Browsing by Author "Parikh, Kisan"
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Item Burden of Glaucoma: Adjunct Eye Disease(2014-02-04) Parikh, Kisan; Vu, Khiem; Markel, Nathan; Adams-Huet, Beverley; Li, Xilong; Kooner, KaranjitPURPOSE: The purpose of this study was to better understand the broad impact of primary open-angle glaucoma (POAG) by identifying eye conditions commonly associated with this multifactorial disease. METHODS: An IRB-approved retrospective chart study was conducted at a major academic institution. A total of 713 ethnically diverse patients met the inclusion criteria: 411 were diagnosed with POAG and 302 were controls with no glaucoma diagnosis. Information was collected on: demographics, refractive errors, and ocular ailments. Cochran-Mantel-Haenszel tests were used to compare eye disease prevalence between the two groups. RESULTS: The POAG group (mean age: 64.3, SD=13.3) was 44% female and the control group (mean age: 64.8, SD=12.3) was 47% female. The POAG group showed a higher prevalence of astigmatism (80% vs 60%,p<0.0001), myopia (66% vs 54%,p=0.0004), legal blindness (4.6% vs 1%,p= 0.004), pseudophakia (43% vs 35%,p=0.01), blepharitis (18% vs 12%,p=0.006), retinal detachment (4.1% vs 1.3%, p=0.03), central retinal vein occlusion (CRVO) (3.4% vs 0%,p=0.001), ptosis (12% v 4%,p=0.0001), and uveitis (2.4% vs 0.3%,p=0.02). DISCUSSION: The POAG group had an increased prevalence of astigmatism, myopia, legal blindness, pseudophakia, blepharitis, retinal detachment, CRVO, ptosis, and uveitis. Some of these results are explainable and expected. Glaucoma is the second leading cause of legal blindness in the United States. In addition, myopes have an increased risk of POAG and retinal detachment compared to emmetropes. The increased prevalence of blepharitis is likely due to side-effects of glaucoma medications. Another side effect is an increased risk of cataracts, which may explain the increased prevalence of pseudophakia. Lastly, glaucoma is a known risk factor for CRVO. The results involving uveitis and ptosis are more difficult to explain. CONCLUSIONS: This study has shown that patients with POAG have a host of other ocular diseases that may affect their quality of life. Awareness of these associations and their causes would be invaluable to clinicians as they screen for and treat ocular diseases. Future work to replicate the findings of this study and the elucidation of potential mechanisms underlying these associations are indicated.Item Does a Positive Family History of Glaucoma Foretell Severity?(2014-02-04) Vu, Khiem; Markel, Nathan; Parikh, Kisan; Adams-Huet, Beverley; Li, Xilong; Kooner, KaranjitPURPOSE/RELEVANCE: There is a threefold increase in the risk of primary open-angle glaucoma (POAG) in individuals with positive family history. We wished to see if the family history also led to a more severe form of the disease. METHODS: In an IRB-approved retrospective chart study at a university-affiliated medical center, data was collected from 224 patients diagnosed with glaucoma. Positive family history was defined by first, second, or third degree relatives affected (FHx-pos). Patients with negative family history were referred to as controls. Patients with unknown family history were excluded. Age, gender, race, BMI, cup/disk ratio (C/D), visual field defects, intraocular pressure (IOP), central corneal thickness (CCT), and current glaucoma medications were recorded. FHx-pos and control groups were compared using Fisher's Exact and Wilcoxon Rank sum tests for categorical and continuous variables, respectively. RESULTS: Among patients with glaucoma, there were 82, 120, and 22 patients with positive, negative, and unknown family history, respectively. The FHx-pos group was 47.6% white, 39% black, and 13.4% Hispanic, while the control group was 40.8% white, 40.8% black, and 18.4% Hispanic; no clinically significant differences were noted. Both groups were similar in age (63.3±14.8 vs. 64.9±11.8 years, p=0.5) and CCT (539 vs. 540 μm, p=0.8). The FHx-pos group was predominantly female (70.7% vs. 45%, p<0.001), had elevated IOPs (16.9±4.0 vs. 15.7±4.2 mm Hg, p=0.040), and were prescribed more glaucoma medications (98.9 vs. 92.5%, p=0.05). The mean C/D for both groups was approximately 0.73 (p=0.86) with the FHx-pos group having slightly more optic cupping (29.6 vs. 26.1% of patients, defined as C/D > 0.9; p=0.6). DISCUSSION: The results suggest that glaucoma patients with affected relatives tend to be female. Sex-specific genetic factors or expression may contribute to disease progression, but a full mechanism has yet to be completely delineated. The FHx-pos group also had higher IOP, required more medications, and experienced slightly more optic nerve cupping, all of which indicate a more severe form of the disease. CONCLUSION: The results of this study corroborate the importance of taking a family history of glaucoma. This is especially important for females, for whom aggressive treatment may be necessary. The gender finding merits further study into the possible heritability of predisposing factors in the pathogenesis of POAG in female populations. REFERENCES: Fingert JH. Primary open-angle glaucoma genes. Eye. 2011; 25, 587-595