Positive Family History Of Glaucoma Research Articles

Population-based evaluation of retinal nerve fiber layer, retinal ganglion cell layer, and inner plexiform layer as a diagnostic tool for glaucoma.

We determined the glaucoma screening performance of regional optical coherence tomography (OCT) layer thickness measurements in the peripapillary and macular region, in a population-based setting. Subjects (n = 1224) in the Rotterdam Study underwent visual field testing (Humphrey Field Analyzer) and OCT of the macula and optic nerve head (Topcon 3-D OCT-1000). We determined the mean thicknesses of the retinal nerve fiber layer (RNFL), retinal ganglion cell layer (RGCL), and inner plexiform layer for regions-of-interest; thus, defining a series of OCT parameters, using the Iowa Reference Algorithms. Reference standard was the presence of glaucomatous visual field loss (GVFL); controls were subjects without GVFL, an intraocular pressure (IOP) of 21 mm Hg or less, and no positive family history for glaucoma. We calculated the area under the receiver operating characteristics curve (AUCs) and the sensitivity at 97.5% specificity for each parameter. After excluding 23 subjects with an IOP > 21 mm Hg and 73 subjects with a positive family history for glaucoma, there were 1087 controls and 41 glaucoma cases. Mean RGCL thickness in the inferior half of the macular region showed the highest AUC (0.85; 95% confidence interval [CI] 0.77-0.92) and sensitivity (53.7%; 95% CI, 38.7-68.0%). The mean thickness of the peripapillary RNFL had an AUC of 0.77 (95% CI, 0.69-0.85) and a sensitivity of 24.4% (95% CI, 13.7-39.5%). Macular RGCL loss is at least as common as peripapillary RNFL abnormalities in population-based glaucoma cases. Screening for glaucoma using OCT-derived regional thickness identifies approximately half of those cases of glaucoma as diagnosed by perimetry.

Involvement of Genetic Variants Associated With Primary Open-Angle Glaucoma in Pathogenic Mechanisms and Family History of Glaucoma

To investigate the associations between the non-intraocular pressure (IOP)-related genetic variants (genetic variants associated with vulnerability of the optic nerve independent of IOP) and primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG) and high-tension glaucoma (HTG), and between the non-IOP-related genetic variants and a family history of glaucoma. Case-control study. Japanese patients with NTG (n = 213) and HTG (n = 212) and 191 control subjects were genotyped for 5 non-IOP-related genetic variants predisposing to POAG near the SRBD1, ELOVL5, CDKN2B/CDKN2B-AS1, SIX1/SIX6, and ATOH7 genes. The load of these genetic variants was compared between the control subjects and patients with NTG or HTG and between the POAG patients with and without a family history of glaucoma. The total number of POAG risk alleles and the product of the odds ratios (POAG risk) of these genetic variants were significantly larger (P < .0025) in patients with both NTG and HTG than in the control subjects, and were significantly larger (P = .0042 and P = .023, respectively) in POAG patients with a family history of glaucoma than in those without. As the number of relatives with glaucoma increased, the total number of risk alleles and the product of the odds ratios increased (P = .012 and P = .047, respectively). Non-IOP-related genetic variants contribute to the pathogenesis of HTG as well as NTG. A positive family history of glaucoma in cases of POAG is thought to reflect the influence of genetic variants predisposing to POAG.

Severe intraocular pressure response to periocular or intravitreal steroid treatment in Australia and New Zealand: data from the Australian and New Zealand Ophthalmic Surveillance Unit.

