Nobody chooses their ancestry. Diseases like glaucoma affect “racial” groups differently. The prevalence of primary open-angle glaucoma (POAG) [1] is highest in Black people (5–6.8%; odds ratio 3.7–4.3) and high in Hispanics (2–4.7%). Primary angle-closure diseases are predominant in people with Asian descent (odds ratio 3.6), and normal-tension glaucoma is more common in people from east Asian countries (prevalence in Japan 2.04%) [2]. Does a different reaction to an established therapy like glaucoma valve implantation, usually applied to all “races,” exist?

In this issue of Graefe’s Archive for Clinical and Experimental Ophthalmology, Tan et al. [3] intended to determine factors associated with vision loss of ≥ 2 Snellen lines 1 year after Ahmed glaucoma valve (AGV) surgery in 241 eyes of Black (149 = 61.8%) or Hispanic (92 = 38.2%) patients with glaucoma (80.9% with POAG) in their retrospective study. Of these eyes, 78 (32.4%) had standalone AGV surgery, whereas 125 (51.9%) eyes had AGV combined with cataract surgery and intraocular lens implantation, and 38 (15.8%) eyes had AGV combined with cyclophotocoagulation ± cataract surgery and intraocular lens implantation. In 202 (83.8%) eyes was no previous surgery; 107 (44.4%) eyes had previous glaucoma laser treatment. The visual field mean deviation was 18.70 ± 9.5 dB (i.e., advanced glaucoma) with split fixation in 54.8%, mean intraocular pressure (IOP) was 26.45 ± 9.79 mmHg, and the mean Snellen visual acuity was 20/50. Main outcome parameter was the presence of a hypertensive phase (HP), defined as an increase of the IOP to > 21 mmHg within the first 3 postoperative months after reduction below 22 in the first week.

Vision loss of ≥ 2 Snellen lines was transient during the first postoperative months, improved partially and occurred in 56 (21.6%) eyes at the 1-year follow-up visit. Mean IOP at 1-year follow-up visit was 15.2 ± 4.63 mmHg. Hypertensive phase (in 112 = 46.5% eyes; OR 4.71) and split fixation (OR 1.47) each increased the odds of vision loss at 1 year, while concurrent cataract surgery decreased the odds (OR 0.42) even after adjustment for other variables according to high-quality statistical analyses.

The retrospective design limits the generalization of the results. But these results should motivate ophthalmologists to a close follow-up during the first 3 postoperative months especially in patients with split fixation to treat any increase in IOP to > 21 mmHg properly (e.g., with antimetabolite injections). A comparison with results of eyes of White patients with AGV would have been very interesting.

Considering published landmark studies about drainage devices like Ahmed or Baerveldt shunts, Black and Hispanic patients were included, but in relatively low numbers. The Ahmed Baerveldt Comparison Study [4] comprised 68 (25%) Black, 33 (12%) Hispanic, and 134 (49%) White patients; the Ahmed versus Baerveldt Study [5] included 28 (12%) Black, 12 (5%) Hispanic, and 170 (71%) White patients, respectively. Therefore, any additional information about outcomes among minority populations from well-designed and analyzed studies is welcome.