Positive Family History Of Glaucoma Research Articles

The accuracy of self-reported family history in glaucoma in Brazil.

To evaluate the accuracy of a positive self-reported glaucoma family history. Cross-sectional study. Each subject was asked if they had a first-degree relative diagnosed with glaucoma. If their answer was affirmative, the relative was invited to attend on ophthalmic evaluation and underwent complementary exams to confirm or exclude the glaucoma diagnosis. Only one relative was included per subject. We included 204 subjects in the study (102 subjects and their respective relatives). The accuracy of family history of glaucoma was 76.96% of the cases. In the univariable analysis, subjects with college degree had 2.34 [(P = 0.010; 95% confidence interval (CI) 1.18-4.63)], with higher family income 3.72 (P = 0.003; 95% CI 1.57-8.85) and those with health insurance 3.42 (P = 0.001; 95% CI 1.67-6.98) more chances to have a true positive family history for glaucoma. In the multivariable logistic regression analysis, none of the variables presented significant association. Around 24% of patients may not provide reliable information about family history for glaucoma. When asking about a glaucoma family history, clinicians should consider the real accuracy of this self-reported data.

Tackling the Silent Thief of Sight: Assessing Glaucoma Awareness, Knowledge, and Risk of Prevalence in Karachi

Background: The objective of the study was to assess understanding of glaucoma awareness and knowledge, alongside the prevalence of glaucoma and associated risk factors among the general population of Karachi, Pakistan. Methodology: This cross-sectional survey-based study determined a sample size of 384 using a z-test score at a 95% confidence interval with a margin of error of 0.05. Data were collected via questionnaire over approximately six months. Basic statistical techniques, including frequency and percentage calculations using MS Excel version 2016, were employed for data analysis. Results: Five hundred individuals participated in the survey. Glaucoma awareness was noted in 56% of respondents, with 9.6% having a confirmed diagnosis of glaucoma. Higher education, positive family history of glaucoma, and previous eye tests were significantly associated with glaucoma awareness. Media served as the primary source of glaucoma information. Higher education correlated with better glaucoma understanding, while increasing age, exposure to high-intensity light, and associated disorders were linked to a higher glaucoma prevalence. Conclusion: Glaucoma, a common eye ailment, can lead to blindness. Training medical personnel to identify symptoms and expanding public knowledge and treatment options are crucial to reducing its occurrence. Raising awareness and providing free medical care to the underprivileged can significantly enhance quality of life.

Predictors of glaucoma knowledge and its risk factors among Jordanian patients with primary open angle glaucoma at a tertiary teaching hospital: A cross-sectional survey.

To assess and compare glaucoma knowledge between Jordanian patients with glaucoma and non-glaucoma ophthalmic patients. A cross-sectional survey was developed after an extensive literature search to investigate glaucoma-related knowledge among participants with glaucoma visiting the Jordan University Hospital clinics from October 2021 to February 2022. Responses were compared to a sample of ophthalmic participants with eye conditions other than glaucoma visiting the ophthalmology clinics at the same time frame. A total of 256 participants filled out the survey, of which 53.1% were diagnosed with glaucoma while 46.9% had ophthalmic conditions other than glaucoma. Our sample of participants is characterized by a mean age of 52.2 ± 17.8 years and a male-to-female ratio of 1.04:1. Overall, participants with glaucoma were more aware of their disease than participants with other ophthalmic conditions. Compared to their ophthalmic non-glaucoma counterparts, those diagnosed with glaucoma face significantly more daily life difficulties due to their ophthalmic disease (p <0.001). Results of the independent sample t-test demonstrate that participants with glaucoma have significantly higher knowledge scores (p <0.001) and were able to recognize more glaucoma symptoms than their non-glaucoma counterparts (p = 0.002). Similarly, those with a positive family history of glaucoma displayed higher knowledge (p = 0.005). Multivariate linear regression demonstrates that family history of glaucoma, higher symptom recognition score, reliance on ophthalmologists, and the internet for glaucoma-related information are positive predictors of higher knowledge scores. We have demonstrated that both glaucoma and non-glaucoma ophthalmic patients display average levels of glaucoma knowledge. Raising awareness through various interventions may improve the lifestyles of patients with glaucoma and alleviate the economic burden associated with treating the disease.