Increase in intraocular pressure is a recognized complication of corticosteroid treatment via intravitreal or periocular injections for treatment of a range of conditions including macular oedema and retinal neovascularization. This surveillance study was designed to determine the incidence and nature of severe intraocular pressure elevation as a complication of intravitreal or periocular corticosteroid injections in Australia and New Zealand. Seventeen cases meeting the defined criteria of severe intraocular pressure elevation, above 35 mmHg, following an intravitreal or periocular corticosteroid injection were included in the study. Over an 18-month period, ophthalmologists were invited to report cases to the Australian and New Zealand Ophthalmic Surveillance Unit. After reporting, further demographic and clinical information was sought via a follow-up questionnaire. Intraocular pressure elevation above 35 mmHg. Follow-up questionnaires were received for 20 cases of 34 initially reported to the unit. Seventeen met the defined criteria. Triamcinolone acetonide was used in all 17 cases, with 16 delivered as a 4-mg intravitreal injection. There was an absence of identified underlying risk factors in the majority of cases with personal history of glaucoma in 2 of 17 cases. No cases reported a positive family history of glaucoma. Trabeculectomy was performed in 8 of 17 patients (47%) for intraocular pressure management. Severe intraocular pressure elevation following intravitreal or periocular corticosteroid injection can occur in the absence of risk factors such as personal and family history of glaucoma. The severe intraocular pressure elevation may ultimately require trabeculectomy.

Risk factors for the development of glaucoma after vitreoretinal surgery

AbstractPurpose To determine risk factors for the development of glaucoma after vitreoretinal surgery.Methods Case‐control study. Cases (n=96) were all patients who received a Baerveldt glaucoma implant after vitreoretinal surgery performed between 1991‐2011. Controls (n=288) were a random subset of patients who underwent vitreoretinal surgery without subsequent glaucoma surgery. Cases and controls were matched with regard to the year in which the first vitreoretinal intervention was performed. The role of age, sex, number of interventions, type of intervention (plombe or vitrectomy), indication of first intervention, use of silicone oil, preoperative lens status, IOP and IOP lowering medication one week after the first intervention, history of glaucoma or OHT, and a positive family history of glaucoma were analyzed with logistic regression.Results Cases were more often men (p=0.03), younger at the moment of the first surgical procedure (p=0.005), underwent more vitreoretinal procedures (p&lt;0.001), had on average a higher mean intraocular pressure (p=0.005) and medication use (p=0.001) 1 week after the first procedure and had more often a history of glaucoma or ocular hypertension (p&lt;0.001). The use of silicone oil became a significant risk factor after removing the number of interventions from the model (p=0.002).Conclusion Patients who develop glaucoma after vitreoretinal surgery have a different risk‐profile compared to patients who do not develop glaucoma. This gives the opportunity to monitor certain subgroups.

Distribution of Central Corneal Thickness and its Association with Ocular Parameters in a Large Central European Cohort: The Gutenberg Health Study

Main objectiveTo evaluate the distribution of central corneal thickness (CCT) in a large German cohort and to analyse its relationship with intraocular pressure and further ocular factors.DesignPopulation-based, prospective, cohort study.MethodsThe Gutenberg Health Study (GHS) cohort included 4,698 eligible enrollees of 5,000 subjects (age range 35–74 years) who participated in the survey from 2007 to 2008. All participants underwent an ophthalmological examination including slitlamp biomicroscopy, intraocular pressure measurement, central corneal thickness measurement, fundus examination, and were given a questionnaire regarding glaucoma history. Furthermore, all subjects underwent fundus photography and visual field testing using frequency doubling perimetry.ResultsMean CCT was 557.3±34.3 µm (male) and 551.6±35.2 µm in female subjects (Mean CCT from right and left eyes). Younger male participants (35–44 years) presented slightly thicker CCT than those older. We noted a significant CCT difference of 4 µm between right and left eyes, but a high correlation between eyes (Wilcoxon test for related samples: p<0.0001). Univariable linear regression stratified by gender showed that IOP was correlated with CCT (p<0.0001). A 10 µm increase in CCT led to an increase in IOP between 0.35–0.38 mm Hg, depending on the eye and gender. Multivariable linear regression analysis revealed correlations between gender, spherical equivalent (right eyes), and CCT (p<.0001 and p = 0.03, respectively).ConclusionsWe observed positive correlations between CCT and IOP and gender. CCT was not correlated with age, contact lens wear, positive family history for glaucoma, lens status, or iris colour.

