Family History Of Primary Open-angle Glaucoma Research Articles

Racial Disparities in Microinvasive Glaucoma Surgery for Management of Primary Open-Angle Glaucoma: A Propensity Matched Cohort Study: Racial Disparities in MIGS for the Management of POAG

PurposeTo evaluate racial/ethnic differences in the use of microinvasive glaucoma surgery (MIGS) for the management of mild-moderate primary open-angle glaucoma (POAG) in the United States. DesignRetrospective cohort study. ParticipantsPatients with a diagnosis of mild or moderate POAG, as defined by current procedural terminology (CPT) codes, were included. The experimental group comprised African American (AA) patients and the control group consisted of patients without an AA designation in the TriNetX database. MethodsPropensity scoring was used to match cohorts for age at diagnosis, Charlson Comorbidity Index, sex, nicotine dependence, glaucoma medications, family history of POAG, Body Mass Index, and weight. Outcome was incidence of MIGS over 1 year of follow up. Odds ratios were calculated between cohorts Main Outcome MeasureIncidence of MIGS over 1 year of follow-up post-POAG diagnosis. Results63,418 POAG patients were included (50% AA, 50% non-AA). AA patients were found to undergo MIGS at a significantly lower rate (1,268 of 31,709) compared to non-AA patients (1,508 of 31,709) (OR 0.834, 95% CI: 0.773 – 0.900). ConclusionAlthough POAG is understood to be more prevalent among African Americans, these patients display lower utilization of MIGS, suggesting a possible nationwide racial disparity in the management of POAG.

The Assessment of Radial Peripapillary Capillary Vessel Density in Adult Children of Patients With Primary Open Angle Glaucoma.

The observed decrease in radial peripapillary capillary vessel density among adult children of individuals with primary open angle glaucoma, in comparison to controls, suggests the possibility of early microvascular alterations in the eyes of these at-risk individuals. To compare the radial peripapillary capillary vessel density (RPCVD) and peripapillary retinal nerve fiber layer (RNFL) thickness values of eyes between healthy adults with a maternal or paternal history of primary open angle glaucoma (POAG) and age-matched healthy controls without a family history of POAG. RPCVD values and RNFL thicknesses in the peripapillary region and 4 quadrants (superior, inferior, nasal, and temporal) were evaluated using optical coherence tomography angiography among 30 adult children of patients with POAG and 30 age-matched healthy controls without a family history of POAG. The mean whole image RPCVD (51.6±1.7% vs. 49.8±1.7%, P =0.0006) and average RPCVD (54.7±1.7% vs. 53.2±2.1%, P =0.006) values were significantly lower in the adult children of patients with POAG compared with age-matched healthy controls without a family history of POAG. There was no difference in terms of RNFL thickness values in any region. Despite having similar RNFL thickness values to the control group, the observation of lower RPCVD in the eyes of adult children of POAG patients may indicate potential early vascular alterations. The result of the present study encourages further longitudinal studies to determine the potential importance of the underlying vascular alterations in these high-risk individuals.

Family History in the Primary Open-Angle African American Glaucoma Genetics Study Cohort

To determine the relationship between positive family history (FH) and primary open-angle glaucoma (POAG) diagnosis and clinical presentation in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) cohort. FH of POAG in first-degree relatives was assessed in 2365 subjects in the POAAGG cohort. A standardized interview was used to assess FH of glaucoma, demographic characteristics, lifestyle choices, and medical and ocular comorbidities. Positive FH was associated with increased risk of POAG (age-adjusted odds ratio and 95% confidence interval 3.4 [2.8, 4.1]). In age-adjusted analysis among POAG cases, positive FH was associated with younger age (P < .001), female sex (P < .001), hypertension (P= .006), use of hypertension medication (P=.03), and prior glaucoma surgery (P= .02). Cases with positive FH also had thicker retinal nerve fiber layers (P= .03). The risk conferred by positive FH suggests strong genetic underpinnings for some patients with this disease, which will be investigated by genome-wide association studies and whole exome sequencing. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Morphological Abnormalities of Schlemm's Canal in Primary Open-Angle Glaucoma From the Aspect of Aging.

To evaluate morphological abnormalities of Schlemm's canal (SC) among primary open-angle glaucoma (POAG) patients with a family history of POAG (group A), those without a family history of POAG (group B), and patients with normal-tension glaucoma (group C) from the aspect of aging. A total of 160 trabeculectomy specimens from 133 POAG patients were processed for light microscopy using immunohistochemical staining of thrombomodulin and transmission electron microscopy. The following parameters were statistically evaluated: SC length, the percentage of the thrombomodulin-negative area (PTNA) of SC, and the inner-wall SC endothelial cell density (SC-ECD/100 μm). No significant differences in age were observed among the three groups (group A: 56.71 ± 14.83; group B: 58.13 ± 18.13; group C: 56.61 ± 9.78). Length of SC in the group A patients (198.70 ± 81.65 μm, n = 70 eyes) was significantly shorter than in group B (250.30 ± 70.83 μm, n = 67 eyes), and group C (277.70 ± 65.52 μm, n = 23 eyes) patients. A positive correlation of patient age and SC length was observed in group B (r = 0.45, P = 0.0013), but SC length in group A tended to decrease with aging (r = -0.22, P = 0.07). No significant difference in SC was found between group A and B patients before age 50 years (P = 0.30). Correlations between patient age and increase of PTNA (r = 0.38, P = 0.0013) and patient age and decrease of SC-ECD (r = -0.53, P = 3.95 × 10(-6)) were observed only in the group B cases. Our findings suggest that SC in group A may easily collapse during middle age, while SC in group B remains open and SC endothelial cells drop out at around middle age.