The short-term effects of intranasal steroids on intraocular pressure in pediatric population.

To evaluate the effect of intranasal mometasone furoate (INMF) on short-term intraocular pressure (IOP) alterations in children with allergic rhinitis (AR). Children diagnosed with AR and to whom INMF nasal spray had been firstly prescribed were enrolled. Cases with any ocular diseases except for refractive errors were excluded. Complete ophthalmologic examinations including IOP measurements using Tonopen XL were performed before the treatment as well as at the first and sixth weeks of follow-up. Demographics and ophthalmologic findings were noted and statistically analyzed. Study population consisted of 62 right eyes of 62 children with a mean age of 8.55 ± 3.14years. Of them, 29 were female (46.8%) and 33 were male (53.2%). Dilated fundoscopy revealed an enlarged Cup/Disc ratio in 12 eyes (19.4%). Family history of glaucoma was positive in 13 cases (21.0%). Mean best corrected visual acuity was found as 0.05 ± 0.08 logMAR. Initial IOP was 17.1 ± 2.3mmHg; whereas it was measured as 18.2 ± 2.0mmHg and 17.3 ± 2.1mmHg at the first and sixth weeks of follow-up, respectively (p < 0.001). Both at the first and sixth weeks of follow-up, significant IOP rise was present in children with a positive family history of glaucoma (p < 0.001 and p = 0.003, respectively). Besides, increased IOP was found in participants with cupping revealed on fundoscopy at the first week of follow-up (p = 0.044). Since children have greater risk for steroid-induced ocular hypertensive response than adults, ophthalmologic evaluation must be recommended in children receiving intranasal steroids.

A Study on Screening of Glaucoma among Patients Attending Tertiary Eye Care Hospital at One of the Cities of Western India

Introduction : Glaucoma is the leading cause of irreversible visual loss in world and also in India. Because of the relatively asymptomatic initial phase of the disease, it is often detected by chance and is frequently associated with extensive and irreversible damage at the time of diagnosis. Objectives:To screen for Glaucoma among patients eligible as per inclusion criteria, to classify the glaucoma cases according to clinical presentation and to correlate the occurrence of glaucoma with different variables. Method: The present study was conducted at one of the tertiary care hospitals of Ahmedabad city during celebration of “World Glaucoma Week - 2021”. Total 1421 patients were offered opportunistic screening after oral informed consent during 6-12 March 2021, who attended the institute. After applying exclusion criteria, 945 were found eligible who underwent a comprehensive ophthalmic examination like visual acuity, intraocular pressure measurement, gonioscopy, optical disc and visual filed examinations were carried out as per standard protocols. Sociodemographic details, any relevant ophthalmic history pertaining to glaucoma and systemic illnesses were also assessed. The data were entered and analyzed in MS excel. Results: The incidence of newly diagnosed cases of glaucoma among opportunistic screened cohort was 36.71% (n=347). Of total newly diagnosed, the presentation as per clinical classification was as follows: Primary open angle glaucoma (POAG) - 202 (58.21%), Primary angle closure glaucoma (PACG) - 77 (22.19%), Primary angle closure suspect (PACS) – 41 (11.82%), Ocular hypertension (OHT) – 6 (1.73%), Normal tension glaucoma (NTG) – 10 (2.88%), Secondary glaucoma – 9 (7.09%) and Congenital glaucoma – 2 (0.58%). In yield, 25 (19.68%) were ≤40 years and 36 (28.35%) had positive family history of glaucoma. Conclusion: Presence of stand-alone Diabetes and Hypertension or presence of both accompanying – all three conditions were found to be statistically significant determinant for occurrence of particular variety of Glaucoma. There was highly significant statistical association between cup-disc ratio level at the time of presentation and clinical variety of glaucoma.

