Our annual glaucoma issue, as it seems to do every year, again reinforces the feeling that, despite the great progress that has been made in understanding this group of diseases and their treatment, there is still so much that is unknown.
The same feeling of uncertainty persists after looking at the issue of glaucoma care among the needier members of our society.

Certainly, it's an artificial designation to limit the discussion to glaucoma, when so many lower-income patients have more acute and chronic conditions in addition to their glaucoma. So be it. Because despite the progress in understanding glaucoma, despite the successes like the lobbying effort that established glaucoma screening as one of only three preventive benefits covered under Medicare, there is much, much more to be done.

The case has well been made about the disproportionate level of glaucoma-related vision impairment among blacks. Though it isn't as widely known yet, Proyecto VER data has shown glaucoma to be the leading cause of blindness among Hispanics in this country.

Because it's an artificial designation, we'll likely never know with certainty what connection may exist between glaucoma and socioeconomic status. We do know that low socioeconomic position has been shown to be as great a risk factor for mortality as smoking. The lack of health insurance that afflicts not just the indigent but so many millions of Americans has been called the sixth leading cause of death among those aged 25 to 64, ahead of diabetes and HIV/AIDS.

As with glaucoma, we measure our progress against the "disease" of low income in small steps. The Medicare Glaucoma Benefit was one. The Student Sight Saver Project of Eve Higginbotham and her colleagues, which recruits medical students to participate in glaucoma screenings is another. Nearly a third of the Academy of Ophthalmology's membership has signed on to the association's Eye Care America project to provide care to needy glaucoma patients. When they work, the drug makers' programs that provide free medications to needy patients are another.

And still, just as there is so much more to learn about glaucoma, we have much to learn about Americans who have glaucoma but don't have money.