A Population-based Survey of the Prevalence and Types of Glaucoma in Central Iran: The Yazd Eye Study

To describe the prevalence and types of glaucoma in Yazd, central Iran. Population-based, cross-sectional study. Iranian adults aged 40 to 80 years, residing in Yazd, Iran, in 2010 and 2011. Eligible samples were selected using cluster random sampling. Each participant underwent an interview and ophthalmologic examinations, including refraction, determination of uncorrected and best-corrected visual acuity, slit-lamp biomicroscopy, Goldmann applanation tonometry, gonioscopy, dilated fundus examination, central corneal thickness measurement, visual field testing, and stereoscopic fundus photography. Prevalence of different types of glaucoma. Of 2320 eligible individuals, 2098 (response rate, 90.4%) participated in the study and 1990 completed all evaluations for glaucoma diagnosis. Overall, 47 persons (2.4%) were categorized with ocular hypertension, 32 persons (1.6%) were categorized with primary angle-closure suspect (PACS), and 16 persons (0.8%) were categorized with primary angle closure (PAC). The total number of subjects with glaucoma was 87 (4.4%; 95% confidence interval, 3.3-5.4), consisting of primary open-angle glaucoma (POAG, 3.2%, including high-tension glaucoma [1.7%] and normal-tension glaucoma [NTG], 1.5%]), primary angle-closure glaucoma (PACG, 0.4%), pseudoexfoliation glaucoma (0.4%), and other secondary glaucomas (0.4%). The mean age of subjects with glaucoma was 63.3 ± 11 years, and 57.5% of them were female. Seventy-eight individuals (89.7%) were unaware of their disease. Positive family history of glaucoma was present in 6.9% of glaucoma subjects. The prevalence of glaucoma in Yazd (4.4%) is comparable to that in other population-based studies in Asia, with POAG accounting for the majority of cases. Most affected subjects were unaware of their disease. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Australian and New Zealand Registry of Advanced Glaucoma: methodology and recruitment

Glaucoma is a sight-threatening disease affecting 3% of the population over the age of 50. Glaucoma is treatable, and severe vision loss can usually be prevented if diagnosis is made at an early stage. Genetic factors play a major role in the pathogenesis of the condition, and therefore, genetic testing to identify asymptomatic at-risk individuals is a promising strategy to reduce the prevalence of glaucoma blindness. Furthermore, unravelling genetic risk factors for glaucoma would also allow a better understanding of the pathogenesis of the condition and the development of new treatments. The Australian and New Zealand Registry of Advanced Glaucoma is a prospective study that aims to develop a large cohort of glaucoma cases with severe visual field loss to identify novel genetic risk factors for glaucoma blindness. Clinical information and blood are collected from participants after referral by eye practitioners. Samples are collected across Australia and New Zealand using postage kits. Our registry has recruited just over 2000 participants with advanced glaucoma, as well as secondary and developmental glaucomas. A positive family history of glaucoma is present in more than half of the advanced glaucoma cases and the age at diagnosis is significantly younger for participants with affected relatives, which reinforces the involvement of genetic factors in glaucoma. With the collection of glaucoma cases recruited so far, our registry aims to identify novel glaucoma genetic risk factors to establish risk profiling of the population and protocols for genetic testing.

Timing Of Opportunistic Check For Glaucoma In An Ophthalmology Clinic Setting In Ghanaians

Purpose: To determine the age, timing and determining factors for the evaluation for glaucoma as part of medical eye evaluation in an ophthalmology clinic. Patients and Methods: A cross sectional study in which patients with primary open-angle glaucoma (POAG) attending the ophthalmology clinic, Korle Bu Teaching Hospital, Ghana were recruited from 2004 to 2007. A historic control group of 253 normal samples was included in the data analysis of cup/disc asymmetry. Results: Number of patients recruited was 390 with ages between 15 to 89 years (mean 54±14.86, median 56 and mode 65). Early-onset-glaucoma diagnosed before age 40 years occurred in 62 patients (15.89%) and adult-onsetglaucoma in 328 (84.10%). Fifteen (3.84%) people had positive family history of glaucoma; 13(3.33%) had diabetes mellitus; hypertension 38 (9.74%) and sickle cell disease, 1 (0.25%). Thirteen (3.33%) had myopia of >-4 dioptres (-4.25 to -14.5D). Eighty (20.51%) patients had visual impairment. Five (1.28%) were blind (no perception of light, NPL, bilaterally) from glaucoma. In the early-onset-glaucoma group, 2/62(3.23%) were blind. Pretreatment intraocular pressure, IOP, was >35 mmHg in 46.18% of eyes. In the early-onset-glaucoma group, IOP ranged from 13-64 (mean 36) mmHg. There was cup/disc ratio of at least 0.7 in 99% of eyes. In the 15-24 year age group, 88.6% had cup/disc ratio of 0.7-1.0. Cup/disc asymmetry 0.2 or more was found in 32% (125/390) compared with 0.4% (1/253) in the Normal patients. Conclusions: We suggest that routine measurement of intraocular pressure and evaluation of the optic disc biomicroscopically be carried out as screening for glaucoma every 2 years until age 30 years; in any African African patient aged 20 years and above with eye complaints attending an eye clinic, as well as those aged 25 years and above as part of comprehensive adult medical eye evaluation. However, after age 30 years and those with positive family history of glaucoma, screening should be yearly.