Should mitral valve prolapse be considered as one of the risk factors for open angle glaucoma? A preliminary observation.

To assess the incidence of mitral valve prolapse in patients with newly diagnosed primary open angle glaucoma. The study included 12 patients without any other comorbidities or taking any general or local medications. Each patient underwent a full ophthalmological examination with visual field assessment and optical computed tomography of the macula and optic nerve head. Carotid Doppler ultrasound was performed to exclude impaired blood flow in this region and transthoracic echocardiography with assessment of the function and morphology of the heart valves. In the study group, mitral valve prolapse was found in seven patients (58.3%), while mitral valve regurgitation in 11 patients (91.7%). One case of normal pressure glaucoma and four cases of juvenile glaucoma were diagnosed. There were also other risk factors for glaucoma: myopia (58.3%), migraine headaches (41.7%), a positive family history of glaucoma (16.7%). Mitral valve prolapse could be indicated as a new risk factor for glaucoma. It seems reasonable to conduct screening tests for glaucoma in patients with mitral valve prolapse in the course of echocardiography.

Demographic and Epidemiological Profile of Patients with Adult-onset Primary Open Angle Glaucoma in a Tertiary Niger-Delta Hospital, Nigeria

Background/Objective: This was a prospective study of patients attending the Glaucoma Clinic at University of Port Harcourt Teaching Hospital, Nigeria and were diagnosed with adult-onset Primary Open Angle Glaucoma (POAG). The objective of the study was to identify and report the demographic and epidemiological characteristics and comorbid states of patients diagnosed with adult-onset POAG. Materials and Methods: Clinical assessment of patients combined with findings from clinical records and interviewer-administered semi-structured questionnaire were used to obtain relevant data from the respondents between January and December 2021. Data collected included demographic data, ethnicity, comorbidity and family history of glaucoma. Results: Eight hundred and fifty(n=850) POAG patients adult aged ≥40 years were recruited in this study. The mean age was 60.5 ± SD 10.1 years. The modal age group was 60-69 years. Seven hundred and seventy-two (n=777; 90.8%) had various forms of visual impairment. Five hundred and twenty-six (n=526; 61.9%) had positive family history of glaucoma in first degree relatives while 120 (14.1%) had positive family history of glaucoma in second degree relatives. Comorbidities associated with adult-onset POAG were cataract (44%), diabetes mellitus (30%) and systemic hypertension (26%). Conclusion: Risk factors for adult-onset POAG in the Niger-Delta are similar to those reported in other black populations in Africa - impaired vision, positive family history of glaucoma, diabetes mellitus, systemic hypertension and cataract. Knowledge of patients’ demographic and epidemiological details are vital for early detection and treatment, thereby reducing the scourge arising from POAG in our population. Keywords: Adult-onset POAG, demographic profile, epidemiological profile, Niger-DeltaRegion, Nigeria.

Glaucoma and its predictors among adult patients attending ophthalmic outpatient department: a hospital-based study, North West Ethiopia

BackgroundNearly 1.9% of global blindness is caused by glaucoma and this is sadly high in Africa which is around 15% and In Ethiopia, glaucoma is responsible for 5.2% of blindness. It is also the fifth cause of blindness in Ethiopia. Scarce information is available regarding glaucoma in Ethiopia; hence we determined the proportion of glaucoma and its associated factors in North West Ethiopia which will be utilized for future related researches and different stakeholders.MethodsInstitution based cross-sectional study was conducted from September 1/2020 to February 30/21 among 258 adults aged 40 and above years old. The participants were selected using the systematic random sampling technique. The data was collected using an interview-administered questionnaire. Binary and Multi-variable logistic regressions were fitted to identify independent predictors of glaucoma. P-value less than 0.05 were used as a cutoff point for declaring statistical significance.ResultsThe prevalence of glaucoma was 66(26%) with a 95% CI of 17.7, 35.4%). Individuals with Positive family history of glaucoma (AOR: 3.72, 95% CI: 1.03–3.53), age (AOR: 3.21, 95% CI: 1.92–5.99) and elevated intraocular pressure (AOR: 3.09, 95% CI: 1.45–6.59) were statistically significant contributing factors for the development of glaucoma.ConclusionThe study found a relatively high proportion of glaucoma in the study area, which is primarily a disease of the elderly. Age, elevated intraocular pressure, and positive family history of glaucoma was contributing factors for the emergence of glaucoma. Therefore, establishing public awareness programs about the identified risk factors for the prevention and early detection of cases is essential.

