Glaucoma spectrum findings among the Yanomami Indigenous people of the Brazilian Amazon

Vollständiger Abstract

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Abstract Purpose This study provides the first systematic characterisation of IOP, optic disc C/D ratio, and fundoscopic findings in the Yanomami, one of the largest and most geographically isolated Indigenous peoples of the Amazon, and identifies findings suggestive of glaucoma. Methods Cross-sectional observational study conducted June–August 2024 at the Yanomami Indigenous Health House (CASAI-Y), Boa Vista, Brazil. One hundred fifty-eight self-identified Yanomami individuals aged ≥ 5 years were examined. Non-contact tonometry (Huvitz HNT-7000), portable non-mydriatic fundus photography (Eyer), portable slit-lamp biomicroscopy, and direct ophthalmoscopy were performed. C/D ratio was graded by fundus photographic review. Associations were assessed by OR with 95% CI, Student t test, one-way ANOVA, Fisher exact test, and Spearman and Pearson correlation. P values were adjusted for multiple comparisons using the Benjamini–Hochberg procedure. Results Among 151 participants with assessable IOP (secondary glaucoma case excluded from descriptive analysis), mean IOP was 13.64 mmHg (SD 1.59) OD and 13.93 mmHg (SD 1.75) OS; ocular hypertension was identified in 1 participant (0.66%). Mean C/D ratio was 0.261 (SD 0.129) OD and 0.267 (SD 0.138) OS among 148 participants; 3 (2.03%) had C/D > 0.5 in at least one eye. No significant IOP–C/D correlation was found (Spearman rₛ = 0.105, P = .210 OD; rₛ = 0.058, P = .496 OS). Secondary angle-closure glaucoma was confirmed in one participant (IOP 35/55 mmHg, 360° synechiae, no light perception). Two further participants had findings suggestive of primary glaucoma. Ocular trauma was associated with retinal cicatricial lesions (OR 13.41; 95% CI 2.55–70.35; P = .008; P adj = .036) and, without retaining significance after adjustment for multiple comparisons, with fundoscopic abnormality (OR 7.98; 95% CI 1.26–50.55; P = .04; P adj = .10); both estimates rest on 7 trauma-exposed participants. No diabetic retinopathy was identified. Conclusions This study provides the first quantitative ophthalmic baseline for the Yanomami regarding IOP, optic disc morphology, and fundoscopic findings. Primary open-angle glaucoma does not appear to constitute a relevant burden. Secondary glaucoma from complicated cataract is the most preventable severe presentation. Angle-closure glaucoma remains uncharacterised. Cataract surgical access, camerular angle screening, and glaucoma investigation are unmet priorities in this population.