Screening First Degree Relatives of Persons with Primary Open Angle Glaucoma in India

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

PRCIS

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.

PURPOSE

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.

Comparative Analysis of Glaucoma Screening Uptake Among First-Degree Relatives After Community-Based and Hospital-Based Approaches

Purpose

Glaucoma is the second leading cause of irreversible blindness globally. Primary open-angle glaucoma (POAG) can be genetically transmitted among first-degree relatives (FDRs). Therefore, screening for glaucoma in FDRs can significantly increase the chances of early detection. This study aimed to evaluate the differences in glaucoma screening uptake among FDRs in community and hospital-based settings and the underlying factors, as well as the prevalence of glaucoma in FDRs.

Patients and Methods

Probands and FDRs who underwent screening were classified into two: community-based (group 1) and hospital-based (group 2). They were invited for screening by Village Health Volunteers and ophthalmic nurses, respectively, using information brochures. The FDRs underwent eye examinations, and those with suspected glaucoma underwent further testing for confirmation.

Results

The response rates of probands were 261 (38.2%) for group 1 and 196 (48.8%) for group 2. The uptake screening of FDRs was 30.1% and 64.5%, respectively. Multivariate analysis identified that female FDRs {odds ratio [OR]=1.64; 95% CI 1.14-2.38} and those aged above 45 years (OR=2.06; 95% CI 1.32-3.21) were more likely to participate. FDRs residing outside Chanthaburi Province were less likely to attend than those within Chanthaburi (OR=0.36;95% CI 0.22-0.58). FDRs related to probands with blindness were more likely to participate (OR=1.69; 95% CI 1.13-2.54), as were FDRs with secondary school education or higher (OR=2.49;95% CI 1.48-4.18). Those receiving both medical and surgical treatment were more likely to participate (OR=2.22;95% CI 1.51-3.25). The prevalence of glaucoma was 8.3%, and 19.2% of screened FDRs were glaucoma suspects.

Conclusion

Group 1 showed a significantly lower screening uptake than Group 2. The factors influencing the uptake of screening by FDRs are gender, age, geographic location, visual acuity of the worse eye in probands, education status of FDRs, and treatment modalities of probands.

Empowering Family Glaucoma Risk Communication Using QR-Code-Mediated Online Intervention

PURPOSE

Attempts at engaging relatives of glaucoma patients in education and screening have had limited success. This study explores the feasibility of an electronic intervention to facilitate direct yet reliable glaucoma risk communication between open-angle glaucoma patients (probands) and their first-degree relatives (FDRs).

DESIGN

Prospective survey and assessment of intervention.

PARTICIPANTS

Fifty adult probands, engaging 140 FDRs.

METHODS

Phase I was an iterative process involving creating a customized website and Quick Response (QR)-code-based intervention designed with input from probands, FDRs of patients, community members, and researchers. In phase II, the intervention was deployed in a clinical setting; this involved recruiting probands who had a smartphone and were willing to use the QR-code to message their FDRs a standard message, including a website link about glaucoma risk in FDRs and the importance of getting examined. Follow-up interviews were conducted with probands 1 to 2 weeks after their clinic visit to assess the impact of the intervention. Demographic data, website analytics, and participant feedback were collected and analyzed.

MAIN OUTCOME MEASURES

Increased awareness of glaucoma risk among FDRs and enhanced discussions.

RESULTS

At the time of the first interview, probands reported that 70% of the FDRs were aware of the probands' glaucoma diagnosis, but only 26% had undergone glaucoma screening. Ninety percent of probands had no issues using the QR-codes. Website analytics recorded 73 visits from 51 distinct internet protocol addresses (IPs). After receiving the standard message, 95% of FDRs followed up with the probands, actively discussing glaucoma. Of the probands, 84% completed the follow-up interview 1 to 2 weeks after enrollment. Fifty-nine percent of the FDRs were reported to have scheduled screening appointments. The collected feedback revealed that 96% of probands found the intervention helpful, fostering glaucoma discussions with their FDRs and improving probands' comfort level in discussing health issues with FDRs from baseline (very comfortable: 88%, comfortable: 8%, neutral: 2%, and very uncomfortable: 2%) to the follow-up interview (very comfortable: 98% and comfortable: 2%).