Prevalence of Normal Tension Glaucoma (NTG) in Peshawar

Aim: Prevalence of Open angle glaucoma with normal intraocular pressure in Peshawar Methodology: It is a cross sectional study. It is done at Physiology Department, Khyber Medical College, Peshawar in collaboration with Ophthalmology deptt. Khyber Teaching Hospital, Peshawar Study period: six months Sample size: 394 cases attended the department of Ophthalmology, Khyber Teaching Hospital Peshawar. Out of 394 patients, 100 patients were included in this study. Results: There were 33(33%) males and 67(67%) females in the study. There were 27(27%) patients lying in the age range of 35-45 years, 46(46%) were in 46-55 years and 27 (27%) patients of 56-65 years. The mean age of patients was 51.21±8.12. All patients were with normal tension glaucoma. There were 29(29%) cases who had a positive family history of glaucoma. The “mean IOP” of the eye on the right side was 17.15±1.78mmHg and the “mean IOP” of the eye on the left side was 17.30±1.94mmHg. Conclusion: Prevalence of normal tension glaucoma (NTG) was 25.4% in Peshawar and its surroundings. Most of the patients were elderly females and 29 (29%) cases had a positive family history of glaucoma. Keywords: Open angle glaucoma, normal tension glaucoma, prevalence

Awareness of Glaucoma in Olorunda Local Government Area, Osogbo, Osun State, Nigeria

Purpose: The commonest type of glaucoma called chronic open angle glaucoma is a silent disease and patients are usually diagnosed late in the disease. Public awareness programs must be actively done to enable a reduction of late detection of the disease and level of awareness must be assessed regularly to appraise the programs. The aim of this study was to assess the level of awareness of the people following the several annual glaucoma week programs we held in the state.&#x0D; Methodology: A descriptive cross-sectional study was done in Osogbo local Government Area (LGA) over six months to assess the awareness of glaucoma following a five-year screening and public health education on glaucoma during the annual World glaucoma week in the state. The interviewer-assisted questionnaire was administered to 279 participants. Obtained data included demography such as age, sex, level of education, occupation, religion, state of origin, knowledge of glaucoma and its treatment, family history of glaucoma and so on.&#x0D; The data were entered and analyzed using SPSS version 21 (SPSS Inc., Chicago, IL). Descriptive statistics was used to analyze demographic data, and cross-tabulations with chi-square were used in comparing variables. Statistical significance was set at P&lt;0.05.&#x0D; Results: Two hundred and seventy-nine people were involved in the study. Many, 192 (68.8%) were aware of glaucoma. Thirty-nine participants (14.0%) had a family history of glaucoma and 63 (22.6%) felt the cause of glaucoma is an act of God. Two hundred and one (72.0%) had tertiary education. Tertiary education was found to be a statistically significant factor associated with glaucoma. Thirty-three (84.6%) of the 39 participants that had a positive family history of glaucoma were aware of glaucoma blindness. Out of participants that claimed to know how to treat glaucoma, eight (5.3%) felt it should be conservatively managed and nothing should be used.&#x0D; Conclusion: The World glaucoma week has yielded results but more efforts must be put in place to increase awareness and knowledge of the populace on the nature of glaucoma. Tertiary education is an important factor in glaucoma awareness. The government must ensure everyone is educated up to tertiary level. Glaucoma patients and their acquaintances may be used in increasing awareness.

