Glaucoma: Diagnosis, Screening, and Management

From the 6th Congress of the European Glaucoma Society Millennium Meeting, London, UK, 26-28 June 2000

Prevalence of Family History of Glaucoma

Eugen Gramer
Wurzburg
Germany

A prospective evaluation was performed to determine whether there are any differences in the prevalence of family history of glaucoma in patients with primary angle closure glaucoma (PACG), ocular hypertension (OH), normal tension glaucoma (NTG), and pigmentary glaucoma (PG) in comparison with primary open angle glaucoma (POAG). Patients with glaucoma were interviewed by questionnaire to determine the glaucoma status of their relatives (mother, father, grandmothers, grandfathers, uncles, aunts). 2122 questionnaires were completed and ophthalmologists confirmed the type of glaucoma. The prevalence of family history of glaucoma is shown in table 1.

Table 1. Family history of glaucoma (n = 2122)

Primary open angle glaucoma Primary angle closure glaucoma Ocular hypertension Normal tension glaucoma Pigmentary glaucoma Prevalence of family history (%) 548/1337 (40.9) 102/233 (43.8) 56/148 (37.8) 37/106 (34.9) 18/50 (36.0)

Direct interview of all relatives of glaucoma patients demonstrates a high prevalence of family history of glaucoma without significant differences in the prevalence between the different types of glaucoma. Glaucoma screening for relatives of people with glaucoma is therefore equally effective for all types of glaucoma and is important for early diagnosis.

Familial Incidence of Normal Pressure Glaucoma

Anne Child
Moorfields Eye Hospital
London, UK

The first genes for normal pressure glaucoma (NPG) have been located (GLC1B, GLC1E). Both these genes appear to be capable of producing glaucoma with an intrafamilial range of intraocular pressures from normal to elevated. While the exact nature of these 2 genes has not yet been elucidated, heterogeneity in NPG is already evident. In a consecutive series of 203 patients (67 male, 136 female) with NPG attending a special diagnostic clinic, 65 (32%) gave a history of at least 1 affected first degree relative. Of these probands, 8 had 2 or 3 generation pedigrees large enough to display definite autosomal dominant inheritance and were suitable for gene linkage studies. This series can be used for mutation analysis once NPG genes are identified.

Frequency Doubling Technology for Glaucoma Screening

Julian Rait University of Melbourne Melbourne, Australia

Dr Rait described a study to evaluate the effectiveness of the C20-1 FDT algorithm for disease screening in a population based survey of eye disease. 1478 eyes of 739 patients were examined with the C20-1 FDT screening algorithm and an expert panel determined probable and definite cases of glaucoma. The results of C20-1 FDT screening were compared with the other glaucoma diagnoses made in the study. Testing at the 1% probability level with the C20-1 FDT algorithm detected visual field loss with a specificity of 93.1% and a sensitivity of 87.5% for detecting definite cases of glaucoma. However, most visual field loss detected was not caused by glaucoma. These researchers concluded that the C20-1 FDT screening strategy is a rapid alternative to full threshold FDT testing and detects definite glaucoma with a high sensitivity. It appears to be useful for population screening where false positive results need to be minimised.

Comparison of Methods to Detect Early Glaucoma


Michael Greaney
Jules Stein Eye Institute
Los Angeles, USA

A study was performed to compare the ability of the Heidelberg retina tomograph (HRT), optical coherence tomography (OCT), scanning laser polarimetry (GDx), and qualitative assessment of optic nerve head (ONH) stereophotographs to distinguish normal eyes from early glaucomatous field defects.