Search

Objective: Characteristics of individuals with angle closure may be useful in targeted screening of family members. Here, we assess if findings gathered during examination and imaging of patients with a known angle-closure diagnosis (probands) could better determine the risk of angle closure in the patients' siblings., Design: Cross-sectional study of patients with known angle closure and their siblings., Participants: South Indian patients (probands) 30 years and older with open angles, primary angle-closure suspect (PACS), or primary angle closure/primary angle-closure glaucoma (PAC/PACG) and a biological sibling age 30 years or older (n = 292 proband/sibling pairs)., Methods: Demographic data, relevant ocular history, and a comprehensive ophthalmic examination with anterior segment OCT (AS-OCT) were obtained. Three clinically relevant models were created to analyze the contribution of specific proband factors in predicting sibling angle-closure diagnosis, using demographic (age, sex), ocular examination (gonioscopy, optic nerve examination, visual acuity, intraocular pressure), and AS-OCT features to improve prediction beyond proband diagnosis alone evaluated by log likelihood ratio testing and statistical comparison of receiver operating characteristics (ROCs)., Main Outcome Measures: Sibling angle-closure diagnostic accuracy., Results: Demographic and ocular examination metrics did not improve the prediction of sibling angle closure for all 3 outcomes (sibling diagnosis: (1) PACS/PAC/PACG vs. OA, (2) PAC/PACG vs. PACS/OA, and (3) PAC/PACG vs. PACS), adding no model improvement when compared to diagnosis alone. Models adding AS-OCT metrics to the prior model including proband diagnosis, demographics, and ocular examination measures led to significantly improved prediction of 2 of the 3 angle-closure outcomes. Specifically, improvement was noted via likelihood ratio testing for prediction of PAC/PACG vs. PACS/OA (P = 0.01) or PAC/PACG vs. PACS (P = 0.001). For all 3 angle-closure outcomes, ROC comparisons demonstrated significant improvement in area under the curve (AUC) between the 3 models predicting sibling outcomes, demonstrating an increase in AUC with each successive nested model across all 3 sibling angle-closure outcomes., Conclusions: Structural features of eyes with angle closure may assist in stratifying the risk of angle closure in patients' siblings. Further studies should consider evaluating this approach to achieve more targeted screenings., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma., Methods: Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF., Results: The mean (standard deviation) rate of change in better-eye MD was -0.08 dB/year (0.5), rate of QoL change was -0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (β = -0.10 logits [95% confidence interval [CI]: -0.13, -0.08]) and greater FoF (β = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL ( -0.004 logits/year, 95% CI: -0.02, 0.01) or FoF (-0.0001 logits/year, 95% CI: -0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (β = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (P = 0.79)., Conclusions: Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage., Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)