Knowledge of glaucoma and associated factors among adults in Gish Abay town, Northwest Ethiopia

BackgroundGlaucoma is a global public health problem and it is the leading cause of irreversible blindness worldwide. Even though public knowledge of glaucoma is a key for early case identification and prevention of blindness, it is unknown in the study area, making provision of interventions difficult. Therefore, this study was intended to assess knowledge of glaucoma and associated factors among adults in Gish Abay town, Northwest Ethiopia, 2018.MethodsA Community based cross - sectional design study with systematic random sampling technique was used to select 630 adults. The study was conducted from April to May, 2018. Data was entered into Epi Info version 7 and was analysed by Statistical Package for Social Sciences version 23. Binary logistic regression model and adjusted odds ratio with 95% confidence level was used to identify the significant factors associated with knowledge of glaucoma. Variables with P–value ≤0.05 was considered statistically significant.ResultsAbout 594 adults were participated with a response rate of 94%. Above half of (52%) the participants were females with median age of 28 years. The proportion of good knowledge was demonstrated in 16.8% [95% CI; 14.0, 19.9]. Educational status: primary education [AOR; 2.89: 1.41, 5.90], secondary education [AOR; 3.03: 1.47, 6.24] college and above [AOR; 5.18: 2.21, 12.13], history of eye examination [AOR; 6.52: 3.37, 12.63]; family history of glaucoma [AOR; 12.08: 4.13, 35.30] and higher income level [AOR; 3.11: 1.55, 6.25] were positively associated with good knowledge of glaucoma.ConclusionsThe proportion of good knowledge of glaucoma was low. Higher educational status, positive family history of glaucoma, eye examination and higher income level were significantly associated with knowledge of glaucoma.

Prevalence and Factors Associated with Raised Intraocular Pressure among Hypertensive Patients—A Hospital-Based Study, Uganda

Background: Raised intraocular pressure (IOP) is a major risk factor for glaucoma. Hypertensive patients are at a risk of developing and progression of Open Angle Glaucoma (OAG) which is a major cause of blindness in the world. The aim of this study was to determine the prevalence of raised IOP and associated factors among hypertensive patients attending the hypertension clinic at Mulago National Referral Hospital in Uganda. Materials and Methods: A cross-sectional study was conducted from December 2018 to March 2019. Our sample comprised hypertensive patients recruited after obtaining consent. Participants were sampled consecutively and underwent both a general medical and ocular examination. A questionnaire was used to collect data on socio-demographic characteristics, ocular and medical factors. Data were entered into the computer using the statistical data package of Epidata version 3.1 and exported to STATA version 14 for analysis. Results: Of the 405 hypertensive study participants, mean age was 57.1 years (range 25 to 90 years, SD = 12.4 years). The overall prevalence of raised intraocular pressure was 11.6% (95% CI 8.8 - 15.1). The mean IOP among all participants was 15.2 mmHg (SD = 4.3) with a range of 3 - 34 mmHg. The factors with a statistically significant association with raised intraocular pressure after multivariate analysis were a positive family history of Glaucoma (OR 57, CI 10.33 - 315.34, P < 0.001) and Eye trauma (OR 7.84, CI 1.02 - 60.02 P = 0.047). Conclusions: The prevalence of raised intraocular pressure among hypertensive patients attending the hypertension clinic in Mulago National Referral hospital, Uganda was found to be high.

Glaucoma suspects: A practical approach.