Analysis of the influence of type of diabetes mellitus on the development and type of glaucoma.

Dear Editor, We read with interest the article by Halilovic et al. regarding the influence of diabetes mellitus (DM) type on the glaucoma development (1). Similar to the results of previous studies, the authors found that the individuals with DM have an increased risk of developing primary open-angle glaucoma (POAG) (2) and neovascular glaucoma (NVG) (3). Glaucoma is a type of optic neuropathy and DM alone could cause optic neuropathy (by accelerated apoptosis of ganglion and retinal inner neurons, altered metabolism of astrocytes and compromised neuro-glial function) with a complex relation between the two of them (2, 3). Longer DM duration is associated with the increased risk of having POAG (2), while use of systemic medications such as statins, systemic β-blockers and nitrates is associated with lower intraocular pressure (IOP) (3). On the other hand, DM is the major etiologic factor for NVG, with majority of cases seen in proliferative diabetic retinopathy (PDR) (3). Poor metabolic control is a good marker for development and progression of diabetic retinopathy (DR), referring to duration and control of DM which is related to hyperglycemia, hypertension, hyperlipidemia, pregnancy, nephropathy and anemia (3, 4). It is important to note that the DM patients have increased risk of cataracts that can significantly influence the visual acuity (VA) too (4, 5). Other risk factors that predict the development of POAG include: family history, older age, male gender, higher intraocular pressure, longer axial length, thinner central cornea, higher waist to hip ratio, higher cup-to-disk ratios of the optic disc, and higher pattern standard deviation values on the Humphrey automated perimeter at baseline examination (6). It should be noted that central corneal thickness is found to be thicker in patients with DM, which could also cause higher IOP readings (3, 6). For these reasons, we would kindly ask the authors to perform the correlations for age, gender, BMI, DM duration and regimen of therapy, HbA1C, patient follow up time, the use of other systemic drugs, VA, family history of POAG, IOP changes and type of therapy, presence and grade of the lens opacification, axial length, stage of DR, cup-disc ratio and deviation values on the automated perimeter between the groups. Without these information’s it would be difficult to hypothesize the direct influence of DM on glaucoma development, especially in patients without PDR. In these patients, glaucoma development could be consequent to summation of more risk factors, including poor metabolic control, rather than DM type. These findings will significantly contribute to the papers scientific value and contribution. Overall we agree with Halilovic et al. that DM remains important risk factor for glaucoma development and all diabetic patients should have regular ophthalmological control examinations. Other systemic and ocular risk factors such as DM duration, glycemic control together with use of other systemic drugs, IOP values and DR progression should be carefully monitored too.

How significant is a family history of glaucoma? Experience from the Glaucoma Inheritance Study in Tasmania

To determine what proportion of primary open angle glaucoma (POAG) in Tasmania, Australia is familial. Between 1994 and 1996 an audit of Tasmanian patients diagnosed with glaucoma was performed. Identified probands along with their family members were invited to participate. Family history of POAG was noted and pedigrees constructed. Each participant underwent a detailed examination, including visual acuity, intraocular pressure measurement, gonioscopy, optic disc assessment and visual field testing. Participants were classified as normal, suspect or POAG. Data from 467 participants in the Twins Eye Study in Tasmania (TEST) were used as a reference for the general population. Of 2062 participants examined, 1700 were classified as POAG. A total of 1014 participants (59.6%) belonged to families in which other members were affected (familial glaucoma). Six hundred and fifty-six of these 1014 familial cases (64.8%) had a first-degree relative affected. The number of affected members in the family groups varied from two to 29. Six hundred and eighty-eight participants had no known family history of POAG (sporadic glaucoma). There were significantly more POAG patients with a family history of POAG compared to the TEST population (chi2 = 161.81, P < 0.0001), and for a person with POAG the odds ratio of having a positive family history was 4.1 (95% confidence interval: 3.2-5.2). Approximately 60% of POAG in Tasmania is familial. This percentage is higher than most previous reports of familial glaucoma and emphasizes the importance of genetics in POAG, with major implications for screening and future research.

Genetic risk factor in primary open-angle glaucoma: a case-control study.

To evaluate the link between primary open-angle glaucoma (POAG) and potential genetic and environmental risk factors. A case/control study was carried out using 175 POAG patients and 175 controls, all Caucasians of at least 40 years of age. The diagnosis of POAG was established based on the presence of characteristic defects in the visual field and on glaucomatous cupping. The presence of risk factors was established by means of a questionnaire. Using a conditional logistic regression, we found that a family history of POAG in first-degree relatives was a major risk factor (OR = 7.67; 95% CI: [3.25-18.1]; p < 10(-5)). We found no link between diabetes and POAG, high blood pressure and POAG, heart disease and POAG, myopia and POAG, or the use of alcohol or tobacco and POAG. Our results indicate a strong genetic influence in the development of POAG and suggest the hypothesis of a polygenic or multifactorial mechanism.