Detect Glaucoma in 60 Seconds
Simple conversations with patients can have a positive impact on disease detection.
Glaucoma is the leading global cause of irreversible blindness. By 2050, an estimated 7.32 million people will have primary open-angle glaucoma.1 In the United States, the prevalence of glaucoma is rising radically. By 2035, the growing population is projected to have more people aged 65 years and older than under the age of 18.2 In addition, the US Census Bureau predicts that, by 2050, the African American, Asian, and Hispanic population in this country will increase from 17% to 34%.2 These groups have an elevated incidence of glaucoma; the prevalence increases ninefold among African Americans and Hispanics in their 80s versus their 40s.3-5
AT A GLANCE
• In the United States, the prevalence of glaucoma is growing radically, yet 50% of people with the disease are unaware that they have it.
• Because the resources available for increasing glaucoma awareness are limited, a logical strategy is to focus efforts on people at high risk of developing the disease.
• Regardless of race or location, a positive family history of glaucoma has a high yield for finding other patients with the disease. By initiating a discussion of hereditary risk with patients and their families, clinicians can increase detection of the disease.
While the treatment of glaucoma continues to advance, the typically asymptomatic nature of the disease means the diagnosis is frequently missed. Fifty percent of people in the United States with glaucoma and more than 90% globally are not aware that they have it. Because the resources available for increasing glaucoma awareness are limited, a logical strategy is to focus efforts on people at high risk of developing the disease.
GLAUCOMA POPULATION STUDIES
The Baltimore Eye Survey showed that a positive family history is strongly associated with having glaucoma and that the risk is even greater among African Americans and highest amongst siblings.3 Australian population-based studies in Tasmania found that familial cases of glaucoma occurred at an earlier age and were more severe than sporadic cases of open-angle glaucoma.6 The Barbados Eye Studies showed that, when evaluating 1,000 relatives from about 200 probands for almost a decade, 23% of the relatives examined had manifest glaucoma.7 In the Rotterdam Eye Study, siblings of glaucoma patients had a ninefold higher risk of developing glaucoma than siblings without a positive family history.8 Regardless of race or location, a positive family history of glaucoma has a high yield for finding other patients with the disease.
Our relationships with glaucoma patients allow us to target their family members. When we see a patient in our office who has been diagnosed with the disease, we need to discuss its hereditary component if we have not done so previously. When family members accompany these patients to clinic visits, are we discussing hereditary risk and strongly recommending that those family members be screened for the disease? Research reveals we cannot assume that glaucoma patients know about the hereditary risk or are even sharing their own diagnosis with family members.9 We clinicians can help patients see that communicating this information is a gift, not a burden.
Initiating a conversation about hereditary factors with my patients takes 60 seconds. Here is what I say: “Mrs. Jones, we are trying to make sure that our glaucoma patients are aware of the hereditary component of
glaucoma. Because you have glaucoma, anybody who is a blood relative is at increased risk of having glaucoma as well. This is especially important for any siblings, children, and parents. It is really important that you share your diagnosis with your family members. Do not view it as a burden but as a gift, the gift of sight. In order for glaucoma to be best treated, the earlier it is found, the better. You know yourself that glaucoma is not easy to notice in its early stages. This is why it is important to let your family members know of your diagnosis and then to encourage them to get checked specifically for glaucoma. When they do get examined, make sure that the doctor who is evaluating them knows about their positive family history and their desire to be specifically checked for glaucoma, not just glasses. Usually, pupillary dilation and special tests are needed. If your family is local or in town, my staff and I would be happy to screen them here.”
Watch it Now
In this episode of GT Journal Club, Constance Okeke, MD, MSCE, discusses a glaucoma awareness campaign targeted at educating patients to encourage family members to be screened for the disease.
Knowledge is power. Educating our patients empowers them to act for themselves and for others. It also shows them that we care and enhances their trust in us.
Any clinician who has difficulty initiating these conversations, as I did myself at first, can use posters as a starting point and as a reminder (Figure). Additional steps toward spreading glaucoma awareness include offering glaucoma screenings at our practices or in conjunction with community organizers. For more information on a campaign inspired by the 2016 annual meeting of the American Glaucoma Society, readers are welcome to contact me via email (see Watch It Now). n
1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262-267.
2. 2014 National Population Projections; Summary Tables: tables 6 and 14. US Census Bureau. http://bit.ly/20eCqM7. Accessed September 10, 2016.
3. Tielsch JM, Sommer A, Katz J, et al. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991;266:369-374.
4. Quigley HA, West SK, Rodriguez J, et al. The prevalence of glaucoma in a population-based study of Hispanic subjects, Proyecto VER. Arch Ophthalmol. 2001;119:1819-1826.
5. Varma R, Ying-lai M, Francis BA, et al. Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004;111:1439-1448.
6. Wu J, Hewitt AW, Green CM, et al. Disease severity of familial glaucoma compared with sporadic glaucoma. Arch Ophthalmol. 2006;124(7) 950-954.
7. Nemesure B, He Q, Mendell N, et al. Inheritance of open-angle glaucoma in the Barbados family study. Am J Med Genet. 2001;103(1):36-43.
8. Wolfs RC, Klaver CC, Ramrattan RS, et al. Genetic risk of primary open-angle glaucoma. Population-based familial aggregation study. Arch Ophthalmol. 1998;116(12):1640-1645.
9. Okeke CN, Friedman DS, Jampel HD, et al. Targeting relatives of patients with primary open angle glaucoma: the help the family glaucoma project. J Glaucoma. 2007;16(6):549-555.
Constance O. Okeke, MD, MSCE
• assistant professor of ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia
• glaucoma specialist and cataract surgeon, Virginia Eye Consultants, which has multiple locations in Virginia
• email@example.com; www.drconstanceokeke.com
• financial interest: none acknowledged