Glaucoma suspects are controversial clinical dilemmas. These individuals harbor certain risk factors or demonstrate some clinical features suggestive of an increased probability to develop glaucomatous optic atrophy in the future. These characteristics range from high intraocular pressure; optic disc, visual field, or retinal nerve fiber layer abnormalities; or abnormal angles to a positive family history of glaucoma and other risk factors. Individuals having these characteristics should be assessed diligently before a diagnosis of glaucoma is made. Glaucoma is a chronic, lifelong condition, having a negative impact on the quality of life, with an increased risk of medication-related side-effects, adverse economic impacts, and the need for lifestyle changes in the patient. Overdiagnosis and unnecessary treatment of such individuals is bereft of any advantage. This review aims to provide a practical blueprint for the proper diagnosis and management of such glaucoma suspects.

The assessment of optical coherence tomographic parameters in subjects with a positive family history of glaucoma

PurposeThe aim was to compare the optical coherence tomographic (OCT) parameters of subjects with and without a family history of glaucoma to determine whether positive family history has an impact on retinal nerve fibre layer and ganglion cell complex analyses.MethodsForty eyes of 40 normal subjects with a proven positive family history (first‐degree relatives) for primary open angle glaucoma (POAG) (study group) and age‐matched 40 eyes of 40 control subjects without a family history for glaucoma (control group) were enrolled. Retinal nerve fibre layer thickness and macular ganglion cell complex thickness were measured with spectral domain OCT and results were compared between both groups.ResultsIn the study group, retinal nerve fibre layer thickness in all quadrants except the superior quadrant was a statistically significant decrease when compared to the control group (p = 0.707 for the superior quadrant, p < 0.05 for other retinal nerve fibre layer parameters; analysis of variance [ANOVA]). Furthermore, ganglion cell complex in all quadrants except the inferotemporal quadrant was a statistically significantly thinner in the study group, when compared with the controls (p = 0.196 for the inferotemporal quadrant, p < 0.05 for ganglion cell complex parameters; ANOVA).ConclusionsIn individuals who have a history of POAG in their first‐degree relatives, OCT parameters including retinal nerve fibre layer and ganglion cell complex are significantly lower than the subjects without a family history. Retinal nerve fibre layer and ganglion cell complex thinning were detected in normal‐looking discs. The importance of these findings remains uncertain. Prospective, controlled clinical trials with longer follow up are necessary to understand, whether or not those changes are an early indicator of glaucoma.

Demographic Characteristics of Normal Tension Glaucoma Seen in a Suburban Tertiary Hospital

Introduction: Normal Tension Glaucoma (NTG) is a form of glaucoma in which there are distinct demographic characteristics and associated factors to its development. Identifying these characteristics helps early diagnosis and prevention of blindness. Aim of the study is to identify the various demographic characteristics and associated factors with the diagnosis of NTG in patients presenting to the glaucoma clinic of a tertiary hospital. Methods: All consecutive newly diagnosed glaucoma patients attending the eye clinic of EKSUTH, Ado Ekiti, from January 2012 to December 2014 were selected for the study. They all had thorough ocular and systemic examination. The patients with diagnosis of normal tension glaucoma had a protocol prepared for the study administered on them. Demographic data, family history of glaucoma, history of migraine, hypertension, and use of antihypertensive drugs at night were obtained from them. Data were analysed using SPSS version 18 and presented as tables, and figures, in frequencies, and percentage. Result: A total of 1265 patients were newly diagnosed to have glaucoma, of these, 864(68.3%) were POAG, 336(26.6%) were secondary glaucomas, 48(3.8%) normal tension glaucoma, 12(0.9%) angle closure glaucoma and 5(0.4%) were developmental glaucoma. Among the NTG patients, 30(62.5%) were females and 18(37.5%) males, (M:F =1.7:1) Age range was between 30years to 68years, median age of 59.3years. The identifiable associated factors in NTG patients include; family history of glaucoma 33(68.8%), hypertension and use of antihypertensive at night before sleep 24(50%), history suggestive of sleep apnea 6(12.5%), migraine headaches 10(20.8%) and thyroid disease 2(4.2%). No statistically significant association of these factors with severity of visual field defect in the subjects studied. Conclusion: This study suggests that age and positive family history of glaucoma are important demographic characteristics for consideration in diagnosis of NTG.

