193817 Young, blind, and illegal: An unusual outcome of juvenile-onset glaucoma in an undocumented person

Monday, November 9, 2009

Mark Sherstinsky, OD, MPH candidate , Master's Program in Global Public Health, New York University / SUNY State College of Optometry, New York, NY
Andre Stanberry, OD , SUNY State College of Optometry, New York, NY
Juvenile-onset glaucoma (JG) is a rare type of primary open angle glaucoma (POAG), usually diagnosed before the age of 18. Like adult-onset POAG, it presents with high intraocular pressure, optic nerve excavation, and visual field loss, although generally with a more severe, rapid course. Diagnosis of JG is also often made at a late stage, due to its asymptomatic nature and to de-emphasized glaucoma screenings in the younger population. We report the case of a 39-year-old Caribbean Black female with JG who develops an acute absolute monocular hemianopic defect in the late stage of her glaucoma, an unusual outcome in the disease. The case management of the patient is not only complicated by her late presentation for treatment, but also by her socioeconomic and undocumented status. Thus, her fears of revealing her illegal status and potential deportation further prevents her to seek timely health care, and results in early blindness. As we chronicle her disease course over 4 years, we also highlight how immigration policy and lack of emphasis on primary prevention can undermine efforts of the public health care system, particularly for poor, undocumented persons.

Learning Objectives:
1. Discuss how undocumented and low socioeconomic status in the US can directly lead to poor visual outcomes. 2. Define and describe juvenile-onset glaucoma, as well as the particularly unusual outcome in this case. 3. Identify and discuss immigration-related barriers to health care in the US. 4. Discuss how an emphasis on primary vision care can improve visual outcomes.

Keywords: Vision Care, Access to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: 1) Assistant Clinical Professor at SUNY State College of Optometry (with previous posters and lectures presented on ocular disease and public health) 2) Student in the New York University Master's program in Global Public Health
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.