Visual field screening with a laptop computer system

Background The aim of this study was to develop a visual field screening system and investigate the importance of using 2 different programs for visual field screening to be used in places in which other perimeters are yet not available. The system consists of a laptop computer with instructions for the patient displayed on the screen and additional equipment to ensure central eye position, eye distance to the screen, optimal optical correction, and light intensity. This visual field screening system combines a screening program consisting of 68 test points with the highest density in areas of high prevalence of visual defects, followed by a supplementary program comprising 82 other test points in a quadratic lattice pattern. Methods The system was compared with Octopus 1-2-3 threshold perimetry, and the applicability of the system when operated by optometrists was evaluated. Results In the glaucoma clinic at the University Hospital, Rigshospitalet, Denmark, the screening program was used to investigate 98 patients (173 eyes) and to compare the results with those of the Octopus Perimetry Program dG2. The sensitivity of the system was 100% and the specificity was 78%. Subsequently, 18 optometrists in different locations in Denmark tested 1,022 patients (2,036 eyes). Patients contacted these optometrists because of the presence of refractive error, subjective vision problems, or eye symptoms. The screening was used as a part of a routine examination. In 432 eyes (21%), visual defects were detected using the screening program. By re-examining 349 eyes, with the addition of the supplementary program consisting of 82 other test points in a quadratic lattice pattern, the visual field defects were not reproduced in 263 eyes, a reduction of primary positive visual field defects by 75%. The additional supplementary program was not conducted with 38 eyes (2%) because of large visual field defects, high intraocular pressures, cataract, positive family history of glaucoma, lack of time, or poor patient cooperation. In 56 eyes (3%) examined with the additional supplementary program, the defects found in the screening program were reproduced. In total, 59 (5.8%) patients (38 + 56 eyes) were recommended to pursue an ophthalmologic eye examination by a local ophthalmologist. Conclusion Confrontation visual field testing in many places is the only method used for examining the visual field. A laptop computer system for visual field screening could be a better method for visual field screening in the primary eye care setting. For clinical relevance, it is necessary to perform the method with 2 different screening programs. The method can be useful as an important part of a routine examination and for directing further examinations.

Incidence of Glaucomatous Visual Field Loss: A Ten-Year Follow-up from the Rotterdam Study

