Glaucoma in a New York City Jail Population

Purpose: Incarceration affords an opportunity to provide ophthalmologic care to populations with otherwise limited access in the community. Inmates have higher rates of diabetes and ocular trauma compared to the general population, which put them at risk for glaucoma. The objective of this study was to evaluate the rate and severity of glaucoma in a New York City jail population. Methods: We performed a retrospective review of the medical records of 533 male inmates referred from Riker's Island Jail seen by the Bellevue Hospital Ophthalmology Consult Service from 2005-2010. Medical records were reviewed for sociodemographics, medical history, diagnosis, intraocular pressure (IOP), cup to disc ratio (c/d), and number of follow up visits. Results: The average age was 38.8 ± 13.2 years old (range 16 to 78). 60% were African American, 27.0% were Hispanic, 10% were Caucasian, and 3% other. Thirty-four patients (6%) were diagnosed with glaucoma: 3 patients (8%) had angle recession glaucoma, 3 patients had traumatic glaucoma (8%), 1 patient (3%) had chronic angle closure glaucoma, and 27 patients (79%) had primary open angle glaucoma (POAG). Average c/d on examination was 0.39 ± 0.17 for all patients vs. 0.72±0.19 for glaucoma patients (p<0.01). Six of the 34 patients returned for automated perimetry (average mean deviation: -16.9 ± 11). Of the 34 patients, 9 (26%) had no documented history of previously seeing an ophthalmologist. The average age for glaucoma patients was 50.2 ± 12.6 (p<0.01), with 27 African American patients (79%) and 4 Caucasian patients (12%). Average IOP of glaucoma patients was 21.4 ± 11.1, while the average IOP of the overall population was 14.8 ± 11.1 (p<0.01). Additionally, 43 patients (8%) were diagnosed as glaucoma suspects secondary to increased c/d, cup to disc asymmetry, or elevated IOP. Of this group, only 8 patients returned for follow up examination. Conclusions: Among incarcerated individuals referred for ophthalmologic care, 6% had glaucoma and 8% were glaucoma suspects, with a greater number being African American. Jail may be an important entry point for ophthalmologic care and may be a good opportunity to engage at risk individuals.