CONCLUSIONS

This innovative online method of communicating the risk of glaucoma to FDRs of probands prompted and increased the comfort level of familial discussions of glaucoma. More than half of FDRs reported making an appointment to get screened for glaucoma.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Opportunistic Eye Screening Among First-Degree Relatives of Glaucoma Patients at a Suburban Tertiary Center in Malaysia

Background and objective

The majority of glaucoma patients are asymptomatic and are usually diagnosed at an advanced stage of the disease. This study aimed to assess the outcomes of glaucoma screening among known first-degree relatives of primary glaucoma patients.

Materials and methods

This study involved primary angle-closure glaucoma (PACG), primary open-angle glaucoma (POAG), and juvenile open-angle glaucoma (JOAG) patients who attended the glaucoma clinic at the Hospital Universiti Sains Malaysia between January 2014 and December 2015. First-degree relatives of the patients underwent a preliminary eye-screening evaluation, including visual acuity (Snellen chart), intraocular pressure (IOP) measurement (air-puff tonometry), and non-mydriatic fundus photography. Patients with visual acuity worse than 6/12, IOP measuring more than 21 mmHg or a difference of more than 3 mmHg between the eyes, and a vertical cup-disc ratio (VCDR) of 0.7 or higher were given a comprehensive eye examination.

Results

Seventy indexed glaucoma patients were recognized, and 368 first-degree relatives were identified. Forty-five relatives underwent the preliminary screening. Of these, 29 showed normal findings (62%), one had corneal pathology (2%), and 16 (36%) underwent a complete eye examination after failing the initial screening. Among the indexed JOAG group, five relatives (11%) were diagnosed as having JOAG; two were treated medically, while the remaining three required surgical intervention.

Conclusion

Opportunistic glaucoma screening of high-risk groups, especially JOAG is a feasible and cost-effective way to detect early glaucoma and prevent irreversible blindness. However, improvement in our healthcare system, including the involvement of multicentre clinics in other states in screening initiatives, is required to promote and facilitate the response to screening opportunities.

Piloting targeted glaucoma screening: experiences of eye care services in Ganjam district, Odisha state, India

Background

The number of patients with visual impairment and blindness from glaucoma is rapidly increasing with wide-ranging impacts for individuals and societies. However, the disease often goes undiagnosed for a long time, especially in low- and middle-income countries where healthcare services are limited. This paper presents the results of a pilot programme, which integrated targeted glaucoma screenings of people aged ≥40 y in community-based eye care services in the Ganjam district of Odisha state, India.

Methods

Using routine programme data, descriptive statistics were produced for the characteristics of patients participating in the screening programme and the rate and uptake of glaucoma referrals. Bivariate analysis was used to examine associations between patient characteristics, clinical risk factors and glaucoma diagnosis.

Results

Out of 23 356 individuals aged ≥40 y screened for glaucoma over a period of 18 mo, 2219 (9.5%) were referred and 2031 presented for further examination. Among them, almost half (n=968, 48%) were diagnosed with glaucoma, representing a screening to diagnosis conversion rate of 4.14% (95% CI 3.9 to 4.4%). A positive diagnosis of glaucoma among suspects was associated with female sex, age >60 y, visual impairment, vertical cap-to-disc ratio ≥0.6:1, intraocular pressure ≥30 mmHg and shallow anterior chamber (p<0.001).

Conclusions

The importance of targeted screening for glaucoma using simple referral criteria to identify patients at high risk of vision loss who can benefit from treatment is critical to slow the progression of the disease and the prevention of blindness. Further studies assessing costs of the targeted screening, the role of technology in improving programme effectiveness and efficiency and the longer term compliance with treatment are needed to support glaucoma policy frameworks, guidelines and clinical practice.

The Effect of Direct Health Education on the Uptake of Screening by First Degree Relatives of Glaucoma Patients in Nigeria

PRCIS

First degree relatives (FDRs) of glaucoma patients are more likely to present for screening when they are directly contacted and educated by health workers on the phone compared with when they are only invited by their relative with glaucoma.