To determine the 10-year incidence of glaucomatous visual field loss (GVFL) and to investigate the influence of risk factors for open-angle glaucoma on this incidence. Population-based cohort study. Participants aged > or =55 years from the Rotterdam Study. Of the 7983 participants in the Rotterdam Study, 6806 underwent ophthalmic examinations at baseline (1990-1993). In 6723 of these 6806 participants (99%), both visual field screening and an assessment of the optic disc were performed. After exclusion of 93 participants with GVFL at baseline, 6630 participants at risk of developing GVFL remained. These participants underwent similar ophthalmic examinations during 2 follow-up visits (1997-1999 and 2002-2006). The incidence of GVFL was determined as an incidence rate and recalculated to a 10-year risk. Risk factors for open-angle glaucoma (age, gender, positive family history of glaucoma, baseline intraocular pressure (IOP), myopia, and baseline vertical cup-to-disc ratio [VCDR]) were assessed using Cox regression. The dependent variable was the development of GVFL. Ten-year risk and incidence rates of GVFL. Hazard ratios of the above-mentioned risk factors. Of 6630 participants, 3939 (59%) completed at least 1 follow-up examination and 2571 (39%) completed both; 108 participants developed GVFL. The overall incidence rate and 10-year risk of GVFL were 2.9 per 1000 person-years (95% confidence interval [CI], 2.4-3.5) and 2.8% (2.3-3.4), respectively. The 10-year risk increased from 1.9% at age 55 to 59 years to 6.4% at age > or =80 years (P<0.001). The incidence increased by 11% per millimeter of mercury increase in IOP (hazard ratio 1.11; 95% CI, 1.06-1.15). Male gender (1.62; 1.10-2.38), high myopia (spherical equivalent < or =-4 D myopic; 2.31; 1.19-4.49), and a baseline VCDR above the 97.5th percentile (4.64; 2.72-7.91) were associated with the development of GVFL. A positive family history was only significantly associated with the development of GVFL if IOP was removed from the model (2.0; 1.2-3.3; P = 0.012). These data provide an estimate of the incidence of GVFL in a white population. The development of GVFL was related to higher IOP, older age, high myopia, male gender, a positive family history of glaucoma, and a larger baseline VCDR.

Quantifying the effect of intraocular pressure reduction on the occurrence of glaucoma

To estimate the effect of reducing intraocular pressure (IOP) on: (i) the incidence of primary open-angle glaucoma (POAG) in patients with ocular hypertension (OH), and (ii) the progression of glaucoma. A meta-analysis of relevant randomized controlled trials was conducted. A literature search was performed to identify trials with: a randomized comparison of IOP-lowering intervention versus placebo or no treatment; visual field loss or optic disc changes as outcome; and follow-up >6 months. A pooled relative risk (RR) was calculated by a random effects model. Risk reduction of glaucoma conversion per mmHg of IOP reduction was quantified in a meta-regression model. We identified nine OH and one POAG trials. A meta-analysis of OH trials gives a pooled RR of 0.61 [95% confidence interval (CI) 0.45-0.83]. A meta-regression shows a decrease of the RR of glaucoma conversion by 14% with each mmHg extra IOP reduction (P = 0.045). No meta-analysis of POAG trials was performed because only one study has been identified. There is sufficient evidence that OH therapy reduces the risk of conversion to glaucoma. This risk reduction increases with greater IOP reduction.

Intraocular pressure adjusted for central corneal thickness as a screening tool for open-angle glaucoma in an at-risk population

Objective: Evaluation of intraocular pressure (IOP) adjusted for central corneal thickness (CCT) screening for open-angle glaucoma (OAG) in an at-risk population. Study Design: Community-based screening clinic. Participants: Three hundred and forty-nine persons of black race, or >50 years of age, or with a positive family history of glaucoma. Methods: Ophthalmological examination including Goldmann applanation tonometry, ultrasonographic corneal pa-chymetry, and visual field testing. Glaucomatous optic nerve damage with visual field loss was the gold standard. IOP was adjusted for CCT based on 3 nomograms. Results were compared with screening using unadjusted IOP. Outcome measures included sensitivity, specificity, areas under the receiver operating characteristic (ROC) curves, positive and negative predictive values (PPVs and NPVs), as well as positive and negative likelihood ratios. Results: No significant difference in CCT was found between those with glaucoma (560 [SD 37] µm, n = 31) and those without (557 [SD 35] um, n = 233). Screening adjusted IOPs for glaucoma with an IOP > 21 mm Hg resulted in PPVs of 23.8% to 25% and NPVs of 89.3% to 89.6%, similar to preadjustment values. Areas under the ROC curves varied from 0.544 to 0.571 post adjustment from the initial value of 0.574. Conclusions: IOP adjusted for CCT is unlikely to improve tonometry as a screening tool for OAG in an at-risk population.

