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Family history of glaucoma leads to earlier diagnosis
But, diagnosis of normal tension glaucoma comes later when a family history exists.
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LONDON - Knowing a family history of glaucoma leads to an earlier diagnosis of many types of the disease, according to Eugen Gramer, MD, of the University Eye Hospital in Wuerzburg, Germany.
A family history of glaucoma often leads to screening and to earlier detection of primary open-angle glaucoma, primary angle-closure glaucoma, ocular hypertension and pigmentary glaucoma. However, it does not lead to earlier detection of normal tension glaucoma.
"Patients with a family history of glaucoma are diagnosed at a younger age compared to patients without a family history of glaucoma," he said. "There is no significant difference in the incidence of family history of glaucoma between the different types of glaucoma compared, in spite of differences in the gene locus of the disease in different glaucomas."
Onset, diagnosis
Dr. Gramer reported his results in a poster session held at the European Glaucoma Society meeting held here.
Researchers interviewed glaucoma patients with a detailed questionnaire about their parents, siblings, children, grandparents, aunts and uncles. The patients' ophthalmologists supplied information about type of glaucoma, age of the patient at diagnosis, stage of visual field loss, maximal IOP, general risk factors and topical and systemic medications.
Dr. Gramer said, "Further evaluations of the stage of the visual field loss of patients with and without family history of glaucoma, which was documented in the questionnaires, will show whether patients with family history of glaucoma are not only diagnosed earlier, but also have an earlier onset of the disease."
Of the 2,122 patients who returned questionnaires, 1,337 had open-angle glaucoma, 233 had angle-closure glaucoma, 148 had ocular hypertension, 106 had normal tension glaucoma and 50 had pigmentary glaucoma. The other 248 patients had other types of glaucoma and were not included in the analysis.
Timing of screening
Family history of glaucoma was found in 548 of 1,337 (40.9%) open-angle glaucoma patients. For the other forms of glaucoma, researchers then determined the incidence rate of a family history and compared it to the incidence rate for open-angle glaucoma.
Among angle-closure glaucoma patients, 102 of 233 (43.8%, P=0.429) had a family history. Also, 56 of 148 (37.8%, P=0.482) of ocular hypertension patients had a family history. And 37 of 106 (34.9%, P=0.285) normal tension glaucoma patients had a family history. Finally, 18 of 50 (36%, P=0.559) pigmentary glaucoma patients had a family history.
Patients with a family history of glaucoma were diagnosed at a significantly younger age for open-angle glaucoma (P=0.0001), angle-closure glaucoma (P=0.0001), ocular hypertension (P=0.0334) and pigmentary glaucoma (P=0.0002) than patients without a family history of glaucoma. However, Dr. Gramer added, this was not significant for patients with normal tension glaucoma (P=0.4733).
There are significant differences in the mean age of patients at the time of diagnosis between different types of glaucoma, according to Dr. Gramer. Patients with pigmentary glaucoma were diagnosed earlier than those with primary open-angle glaucoma (P=0.0001). Patients with ocular hypertension were diagnosed earlier (P=0.0011), and patients with normal tension glaucoma were diagnosed later (P=0.0365) than those with primary open-angle glaucoma (POAG).
Directly interviewing all relatives of glaucoma patients shows there is no significant difference in the incidence of these types of glaucoma compared to open-angle glaucoma, Dr. Gramer said. The study showed that knowing about a family history of glaucoma leads to diagnosis at a younger age.
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| Type of glaucoma | Patients with family history of glaucoma | Mean age at diagnosis, in years | Patients without family history of glaucoma | Mean age at diagnosis, in years | P value | Earlier diagnosis in patients with family history of glaucoma |
| POAG | 533 | 51.61±12.79 | 741 | 57.1±11.88 | P=0.0001 | Yes |
| PCAG | 97 | 52.13±13.37 | 124 | 59.17±11.41 | P=0.0001 | Yes |
| OH | 53 | 48.26±13.06 | 80 | 52.95±10.94 | P=0.0334 | Yes |
| PG | 17 | 35.35±9.30 | 32 . | 48.21±12.58 | P=0.0002 | Yes |
| NTG | 36 | 56.16±13.23 | 68 | 58.17±14.06 | P=0.4733 | No |
| SOURCE: EUGEN GRAMER, MD, LLD | ||||||
For Your Information:
- Prof. Eugen Gramer, MD, LLD, can be reached at University-Augenklinik, Josef-Schneiderstr 11, Wuerzburg D-97080, Germany; (49) 931-201-2477; fax: (49) 931-93-773. Dr. Gramer has no direct financial interest in any products mentioned in this article, nor is he a paid consultant for any companies mentioned.