Glaucoma history and risk factors

Apart from the risk of developing glaucoma there is also the risk that it is not detected and irreversible loss of vision ensues. Some studies of methods of glaucoma diagnosis have examined the results of instrument-based examinations with great if not complete reliance on objective findings in arriving at a diagnosis. The very valuable advances in glaucoma detection instrument technologies, and apparent increasing dependence on them, may have led to reduced consideration of information available from a patient history in those studies. Dependence on objective evidence of glaucomatous pathology may reduce the possibility of detecting glaucoma suspects or patients at risk for becoming glaucoma suspects. A valid positive family history of glaucoma is very valuable information. However, negative family histories can often be unreliable due to large numbers of glaucoma cases being undiagnosed. No evidence of family history is appropriate rather than no family history. In addition the unreliability of a negative family history is increased when patients with glaucoma fail to inform their family members. A finding of no family history can only be stated as no known family history. In examining the potential diagnostic contribution from a patient history, this review considers, age, frailty, race, type and degree of refractive error, systemic hyper- and hypotension, vasospasm, migraine, pigmentary dispersion syndrome, pseudoexfoliation syndrome, obstructive sleep apnea syndrome, diabetes, medication interactions and side effects, the degree of exposure to intraocular and intracranial pressure elevations and fluctuations, smoking, and symptoms in addition to genetics and family history of the disease.

Examining Delay Intervals in the Diagnosis and Treatment of Primary Open Angle Glaucoma in an Egyptian Population and Its Impact on Lifestyle.

Purpose. To examine causes as well as extent of delay in diagnosis and treatment of primary open angle glaucoma patients in a sample of Egyptians. Patients and Methods. 440 patients with primary open angle glaucoma were interviewed to evaluate delay in their diagnosis and treatment. The extent and cause of delay were investigated. The total delay interval, if any, was correlated with socioeconomic and other factors. Results. The median total delay was one year, with 50% of patients having a total delay of 1 year or less, of which 25% exhibited zero total delay. 25% of patients had a delay ranging from 1 to 3 years, and 25% had a total delay ranging from 3 to 27 years. Diagnostic delay accounted for 43.03% of cases. Longer delays were met in patients with certain socioeconomic factors. Patients with a positive family history of glaucoma displayed shorter delay periods. Conclusion. Significant delay in the diagnosis and treatment of glaucoma was found. Poor socioeconomic status seems to hinder timely diagnosis and treatment of POAG. Certain socioeconomic factors seem to correlate with the extent of delay. More effort is thus needed to subsidize the cost of investigations and treatment for glaucoma patients.

How accurate are optometrist referrals for glaucoma in the NICE era?

PurposeTo determine if the reason(s) stated by the optometrist affect the positive predictive value (PPV) of referrals for suspected glaucoma.MethodsOptometrist referrals in Portsmouth are streamlined though the Glaucoma Referral Refinement Scheme (GRRS). We retrospectively analysed 100 ‘positive’ and 100 ‘negative’ referrals to the GRRS. Positives: those referred on to a secondary care glaucoma clinic; negatives: those discharged from the GRRS. Reason(s) for referral were determined and classified: intraocular pressure (IOP) optic disc changes (OD), visual field defect (VF), shallow anterior chamber depth (ACD). Since negative referrals to GRRS are four times more prevalent than positives, we calculated a ‘corrected’ PPV for each reason by multiplying the number of negatives by 4.ResultsThe overall PPV was 0.16. 70.4% cases were referred for a single reason (47.2% IOP, 12.2% OD, 8.8% VF, 2.4% ACD); the PPV was 0.11 for IOP and for OD, 0.05 for VF, 0.17 for ACD. 26.2% were referred for two reasons; the PPV was 0.47 for IOP + OD, 0.21 for OD + VF and 0.14 for IOP + VF. 4.2% were referred for IOP + OD + VF with a PPV of 0.62. Positive family history of glaucoma (21.4% referrals) did not increase PPV. The GRRS increased the PPV to 0.8.ConclusionsThe majority of patients are referred for a single reason, yet the chance of a positive diagnosis is low. Accuracy is increased when IOP is reported in combination with OD, but VF adds little value as a second parameter. The highest PPV is found when all three reasons are stated (IOP + OD + VF). The proportion of referrals for IOP alone is similar to that found prior to the NICE guidelines. However, the PPV is considerably lower; 0.11 compared to 0.3–0.4 found in previous studies. In the NICE era, refinement schemes play an important role in reducing false positive referrals.