The groningen longitudinal glaucoma study III. The predictive value of frequency-doubling perimetry and GDx nerve fibre analyser test results for the development of glaucomatous visual field loss

To investigate whether frequency-doubling perimetry (FDT) and nerve fibre analyser (GDx) test results are able to predict glaucomatous visual field loss in glaucoma suspect patients. A large cohort of glaucoma suspect patients (patients with ocular hypertension or a positive family history of glaucoma without visual field abnormalities at baseline) was followed prospectively for 4 years with SAP (HFA 30-2 SITA fast), FDT (C-20 full threshold), and GDx (version 2.010) in a clinical setting. After the follow-up period, baseline FDT and GDx test results of converters (glaucoma suspect patients who had converted to a reproducible abnormal SAP test result during follow-up) were compared to that of non-converters (suspects with normal SAP test results at the end of the follow-up) by calculating relative risks. Cutoff point for FDT was >1 depressed test point P<0.01 in the total deviation probability plot; cutoff point for GDx was the number >29. Of 174 glaucoma suspect patients, 26 had developed reproducible glaucomatous visual field loss (conversion rate: 3.7% per year). Relative risk was 1.8 (95% confidence interval: 0.9-3.7; P=0.10) for FDT and 2.7 (95% confidence interval: 1.2-6.3; P=0.01) for GDx. Positive predictive value was 0.22 for both FDT and GDx; negative predictive value was 0.88 for FDT and 0.92 for GDx. In a clinical setting, especially GDx may be helpful for identifying glaucoma suspect patients at risk of developing glaucomatous visual field loss as assessed by SAP.

Compliance and knowledge about glaucoma in austrian patients

Abstract Purpose To document the rate of non‐compliance and patients’ attitude towards and knowledge of glaucoma in Austrian patients. Methods Prospective observational case series. One‐ hundred consecutive glaucoma patients of an Austrian outpatient glaucoma department were included in the study. Patients were already under medical treatment for glaucoma. Personal characteristics, presence of systemic disease, compliance with glaucoma medication, and glaucoma‐related attitudes were ascertained by means of a predetermined questionnaire with 40 questions. Patients were subsequently assessed for the ability to correctly instil placebo eye drops. Non‐compliance was defined as omitting glaucoma medication more than once a week. Univariate and logistic regression was used to examine how patient characteristics and knowledge were related to reported compliance Results Average age was 63.6 years (range 19‐88). Overall, 89% (n= 89) of patients reported to be compliant. Knowledge about the disease was associated with higher compliance (RR 3.05, 95% CI 1.7‐9.6). Forgetfulness was the most frequently cited reason for non‐compliance (20%). Although 84% patients believed glaucoma medication to be efficient, only 26% could give a simple correct definition of glaucoma. 29% had a positive family history for glaucoma. Conclusion Despite the comparatively high compliance rate of Austrian patients with their glaucoma medication, knowledge of glaucoma remains poor in long term glaucoma sufferers.Patient compliance to glaucoma treatment could be improved mainly by increasing patient knowledge of the disease.

Risk factors for first presentation of glaucoma with significant visual field loss

To identify risk factors associated with visual field (VF) loss on first presentation of glaucoma. A case-control study of 107 consecutive newly diagnosed glaucoma patients was performed. Information collected included demographic data, reasons for referral, ophthalmological assessment and VF testing. VF grading was based on Advanced Glaucoma Intervention Study (AGIS) scoring and was additionally classified for the presence of a nasal step, paracentral scotoma and/or arcuate scotoma. Demographic parameters were: mean age 59 years (standard deviation [SD] 14), mean deviation -4.37 dB (SD 4.5), intraocular pressure 21.4 mmHg (SD 6.6) and cup:disc ratio 0.69 (SD 0.1). Thirty-seven per cent of all participants had a positive family history of glaucoma. Older age was associated with a VF defect at presentation (mean age of 54 years with no VF defect, compared with 63 years for mild, moderate or severe VF defect, P = 0.0014). Multivariate logistic regression analysis identified positive family history (odds ratio [OR] 10.43; 95% confidence interval [CI] 1.67-67.49) and age (OR 1.15; 95% CI 1.06-1.26) as independent risk factors for VF loss at presentation. Fifty-six per cent had a paracentral VF defect at first diagnosis and 29% of patients showed evidence of substantial VF loss with AGIS score of >/=6 on initial presentation. Patients who have a positive family history of glaucoma are 10 times more likely to have a VF defect at the time of glaucoma diagnosis. An increased focus on family history may help identify these patients earlier and prevent significant visual loss at the time of presentation.

