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Glaucoma Cascade Screening in a High Risk Afro-Caribbean Haitian Population: A Pilot Study
Ta C Chang1, Linda Celestin1, Elizabeth A Hodapp1
1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
Insights
Glaucoma cascade screening in relatives of young Haitian patients identified a high rate of undiagnosed glaucoma. Enhancing provider recruitment and public awareness could improve participation in future screening efforts.
Area of Science:
- Ophthalmology
- Genetics
- Public Health
Background:
- Juvenile open-angle glaucoma (JOAG) in Haitian populations necessitates understanding familial risk.
- Cascade screening in first-degree relatives (FDRs) is a strategy to identify at-risk individuals.
Purpose of the Study:
- To assess the effectiveness of glaucoma cascade screening in FDRs of Haitian JOAG patients.
- To determine the prevalence of manifest and suspected glaucoma within this at-risk group.
Main Methods:
- Identified index patients with JOAG and their FDRs in South Florida.
- Invited FDRs for free glaucoma screening, including comprehensive eye exams, gonioscopy, visual field testing, and OCT.
- Collected and analyzed FDR characteristics and clinical findings.
Main Results:
- Of 77 invited FDRs, 26 (33.8%) participated.
- Screening identified 2 (7.7%) with manifest glaucoma and 6 (23.1%) with suspected glaucoma.
- FDRs with manifest glaucoma showed poorer visual acuity and thinner retinal nerve fiber layers.
Conclusions:
- Glaucoma cascade screening yielded a 30.8% diagnosis rate for suspected or manifest glaucoma in FDRs of Haitian JOAG patients.
- Provider-initiated recruitment and public education are crucial for increasing screening participation.
- Targeted screening can identify glaucoma early in high-risk family members.
Prcis:
Glaucoma cascade screening in first-degree relatives (FDRs) of young Haitian glaucoma patients had high yield for diagnosing manifest and suspected glaucoma in 30.8% of those screened despite modest participation.
Purpose:
To evaluate the outcomes of glaucoma cascade screening in FDRs (parents, siblings, and offspring) of Haitian juvenile open-angle glaucoma (JOAG) patients.
Patients And Methods:
Consecutive index patients (Haitians with JOAG) were identified, and the number/type of FDRs residing in South Florida were recorded. These FDRs were invited for free glaucoma screening, which included a comprehensive ophthalmic exam, gonioscopy, automated visual field testing and optical coherence tomographic analysis of the retinal nerve fiber layers. FDR characteristics and clinical findings from screening are reported.
Results:
A total of 77 FDRs were invited, 26 (33.8%) agreed to undergo screening (18 females, 9 males), which revealed 2 (7.7%) with manifest glaucoma (mean age 77.5 y; one of whom was previously unaware of his glaucoma diagnosis), 6 (23.1%) with suspected glaucoma (mean age 29.8±18.3 y), and 18 (69.2%) without manifest or suspected glaucoma (mean age 37.2±21.8 y). Siblings of index patients were least likely to participate in cascade glaucoma screening when compared with index patients' parents or offspring. FDR eyes with manifest glaucoma had significantly worse best-corrected visual acuities, higher intraocular pressures, thinner central corneal thicknesses, and thinner circumferential papillary retinal nerve fiber layer thicknesses than those without glaucoma.
Conclusion:
Glaucoma cascade screening of Haitian JOAG patients' FDRs revealed that 30.8% had suspected or manifest glaucoma. Future efforts centered on provider-initiated recruitment and improving public glaucoma awareness and education may increase screening participation.
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