OBJECTIVE

The aim was to determine the effect of direct health education by phone calls on the uptake of glaucoma screening among FDRs of primary open angle glaucoma patients as a glaucoma blindness control strategy in an asymptomatic high-risk African population.

METHODS

This was a randomized clinical trial in which 102 primary open angle glaucoma patients (probands) were randomized into control and intervention groups. Both proband groups were educated about glaucoma and requested by the investigator to invite their adult FDR to attend a screening clinic within 1 month. In addition, the FDRs in the intervention group were directly contacted, educated, and invited for examination by phone calls. A total of 560 FDRs were enumerated by the probands. The main outcome measure was proportion of FDR that presented for screening.

RESULTS

A total of 218 (38.9%) FDRs took up glaucoma screening services. Eighty-nine (30.1%) of the 296 FDRs in the control group and 129 (48.9%) of the 264 FDRs in the intervention group presented for examination. After multivariate analysis, FDRs in the phone call group were 2.506 times [95% confidence interval (CI): 1.695-3.706] more likely to present than FDRs in the no phone call group. Young FDRs were more likely to present [odds ratio (OR)=3.593; 95% CI: 1.613-8.007] than the elderly FDRs, while FDRs living within 200 km of the hospital were also more likely to present (OR=5.200; 95% CI: 2.860-9.456) than those living far (>200 km) away. Probands with moderate to severe visual impairment were significantly more likely (OR=3.073; 95% CI: 1.845-4.352) to have their FDRs present than probands with mild or no visual impairment.

CONCLUSION

Direct contact and health education of FDRs through phone calls had a significant positive effect on the uptake of glaucoma screening by FDRs. We recommend direct contact and education of the FDRs of glaucoma patients.

Screening first-degree relatives of glaucoma patients reveals barriers to participation

PURPOSE

To report the results of a glaucoma screening campaign targeting first-degree relatives of glaucoma patients in South India.

METHODS

1598 glaucoma patients were contacted via letter or letter and phone call and asked to bring their siblings and children to a glaucoma screening. Participants underwent standardised eye examinations and completed questionnaires that assessed barriers to participation and awareness of glaucoma risk. Two-proportion z-tests were used to compare categorical data. Costs associated with the screening were recorded.

RESULTS

206 probands (12.9%) attended the screening along with 50 siblings and children. Probands were nearly twice as likely to attend if they had been contacted via both letter and phone call rather than letter only. Over half of probands reported that their relatives could not participate because they did not live in the region, and one-fifth reported that their relatives had other commitments. Fifty-eight per cent of the siblings and children who attended did not know that they were at increased risk for glaucoma due to their family history, and 32.0% did not know that the relative who had invited them to the screening had glaucoma. Thirteen siblings and children (26.0% of those who attended) were found to have findings concerning for glaucoma. The average cost per first-degree relative who was screened was INR2422 (£26).

CONCLUSION

Participation in this glaucoma screening campaign was poor. The major barrier to participation was distance from the screening site and associated indirect costs. Better strategies for bringing first-degree relatives in for examinations are needed.

Assessment of Reasons for Presentation in New Primary Glaucoma Patients and Identification of Risk Factors for Late Presentation

PURPOSE

To evaluate the reasons for seeking care among South Indian primary glaucoma patients and to determine the relationship of various patient characteristics to glaucoma severity at presentation.

DESIGN

Cross-sectional study.

PARTICIPANTS

One hundred sixty-one new primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) patients seeking treatment at a tertiary eye hospital.

METHODS

After confirmation of diagnosis, participants' clinical information and their reported reasons for presentation were assessed. Data collected include age, gender, education, occupation, rural or urban residence, distance traveled to the hospital, method of transportation, need for an accompanying person, place of screening before referral or whether they came by themselves for testing. Advanced glaucoma was defined by a cup-to-disc ratio of 0.85 or higher in either eye.

MAIN OUTCOME MEASURES

The primary outcomes were the various reasons for presentation. The secondary outcome was to determine whether a relationship existed between the patient characteristics mentioned above and presentation with advanced glaucoma.