Characteristics of Patients who Dropout From a Glaucoma Clinic

To find the dropout rate and identify the clinical characteristics of patients who drop out in the first year of follow-up from a glaucoma clinic. Descriptive hospital-based study at a tertiary hospital eye department. Clinical characteristics of consecutive patients newly diagnosed with glaucoma who dropped out (n=452) were compared with patients who did not drop out (n=295) within 12 months. The rate of dropout from follow-up was 60.5% within 1 year; 43.1% of the study group dropped out after their first follow-up visit. The dropout rate was high in all age groups, but higher in the age groups 21 to 30 years, 41 to 50 years, and over 70 years. Males had a higher dropout rate than females (78.6% vs. 34.5%). Dropout rate was higher among those with mild/moderate glaucoma than those with severe disease (88.2% vs. 37.2%); those who lived further away from the hospital than those who lived nearer to the hospital (72.5% vs. 40.8%), those who were referred from screening clinics for nonblinding eye disease compared with those referred because of a blinding eye disease (72.2% vs. 58.9%). More patients (63.8%) unsure of their family eye disease history dropped out, compared with 34.3% of those with positive family history of glaucoma and other potentially blinding diseases. More patients who had no systemic disease dropped out, than those with systemic disease (54.6% vs. 39.6%); whereas patients on 2 medications or more had a higher dropout rate than those on less than 2 medications (68.1% vs. 52.1%). Of the study factors, those that were statistically significantly associated with dropping out of follow-up from the glaucoma clinic were age, sex, place of domicile, diagnosis at referral, severity of disease, family history, and polydrug use. The dropout rate from this glaucoma clinic in the first year was high (60.5%). Patients who were more likely to dropout were younger patients, male, those who travelled far distances to the clinic, those with mild to moderate glaucoma, those with no family history of blinding eye diseases, and patients taking 2 or more eyedrops. Patients who seem to perceive their problems as not serious dropped out of follow-up. These findings have great implications in planning future studies and intervention to improve the follow-up of glaucoma patients in the study area.

Sociodemographic, Family History, and Lifestyle Risk Factors for Open-angle Glaucoma and Ocular Hypertension: The Los Angeles Latino Eye Study

To evaluate the relationship between sociodemographic, family history, and lifestyle risk factors and open-angle glaucoma (OAG) and ocular hypertension (OHT) in Latinos. Population-based cohort study. Latinos 40 years and older from 6 census tracts in La Puente, California. Participants underwent an in-home interview and in-clinic examination. Demographic, lifestyle, and family history variables were analyzed as risk factors using multivariable regression models to identify independent associations with OAG or OHT. Open-angle glaucoma and OHT. Two hundred eighty-nine participants were diagnosed as having OAG, 219 were found to have OHT, and 5624 persons had no evidence of either OAG or OHT. After adjustment for intraocular pressure, stepwise logistic regression analyses revealed that older age, male gender, unmarried marital status, and being a first-degree relative were independent risk factors for OAG. For age, the relative risk doubled with each decade. Males and unmarried participants had a higher risk of having glaucoma than females and those who were married (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.30-2.30, and OR, 1.39; 95% CI, 1.03-1.87, respectively). A positive family history of glaucoma in first-degree relatives was a risk factor for OAG (OR, 1.92; 95% CI, 1.25-2.94). Smoking, alcohol use, and female reproductive hormone use were not associated with OAG. Additionally, increasing age, Native American ancestry, unemployed status, and family history of glaucoma were found to be independent factors for increased risk of OHT. Although the mechanisms whereby age and family history lead to increased risk are partly understood, further study is needed to understand the biological significance of the other demographic risk factors identified such as male gender and unmarried status.

