COLUMBIA, S.C. >> It’s as if she’s squinting through a smoke-filled room. But it’s Charisse Brown’s eye condition, glaucoma, that diminishes her vision.

Brown, 38, has worked all her adult life, with a personal policy of keeping two jobs at once. But when she started losing sight in her left eye last year, she was forced to quit her call center job. That left her with one income stream, her marketing research job, to pay her $1,300 monthly rent and other bills.

If glaucoma is caught early, monitored by a doctor and properly treated, it’s possible to stall the progression of the disease. Eye drops are necessary for keeping eye pressure down to slow glaucoma-induced damage. Without insurance, the monthly cost of the medication can run anywhere from $80 per bottle for a generic version to $200 or $300 for a brand-name one.

As an adult without children, Brown doesn’t qualify for Medicaid in South Carolina, which has not expanded the program under the Affordable Care Act.

She’s enrolled in the lowest-premium plan on her state’s health care insurance marketplace, but ophthalmologists in the area won’t accept her insurance.

She said she called 211, a hotline for community services in South Carolina, but her voicemails weren’t returned. In medical debt and about to get kicked out of her apartment, she had to choose between her medication and paying for daily necessities like food and feminine care items. One food stamps enrollment worker told her: “We can’t approve you. If you go and have a baby, this will be a lot easier.”

“Single people — we’re struggling,” Brown said. “I feel like I’m getting punished for trying to do what’s right.”

Glaucoma is a group of eye diseases that can cause a buildup of pressure that damages the optic nerve. Long called the “thief of sight,” it’s the leading cause of blindness in Black Americans like Brown. Black people are five times more likely to have glaucoma, and lose their sight at six times the rate of white people. Hispanic and Latino communities suffer similar disparities.

Among Black patients, a timely diagnosis is paramount: Glaucoma occurs on average a decade earlier — and advances faster.

But diagnosis and treatment can be costly and out of reach for many.

In South Carolina and the other nine states that have not expanded Medicaid, opponents of expansion say it would be too expensive to provide health coverage to more people, even though the federal government picks up 90% of the tab. But forgoing expansion also has costs. People without insurance or not enough insurance are more likely to visit the emergency room, as glaucoma and other chronic diseases take their toll. When it comes to eye diseases, vision can deteriorate without coverage for preventive care. And racial health disparities are higher in states that have not expanded.

“You see a lot of end-stage disease,” said Dr. Rebecca Epstein, a glaucoma specialist and ophthalmologist at South Carolina’s Clemson Eye, which was not involved in Brown’s care. “They don’t have insurance, and so they will delay care. And then they come in, one eye is already gone, another eye is on its way — and I’m sitting here having to tell them I’ve got to operate on their only eye.”

For about two months, Brown was fully blind in her left eye. Surgeries to address her warping cornea, a condition called keratoconus, and another to relieve pressure causing her glaucoma would cost upward of $10,000. Asked if they could offer a payment plan, her doctor’s office staff said no.

For days, Brown and her siblings called dozens of charities, asking for help to pay for her surgery. They called doctors across the state, asking if they had the necessary surgeon specialists and whether they accepted her insurance. Some nonprofits told Brown she was too young, that their help was reserved for older adults.

She finally landed on the South Carolina charity Lions Vision Services, affiliated with Lions Club International. The group offers eyeglasses, vision screenings and reimbursements to local doctors for surgeries patients living below the poverty line can’t afford. The charity told her it could pay for her eye surgeries, and Brown was in disbelief.

“Access shouldn’t be this hard. Our state should do a better job of making sure that we have coverage for people and that they have access to care — before they’re blind,” Epstein said. “Here’s the crazy thing to think about: So, you don’t give them access to care. You let them go blind, and then you’re going to pay for their disability when they go blind, right? How backwards is that?”

Had she not gotten the surgeries, Brown would have lost sight completely in that left eye, doctors told her.

Before she found Lions, the search had been so frustrating that she told her mother through tears, “Maybe I should just let this eye go.”