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/CAUTION -- ADVANCE FOR RELEASE AT 6 P.M. EST, WEDNESDAY, NOV. 13

/CAUTION -- ADVANCE FOR RELEASE AT 6 P.M. EST, WEDNESDAY, NOV. 13
 STUDY REVEALS UNDERTREATMENT FOR GLAUCOMA IN BLACK AMERICANS
 /ADVANCE/ WASHINGTON, Nov. 13 /PRNewswire/ -- Findings of a team of researchers from Georgetown University Medical Center and the Health Care Financing Administration released today in The New England Journal of Medicine suggest a substantial gap in glaucoma treatment between black and white Medicare beneficiaries that may in part account for the increased rate of blindness due to glaucoma in black Americans and calls for research into the underlying cause of racial variation in the delivery of care for glaucoma.
 Jonathan Javitt, M.D., M.P.H., director of the Worthen Center for Eye Care Research at Georgetown University Medical Center says, "Although epidemiological studies show that black Americans are four times more likely to have glaucoma and six to eight times more likely to be blind from this disease, our research shows they are only 2.2 times more likely to be treated with incisional or laser surgery (two of the three major treatments for glaucoma) under the Medicare program." Glaucoma is the leading cause of irreversible blindness in black Americans.
 Findings of the study are based on examination of the Medicare records of 1.5 million Americans, aged 65 and older, enrolled between 1986 and 1988.
 "If the treatment gap identified in this study in fact represents under-utilization of sight-saving care, this is of major public health significance. The finding is all the more striking, since all individuals studied were enrolled in the Medicare program, which provides basic insurance coverage for glaucoma surgery," says Javitt. Preliminary results from ongoing analysis of the Medicare data by the researchers shows ophthalmologists accepted assignment from 88.5 percent of the black patients studied, indicating the root cause of the problem is not simply ability of patients to pay for care.
 Although the researchers call for further study into the causes of racial variation in the delivery of glaucoma treatment, Harris and Gallup Poll data recently cited by the National Institutes of Health reports that 75 percent of black Americans do not know about glaucoma and that 85 percent do not know that black Americans are at greatest risk for the disease. Also to be considered may be differences in tendencies between black and white Americans in where they seek eye care in general and their preferences for ophthalmologists, optometrists or one-stop "vision centers."
 Glaucoma is a silent, symptomless disease whose damage to sight is only apparent when the disease is far advance and treatment is much less effective. A quick "glaucoma check," consisting of measuring the pressure of the eye has been shown to be of little value in detecting glaucoma. Although high pressure in the eye significantly increases the risk that a person will develop glaucoma, 50 percent of those with the disease have normal eye pressure on a single test and 20 percent of those with glaucoma do not demonstrate high pressure despite repeated measurements. Only a comprehensive ophthalmologic examination that includes careful examination of the internal structures of the eye and dilated ophthalmoscopic examination of the optic nerve is likely to detect glaucoma in a majority of persons. While ophthalmologists and optometrists are both licensed to examine the eyes for glaucoma, only ophthalmologists, who have completed four years of medical school and four or more years of specialized postgraduate education are trained to perform laser and incisional surgery for glaucoma.
 Treatment for glaucoma may consist of eye drops or oral medication, laser surgery or incisional surgery. Since the Medicare program does not pay for prescription medications, only the latter two treatments were studied by Javitt and his colleagues.
 Health Care Financing Administration professionals who collaborated in the study include Marshall A. McBean, M.D., M.Sc.; Geraldine Nicholson, M.P.A.; J. Daniel Babish, M.P.H.; Joan L. Warren, Ph.D.; and Henry Krakauer, M.D., Ph.D.
 The Worthen Center for Eye Care Research is a division of the Center for Sight (Department of Ophthalmology), Georgetown University Medical Center. It is dedicated to studying the delivery, effectiveness and cost-effectiveness of eye care in the United States and to designing and implementing public health interventions that increase availability and access to sight-saving care.
 Research support for the study was provided by the National Eye Institute and Research to Prevent Blindness, Inc.
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 /NOTE: Dr. Javitt will present his findings at a press conference, Wednesday, Nov. 13, 10-11 a.m., Zenger Room, National Press Club, 14th and F streets, N.W., Washington. All information is embargoed until 6 p.m. that evening, in accordance with the New England Journal Regulations./
 /CONTACT: Clare Fiore of the Georgetown University Medical Center, 202-687-5100/ CO: Georgetown University Medical Center ST: District of Columbia IN: MTC SU: MH -- DC005X -- 3037 11/11/91 12:23 EST
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Date:Nov 11, 1991
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