Lifetime Visual Disability in Open-angle Glaucoma and Ocular Hypertension

To study how many of the patients with treated glaucoma or ocular hypertension go blind during their lifetime and which factors are associated with blindness. The data on 106 consecutive patients who had died between 1991 and 2002 was retrospectively evaluated. At diagnosis 39 patients had primary open-angle glaucoma, 27 had exfoliation glaucoma, and 40 had ocular hypertension. Clinical records and causes of death were reviewed. Visual disability at the last visit before death was evaluated. Outcome measures were visual handicap and blindness based on visual acuity and/or visual fields. At the last visit, 17 patients [16%, 95% confidence interval (CI) 9-23] were visually handicapped. Thirteen patients (14%) were bilaterally blind. Glaucoma was the cause of blindness in one or both eyes in 16 patients (15%, 95% CI 8-22) and in both eyes in 6 patients (6%, 95% CI 1-10). In the analysis of only 1 eye of each patient, the cumulative incidence of glaucoma-caused blindness was 6% (95% CI 2-11) at 5 years, 9% (95% CI 4-15) at 10 years, and 15% (95% CI 9-23) at 15 years. An advanced stage of glaucoma at diagnosis, fluctuation in intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance increased the occurrence of blindness. Positive family history of glaucoma and vascular causes of death had no effect on visual outcome. Glaucoma-caused blindness was associated with an advanced stage of glaucoma at diagnosis, fluctuation of intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance. The risk of going blind from glaucoma in both eyes was 6%.

Vascular risk factors in glaucoma: the results of a national survey

The role of vascular risk factors in glaucoma is still being debated. To assess the importance of vascular risk factors in patients with primary open-angle glaucoma (POAG), data from the medical history of 2,879 POAG patients and 973 age-matched controls were collected and analyzed. observational survey. 35 Italian academic centers. POAG patients and age-matched controls. In order to reduce bias consecutive patients were included. data concerning vascular risk factors were collected for all patients with a detailed questionnaire. A complete ophthalmological examination with assessment of intraocular pressure (IOP), visual field, optic disc, and systemic blood pressure was performed. the ESH-ESC (European Society of Hypertension-European Society of Cardiology) guidelines were used to calculate the level of cardiovascular risk. Crude and adjusted estimates of the odds ratios (OR) were calculated for all cardiovascular risk factors in POAG and controls. The study included 2,879 POAG patients and 973 controls. POAG cases had a significantly higher systolic and diastolic blood pressure (p = 0.001) and systolic perfusion pressure (p = 0.02) as compared with controls. Also mean IOP was significantly higher in the POAG group (p = 0.01), while diastolic perfusion pressure was not significantly different in the two groups. Myopia was more prevalent in the POAG group (23 vs 18%, p = 0.005) as well as a positive family history for glaucoma (26 vs 12%, p = 0.004). POAG patients tended to have a higher cardiovascular risk than controls: 63% of glaucoma cases vs 55% of controls (OR: 1.38, p = 0.005) had a "high" or "very high" cardiovascular risk. The level of cardiovascular risk was significantly higher in glaucoma patients than in controls.

Distribution of optineurin sequence variations in an ethnically diverse population of low-tension glaucoma patients from the United States.

Previous studies have suggested that Optineurin (OPTN) sequence variants contribute to low-tension glaucoma (LTG) in ethnically homogeneous populations. The purpose of this study is to evaluate the prevalence of OPTN sequence variants in an ethnically diverse population of LTG patients from the United States, and to describe the phenotype of patients with OPTN sequence variants preferentially found in LTG patients. Genomic DNA purified from 67 LTG patients was screened for DNA sequence variants located in the exons and flanking introns of the OPTN gene using high-performance liquid chromatography analysis and direct genomic DNA sequencing. Eighty-six primary open-angle glaucoma probands and 100 control patients were also analyzed. Nine OPTN DNA sequence variants were identified in this patient population including the 2 previously identified heterozygous nonsynonymous single-nucleotide polymorphisms in exons 4 and 5. Four LTG patients with severe disease and positive family history of glaucoma, were found to have DNA sequence changes not found in primary open-angle glaucoma probands or control individuals including the previously reported E50K variation. The results of this study support the rare association of OPTN sequence variants with familial forms of LTG. The E50K mutation seems to be associated with a severe form of LTG, and although rare, the identification of this sequence variant in patients at risk may help direct appropriate therapy.