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

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.