Enhancing early glaucoma detection through family screening to reduce glaucoma related blindness

Abstract

Purpose : A positive family history is a known risk factor for glaucoma. However, the response of family members to glaucoma screening is poor. Literature suggests that the response rate is less than 20%. We hypothesize that by having an automated system in place, we would be able to improve the screening rate and glaucoma detection at an early stage. We have devised a software for this purpose.

Methods : A multicenter prospective cohort study was conducted at five tertiary eye care centers in south India from January 2020-October 2023 (project ongoing). Patients with primary open angle glaucoma, primary angle closure, primary angle closure glaucoma, and pseudoexfoliation glaucoma who seek care were enrolled. Glaucoma suspects and ocular hypertensives were excluded. After completing examination, the details of their first-degree relatives and spouses who were over 18 years of age were obtained and entered into a software that sends automated short message service (SMS) to the relatives offering free screening. On presentation, the relatives are directly screened in the glaucoma services by assessing visual acuity, intraocular pressure, central corneal thickness, gonioscopy, ocular examination and, if necessary, optical coherence tomography for retinal nerve fibre layer analysis and visual fields by Humphrey automated perimetry. The response rate and the prevalence of glaucoma in first-degree relatives and spouses were analysed.

Results : Through October 2023, 26,493 probands were enrolled and SMS were sent to 56,125 relatives, 22,480 (40.1%) of whom visited the hospital for screening. Among those screened, 1,024 (4.6%) were diagnosed with glaucoma and 3,847 (17.1%) were identified as glaucoma suspects and are under observation or further evaluation (Table).

Conclusions : We find that the response rate is better than the various other methods of family screening reported in literature to date. One of the major barriers in traditional family screening programs is poor communication between relatives. This barrier is bypassed by the current method which improves response rate. One in 4-5 relatives over 18 years of age were found to have either glaucoma or is identified as suspect requiring regular review. Early detection may help reduce the magnitude of blindness due to glaucoma.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Table showing the number of probands, relatives screened and the prevalence of glaucoma or suspects amongst the relatives