective observational study. Participants: A total of 1 855 970 patients were diagnosed with glaucoma, 2011 to 2020. Methods: Glaucoma was identified from diagnosis codes. Incidence and associated patient characteristics were determined for primary open-angle glaucoma, juvenile open-angle glaucoma, pigmentary glaucoma, and pseudoexfoliation glaucoma. Treatments (selective laser trabeculoplasty, microinvasive glaucoma surgery [MIGS], and incisional glaucoma surgery) and inferred subspecialty of the treating physician were evaluated for each subtype. Results were stratified by patient race and ethnicity, and multivariable logistic regression was used to evaluate the likelihood of pseudoexfoliation and pigmentary glaucoma, respectively, among American Indian or Alaska Native patients compared with other race/ethnicities. Main Outcomes Measures: Glaucoma incidence by subtype and race and ethnicity; incidence of incisional procedures, MIGS, and selective laser trabeculoplasty in American Indian or Alaska Native patients; and adjusted odds ratios (ORs) for the likelihood of pseudoexfoliation and pigmentary glaucoma based on race/ethnicity. Results: We identified 6270 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 >3 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 (OR, 2.12; 95% confidence interval [CI], 1.85-2.42) compared with other demographic groups, and the second-highest odds of pigmentary glaucoma (OR, 1.33; 95% CI, 1.14-1.56). Pigmentary glaucoma was more often diagnosed at younger ages among American Indian or Alaska Native patients. More American Indian or Alaska Native patients with glaucoma underwent MIGS (15.24%) compared with patients of other races and ethnicities, with more MIGS procedures performed by a glaucoma specialist (33.9%). Conclusions: American Indian or Alaska Native patients have a strikingly increased burden of pigmentary and pseudoexfoliation glaucoma. Because of a smaller population size, these groups are historically less studied and may not be recognized as higher risk. Vigilance is warranted to identify pseudoexfoliation and pigmentary glaucoma among American Indian or Alaska Native patients. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.