As medical research and epidemiological data become increasingly specific, the ethnic/racial/heritable differences between patients of different backgrounds have acquired greater attention. Diabetes, one of most debilitating and prevalent diseases of this century is the leading cause of blindness in the United States. Recent data has revealed the surprisingly disproportionate impact the illness will have on Asian patients. Other studies are showing how the Body Mass Index (BMI) measures of obesity may be severely underestimating (nearly 3 fold) the cardiovascular damage of weight gain in Asian patients. Asian patients are created differently. Although some common medical problems rarely impact Asians, for other diseases, Asians may be more susceptible, having evolved to survive in a different environment. Is it so tough to imagine that different medicines or even alternative surgical approaches might be better choices to optimize the treatment of the Asian patient?
Thyroid eye disease (TED) is an autoimmune disorder that attacks the tissues around the eyes, which in non-Asian patients typically presents as proptosis, or protrusion of the eyes. Clinically, the consequences are often only cosmetic. But for Asian patients, the 3D configuration of the orbital bones and eyelids often minimizes the eye widening, or surprised look that typifies TED in African American and Caucasian patients. Instead, Asians are more likely to present with more visually significant symptoms or even blindness. This is just an example of how these racial/ethnic differences impact the clinical presentations of even the same disease. Early appreciation is often critical to preventing serious damage.
Here are some other medically and visually significant differences that are more prevalent in certain patients of Asian background:
Sleep Apnea
Dry Eyes
High Myopia (Near-sightedness)
Primary Angle Closure Glaucoma
Chinese were recently found to have a surprisingly high incidence of the most visually debilitating form of macular degeneration, the wet, or exudative type. Once believed to be rare in pigmented races, this increased incidence perhaps might be related to the surprisingly low density of iris melanocytes.
Iris color has been shown to be related to the density and size of melanosomes within the anterior stromal iris melanocytes, not the cell density. In Asians with darkly pigmented irides however, melanocyte cell density was found to be significantly lower, which may help to explain the higher incidence of macular degeneration.