How accurate are optometrist referrals for glaucoma in the NICE era?

PurposeTo determine if the reason(s) stated by the optometrist affect the positive predictive value (PPV) of referrals for suspected glaucoma.MethodsOptometrist referrals in Portsmouth are streamlined though the Glaucoma Referral Refinement Scheme (GRRS). We retrospectively analysed 100 ‘positive’ and 100 ‘negative’ referrals to the GRRS. Positives: those referred on to a secondary care glaucoma clinic; negatives: those discharged from the GRRS. Reason(s) for referral were determined and classified: intraocular pressure (IOP) optic disc changes (OD), visual field defect (VF), shallow anterior chamber depth (ACD). Since negative referrals to GRRS are four times more prevalent than positives, we calculated a ‘corrected’ PPV for each reason by multiplying the number of negatives by 4.ResultsThe overall PPV was 0.16. 70.4% cases were referred for a single reason (47.2% IOP, 12.2% OD, 8.8% VF, 2.4% ACD); the PPV was 0.11 for IOP and for OD, 0.05 for VF, 0.17 for ACD. 26.2% were referred for two reasons; the PPV was 0.47 for IOP + OD, 0.21 for OD + VF and 0.14 for IOP + VF. 4.2% were referred for IOP + OD + VF with a PPV of 0.62. Positive family history of glaucoma (21.4% referrals) did not increase PPV. The GRRS increased the PPV to 0.8.ConclusionsThe majority of patients are referred for a single reason, yet the chance of a positive diagnosis is low. Accuracy is increased when IOP is reported in combination with OD, but VF adds little value as a second parameter. The highest PPV is found when all three reasons are stated (IOP + OD + VF). The proportion of referrals for IOP alone is similar to that found prior to the NICE guidelines. However, the PPV is considerably lower; 0.11 compared to 0.3–0.4 found in previous studies. In the NICE era, refinement schemes play an important role in reducing false positive referrals.

A new combined surgical approach in a patient with microspherophakia and developmental iridocorneal angle anomaly

We describe a patient with microspherophakia due to Weill-Marchesani syndrome accompanied by developmental angle anomaly who was successfully treated with a surgery of combined PPL and goniotomy. We report ocular findings of a 1-year-old girl who was diagnosed with Weill-Marchesani syndrome with a positive family history of glaucoma in her cousins and glaucoma with anterior segment dysgenesis in her older brother. Anterior segment examination revealed clear corneas with 13 mm horizontal diameter in the right and 12.5 mm in the left and very shallow anterior chambers centrally and peripherally in both eyes. Although axial lengths were 18.9 mm in the right and 19.1 mm in the left eye, cycloplegic refractive errors were -7.75 DS (-2.75 at 1800) in the right eye and -8.50 DS (-2,75 at 1800) in the left eye. Intraocular pressures were 34 mmHg in the right and 38 mmHg in the left eye. Following pars plana lensectomy, gonioscopy revealed developmental iridocorneal angle anomaly and goniotomy was performed at the same session. During 3 years of follow-up, the patient experienced no complications. IOP was 12 mmHg without medication in the last visit; cup-to-disc ratio and corneal diameters were stable. The coexistent microspherophakia and developmental iridocorneal angle anomaly can be successfully treated with combined pars plana lensectomy and goniotomy.