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Rengaraj Venkatesh, Pradeep Y. Ramulu, Srinivasan Kavitha, Avinash Sinha, Robert Wojciechowski, Emilie S. Chan, David S. Friedman; The Importance of Family History in Angle Closure Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4507. doi: https://doi.org/.
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To determine if sibling screening effectively identifies undiagnosed angle closure.
Probands with primary angle closure suspicion (PACS), primary angle closure or primary angle closure glaucoma (PAC/PACG), and open angles without glaucoma (OA) were identified from patients of the Aravind Eye Hospital in Pondicherry, India. One sibling of each proband was examined and classified gonioscopically by a physician masked to the probands diagnosis. Angle closure was defined as ≥ 180° of iridotrabecular contact with or without PAS, IOP elevation or glaucoma (i.e. PACS, PAC or PACG).
Two hundred sibling pairs were examined with proband diagnoses of PAC/PACG, PACS, or OA in 48, 94, and 58 pairs, respectively. Angle closure was found in 1.8% of OA proband siblings compared to 25.5% of siblings of PACS probands (p<0.001), and 27.1% of siblings of PAC/PACG probands (p<0.001). No siblings of OA probands had PAC or PACG, as compared to 2.1% of PACS siblings (p=0.27), and 8.3% of PAC/PACG siblings (p=0.03). The prevalence ratio of angle closure in siblings of angle closure probands as compared to siblings of OA probands was 15.2 (95% CI=2.1 to 108.1, p<0.001). After adjusting for age and sex, the estimated odds of angle closure was 21.1 times higher among siblings of PACS, PAC or PACG probands compared to siblings of OA probands (95% CI=2.8 to 160.1, p=0.003).
Siblings of Indian patients with angle closure have a substantially higher risk of angle closure as compared to siblings of individuals with open angles. Roughly one in 4 siblings of Indian angle closure patients will have prevalent angle closure, while 1 in 12 siblings of PAC/PACG patients will also have PAC/PACG diagnoses. Given the significant risk of angle closure in siblings of angle closure patients, advising patients to have their siblings screened may be of high clinical yield.
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