Prioritizing Eye Health Across Cultures 

May 6, 2025

Diana L. Shechtman, OD, FAAO

As we enter Healthy Vision Month, it is imperative to remember that eye diseases disproportionately affect minority populations, particularly African American and Hispanic communities.  Glaucoma is about five times more common among African Americans, and blindness from glaucoma is six times more prevalent among this group.¹ Additionally, African American and Hispanic populations have approximately twice the rate of diabetes compared to non-Hispanic Whites.² Notably, the duration of diabetes is the strongest predictor for the development of diabetic retinopathy (DR).

Unfortunately, proper management of diseases, like DR, with a favorable prognosis requires early intervention. Yet, many patients are unaware they have these “silent” eye diseases or are at risk for them. Research shows that many of diabetic retinopathy cases among Latinos are undiagnosed, along with a large portion of glaucoma cases. Even symptomatic conditions like cataracts and refractive error often go undiagnosed in this population.³ In my experience, this results in patients presenting with late-stage, symptomatic diseases that are not only more difficult to manage but may lead to permanent visual impairment.

The disparity in timely diagnosis highlights the urgent need to identify and address barriers to eye care—particularly among Hispanic and other minorities. These barriers are multifaceted, encompassing both patient-specific and socioeconomic factors. Common challenges include limited understanding of the importance of routine eye exams, lack of access to health insurance, and social determinants such as poverty, cultural differences, and language barriers. One recent survey found that half of Latinos face difficulties in obtaining timely health screenings due to demanding work schedules, including long hours, difficulty taking time off, and limited access to childcare or transportation.⁴

As eye care providers, we must take proactive steps to overcome these challenges and preserve vision. It is our responsibility to educate communities about prevalent eye conditions, such as diabetic retinopathy and glaucoma, and the critical importance of early detection through comprehensive annual eye exams. Below are some strategies to help at-risk patients access the care they need:

• Implement cost-saving initiatives to make eye care more affordable.
• Utilize telemedicine to reach patients who may have difficulty attending in-person visits.
• Address scheduling by offering flexible hours, including weekends.
• Patients often take interest in their own health and utilize different forms of social media to educate themselves. Thus, leverage social media along community events like health fairs can help raise awareness about the importance of annual comprehensive eye exams and educate the public about diseases like diabetes and the impact on eye health.
• Discuss family history during exams, as many eye conditions have a genetic component. A patient with a parent or grandparent who suffered from a blinding disease should understand their increased risk.
• I often use imaging technologies to visually demonstrate and explain eye conditions to patients.
• Redefine the purpose of an eye exam. Many still think of it as "just for glasses," but a comprehensive eye exam can detect undiagnosed systemic diseases like diabetes and screen for asymptomatic conditions like glaucoma.
• Communicate in the patient's preferred language, when possible. This is crucial not only for accurate case histories and education but also for building trust. While language proficiency is important, the quality of care significantly improves when the provider speaks the patient’s language. The Latinos en Optometry website offers valuable information on the benefits of being bilingual in clinical practice.
• Simplify complex information. For example, when explaining glaucoma, I often compare the optic nerve and its “cupping” to a plate and cup—where a healthy cup should be one-third the size of the plate. If the cup resembles a bowl, that may suggest a possible problem.

It’s not uncommon for a comprehensive eye exam to reveal a previously undiagnosed case of diabetes. This “head to toe” disease affects the entire body and is the leading cause of blindness among young adults. Yet, diabetic retinopathy in many cases remains asymptomatic, even at a late stage of the disease. While treatment options exist, early intervention and tight metabolic control is essential, and coordinated communication with the patient’s entire diabetic care team is vital.

We must embrace collaborative care—a model that emphasizes how different providers can work together to improve outcomes. The number of optometrists continues to grow, while the number of ophthalmologists remains stagnant or is projected to decline. This makes collaboration not just beneficial, but a must—especially within Latino communities. I encourage colleagues to be proactive and consistent with referrals to all other specialists, who are participating in the patient’s care. Ensure that patients understand why they are being referred, the expected timeline for follow-up, and whenever possible, follow up with them to confirm they’ve scheduled their appointments. It is equally important that patients continue follow-ups with you, their primary eye care provider. We play a critical, ongoing role in their overall care.

A simple comprehensive eye exam can have a profound impact—uncovering hidden ocular and systemic conditions. Effective and early intervention of these diseases is crucial in preserving vision. We must remain vigilant in closing the gaps in access to care, fostering collaboration between providers, and empowering each patient to actively participate in managing their health; specially those most at risk like our Latino community.

For more information

References:

1. All About Vision. Eye disease prevalence in African American communities. https://www.allaboutvision.com/conditions/eye-disease-prevalence-in-african-american-communities/
2. American Diabetes Association. https://diabetes.org/about-diabetes/statistics/about-diabetes
3. Varma R, Ying-Lai M, Klein R, Azen SP; Los Angeles Latino Eye Study Group. Prevalence and risk indicators of visual impairment and blindness in Latinos: The Los Angeles Latino Eye Study. Ophthalmology 2004;111(6):1132040.
4. 2024 Wellness Matters Survey, Salud America! https://salud-america.org/what-do-latinos-think-about-preventative-care/

Diana L Shechtman, OD, FAAO, is a board-certified Optometric Physician. She was a full-time professor for 18 years at Nova Southeastern University. She is also the host of Dueling Perspective and Chair of Gold Coast and AOECE “Master Series.” She is currently the consultative optometric physician and medical optometric physician at Loh Ophthalmology & Retina Consultants of Miami.  She is a board director for Latinos en Optometry.

Disclosure: Dr. Shechtman is a consultant for Astellas, Glaukos and speaker for Optos.

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