• Rotterdam Study (1998)3 - POAG

• Found the prevalence of glaucoma in first degree relatives to be 10.4% in siblings and 1.1% in offspring of patients.

• Baltimore eye Survey(1994) 1 – POAG

• A total of 16.1% of cases reported a postive family history of glaucoma among first degree relatives.

• The Stronger association was with siblings (9.9%; Odd’s Ratio 3.69) than in parents (5.6%; Odds Ratio 2.17) and weakest with their children (1.2%; Odds Ratio 1.12)

• Finish twin Cohort Study (1987)4 - POAG

• In a twin study in Finland the heritability estimate was 10.2%

• Barbodos Family Study(1996)2 - POAG

• Found 19.8% (67/338) of siblings to have OAG in a population mainly of Afro-Caribbeans.

• In Eskimos, prevalence of PACG in first degree relatives was found to be 3.5 times higher than in general population5.

• Heritability and siblings’ risk of narrow angle, reveals a high heritability of narrow angles of almost 60%. Siblings of Chinese patients with PAC/PACG have almost 50% probability of having narrow angle and are more than 7 times to have narrow angles than general population6.

• Our study prevalence of Open Angle Glaucoma is 10.73% and that of Angle closure was 4.53%.

Total Screened

434 Relatives

300 POAG Relatives

134 PACG Relatives

• We counselled all glaucoma patients to request all their first degree relative to come for a check up.

• Consent was obtained from patients to contact all family members and to participate in the study.

• We contacted the relatives of glaucoma patients by means of printed mails or telephonic call.

• All patients were examined at Aravind Eye Hospital, Tirunelveli between Jan 2010 to Jan 2011.

• All qualified family members were offered a comprehensive eye examination that includes:

Slit Lamp biomicroscopy,

Applanation tonometry,

Gonioscopy,

Fundus examination.

Pachymetry.

Visual field testing.

• A positive family history of glaucoma has long been assumed to be associated with significantly elevated risk of primary open angle glaucoma, which has been reported in 13-25% of the cases. (Arch Ophthalmol 1994;112:69-7)1

• The Baltimore Eye Survey1 reported a higher risk of glaucoma in siblings than in parents or children of known glaucoma patients.

• The Barbados Eye Study2 documented four times increased risk of glaucoma in siblings of known glaucoma patients.

• The examination of family members of those with diagnosed glaucoma could be an efficient means to identify a group at greater risk.

• In this study we offered an eye examination to family members of proven glaucoma (POAG & PACG) with the help of Aravind Family Glaucoma Project (AFGP).

BACKGROUND

PURPOSE

RESULTS

DISCUSSION

CONCLUSION This study demonstrates a novel program (AFGP) to identify family

members of known glaucoma patients, who are at higher risk of

developing glaucoma. This study also reconfirms that the first

degree relatives of known glaucoma patients are the most AT RISK

group to develop glaucoma & of those siblings have the highest risk.

•To identify the risk of glaucoma in first degree relatives of

definitive glaucoma patients.

Aravind Eye Hospital, Tirunelveli, India

Chief Investigator: Dr. Mohideen Abdul Kader.

Co-investigators: Dr. Devendra Maheshwari, Dr. R Ramakrishnan.

Family Screening of POAG and PACG Patients:

The help of family glaucoma screening project

METHODS

174

260

Sex Distribution

Females Males

Normal

84.74% OPEN ANGLE

10.73%

CLOSED

ANGLE 4.53% Glaucoma

15.26%

INTERPRETATION

52.6

67.6

30

35

40

45

50

55

60

65

70

75

80

POAG PACG

Mean Age in years

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

Diagnosed cases

8.50%

1.16%

0.70%

OPEN ANGLE GLAUCOMA

POAG POAS OHT

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

Diagnosed cases

2%

1.38% 1.15%

ANGLE CLOSURE GLAUCOMA

PACG PACS PAC

REFERENCES 1. Tielsch JM Kat:J Sommer A et al. Family history and risk of primary openangle glaucoma. The Baltimore Eye Survey. Arch Ophthalmol

1994;112:69-73.

2. Namesure B, Leske MC, He Q, et al. Analyses of reported family history of glaucoma: a preliminary investigation. The Barbados Eye Study Group. Ophthalmic Epidemiol 1996;3:135-41.

3. Wolfs RC, Borger PH, Ramrattan RS et al; Changing views on open-angle glaucoma: definitions and prevalences - The Rotterdam Study.; Invest Ophthalmol Vis Sci. 2000 Oct;41(11):3309-21.

4. Teikari JM.; Genetic factors in open-angle (simple and capsular) glaucoma. A population-based twin study.; Acta Ophthalmol (Copenh). 1987 Dec;65(6):715-20.

5. Albrisk PH; Primary Angle Closure Glaucoma; Oculometry, epidemiology and genetics in a high risk population. Acta Ophthalmol 54(127):5-13, 1976

6. Nishani Amerasinghe, Jian Zhang et al; The Heritability and sibling risk of angle closure in asians. Ophtalmology 2011;118:480-485.

In POAG group total 300 relatives of 87 POAG patients were screened and 44 (10.73%) were diagnosed to have glaucoma

% NO. Sibling Children Parents

POAG 8.5 36 26 6 4

POAS 1.16 5 3 2 0

OHT 0.7 3 3 0 0

TOTAL 10.82 44 32 8 4

In PACG group a total 134 relatives of 47 PACG patients were screened and 20 (4.53%) were to have diagnosed to have glaucoma

% NO. Sibling Children Parents

PACG 2 9 5 2 2

PACS 1.38 6 5 1 0

PAC 1.15 5 3 1 1

TOTAL 4.76 20 13 4 3

In the present study the prevalence of glaucoma in first degree relatives was found to be 10.73% in POAG and 4.53% in PACG group

POAG (Out of 44) PACG (Out of 20)

Siblings 32 (73%) 13 (65%)

Children 8 (18%) 4 (20%)

Parents 4 (9%) 3 (15%)

LIMITATIONS We were unable to screen the complete family due to various

reasons (not in native place, not willing / few passed away).

Small sample size.