Christopher A GirkinUniversity of Alabama at Birmingham School of Medicine, Birmingham, AL, USAAbstract: Glaucoma disproportionately affects individual of African ancestry. Additionally, racial differences in the optic nerve head have been well described that may alter the vulnerability to intraocular pressure related injury and, in addition, alter the clinical ability to detect the presence of early optic nerve injury. This paper will review the literature describing racial differences in the optic nerve head between individuals of African and European ancestry with regards to the potential effects of these differences on the ability to detect glaucoma in different racial groups and to potential differences in the pathogenesis of glaucomatous injury.Keywords: primary open angle glaucoma, African American, optic nerve, optic disc, retinal nerve fiber layer