Biological measurements, family history may be more important factors in predicting, treating glaucoma

Issue: August 10, 2009

BOSTON — Glaucoma diagnosis and therapy should be based on biological measurements such as corneal thickness and cup-to-disc ratio and risk factors such as family history, not race, a physician said here.

Eve J. Higginbotham

At the World Glaucoma Congress, Eve J. Higginbotham, MD, spoke about how race in glaucoma is largely a social issue, not a biological one. She said clinicians should consider a patient's country of origin and family history to be the most specific and significant risk factors for the disease.

"If we keep thinking about people in just these four or five [racial] categories, I think we're missing the opportunity to identify more specific biological causes related to apparent responses to therapy," Dr. Higginbotham said.

While anthropological and genetic research has shown that race does not have a role in the scientific community, it continues to play a role in the medical community, Dr. Higginbotham said.

"When you think about the social implications, particularly in this country, such as access to care and the effectiveness of the relationship between physicians and patients, one might consider using race along those lines," she said.

Our teaching and traditions in medicine sometimes are not helpful as we expand our understanding of a disease such as glaucoma. Dr. Higginbotham makes this clear in her discussion of using biological measurements as the basis for diagnosis and treatment of glaucoma. We can do better than try to determine risk or treatment plan based on race. As we gain greater insights into the genetic and molecular foundations for glaucoma and variation in response to treatment, we will find little use for some of our older concepts. It is useful to understand the limitations of these historical concepts.

– Robert D. Fechtner, MD
Institute of Ophthalmology and Visual Science, UMDNJ-New Jersey Medical School