RESULTS

The mean age of the participants was 60.8 years. The primary reason for presentation was defective vision (55.2%) followed by routine ophthalmic evaluation (13%). Sixty-four patients (39.8%) showed advanced glaucoma in at least 1 eye at presentation. Unilateral blindness was noted in 18 patients (11.2%). The mean vertical cup-to-disc ratio was 0.66 (standard deviation [SD], ±0.16) in the better-seeing eye and 0.76 (SD, ±0.12) in the worse-seeing eye. The mean presenting intraocular pressure was 22.9 mmHg in POAG and 25.5 mmHg in PACG patients. Multivariate logistic regression analyses showed that people who are currently unemployed (P < 0.001; odds ratio [OR], 4.19; 95% confidence interval [CI], 1.95-8.99) and rural residence (P = 0.04; OR, 0.46; 95% CI, 0.21-0.99) had greater odds of demonstrating advanced glaucoma at presentation. Presentation with defective vision, older age, and education less than college graduation were associated with greater odds of showing advanced glaucoma in univariate analysis, but not in multivariate analyses.

CONCLUSIONS

In a South Indian population, absence of work and rural residence was associated with advanced glaucoma at presentation. The population in whom these risk factors are common should be targeted for screening and outreach.

The Effect of a Reminder Short Message Service on the Uptake of Glaucoma Screening by First-Degree Relatives of Glaucoma Patients: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to determine the role of a reminder short message service (SMS) on the uptake of glaucoma screening by first-degree relatives (FDRs) of patients with primary open-angle glaucoma (POAG) in North-central Nigeria following a telephone invitation for screening.

MATERIALS AND METHODS

A randomized controlled trial was conducted in the eye clinic of a tertiary hospital in Jos, North-central Nigeria. Two hundred FDRs of patients with POAG were invited through phone for free glaucoma screening and randomly allocated into two groups. The intervention group received a reminder SMS, whereas the control group did not receive a reminder. Those who failed to turn up for screening were contacted through phone to determine the reasons for their nonattendance. Chi-square test and bivariate analysis were used to compare attendance rate between the two groups.

RESULTS

Sending a reminder SMS following a telephone invitation had no effect on the uptake of glaucoma screening. The response rate was lower in the phone call plus reminder SMS group (43.0% vs. 53.0%) though the difference was not statistically significant (P = 0.157). Competing needs such as work and lack of transport fare were the most common reasons given for not attending the screening.

CONCLUSION

A reminder text message is not an effective tool for increasing the uptake of glaucoma screening in at-risk individuals in North-central Nigeria. Existing barriers to health care in the country need to be addressed before mobile phone technology can be effectively used in increasing the utilization of any free eye screening service.

Heritability of glaucoma and glaucoma-related endophenotypes: systematic review and meta-analysis protocol

INTRODUCTION

Glaucoma is the second leading cause of age-related vision loss worldwide; it is an umbrella term that is used to describe a set of complex ocular disorders with a multifactorial aetiology. Both genetic and lifestyle risk factors for glaucoma are well established. Thus far, however, systematic reviews on the heritability of glaucoma have focused on the heritability of primary open-angle glaucoma only. No systematic review has comprehensively reviewed or meta-analysed the heritability of other types of glaucoma, including glaucoma-related endophenotypes. The aim of this study will be to identify relevant scientific literature regarding the heritability of both glaucoma and related endophenotypes and summarise the evidence by performing a systematic review and meta-analysis.

METHODS AND ANALYSIS

This systematic review will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 checklist, which provides a standardised approach for carrying out systematic reviews. To capture as much literature as possible, a comprehensive step-by-step systematic search will be undertaken in MEDLINE (PubMed), EMBASE, Web of Science and ScienceDirect, and studies published until 31 December 2017 will be included. Two reviewers will independently search the articles for eligibility according to predefined selection criteria. A database will be used for screening of eligible articles. The quality of the included studies will be rated independently by two reviewers, using the National Health Institute Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. A random-effects model will be used for the meta-analysis. This systematic review is registered with the International Prospective Register of Systematic Reviews with a registration number: CRD42017064504.

ETHICS AND DISSEMINATION

We will use secondary data from peer-reviewed published articles, and hence there is no requirement for ethics approval. The results of this systematic review will be disseminated through publication in a peer-reviewed scientific journal.