Sukuanamneesi glaukooman riskitekijänä

Anja Tuulonen

Näytön aste: C

Positiivinen sukuanamneesi ilmeisesti lisää riskiä sairastua glaukoomaan.

Systemaattinen katsaus 1

The systematic review «Burr JM, Mowatt G, Hernández R ym. The clinical ef...»1 aimed to identify the magnitude of risk of OAG attributable to age, ethnicity, family history, myopia and diabetes. Population-based cohort and cross-sectional studies, investigating the risk of developing OAG were included, as well as meta-analyses and systematic reviews of observational population-based studies. Studies reporting populations in UK, Europe, North America, Canada or Australia were included. Hospital or clinic-based setting were excluded. The review was restricted to English language publications. The methodological quality of the included studies was assessed.

4383 reports were identified from the search for studies on epidemiology, risk and disease progression, of which 285 were selected for full assessment for this review. 92 reports describing 27 studies met the inclusion criteria for the review.

The overall quality of each study was summarised as (A) no major flaws or (B) possible important flaws. Studies were included when they rated ‘A’ in all fields. Exceptions were made to include ‘B’ studies when no better evidence was available. In most studies (81 %), participants were sampled adequately and selected from a relevant population. Suboptimal approaches to diagnose OAG (e.g. high IOP, absence of a visual test, baring of the blind spot, case records, unstandardised criteria) were used in five studies (19 %). Family history of OAG was defined as participants having any first-degree relative affected by OAG confirmed by clinical examination. Only one (20 %) obtained family history status from a secure source, by examination of first degree relatives of detected cases

Crude and adjusted relative risks (or odds ratios depending on study design) of OAG for the risk factors under investigation were abstracted. Where two or more studies contributed data, a random effects meta-analysis was undertaken. If both an unadjusted and adjusted ratio were reported in a study, an age- and gender-adjusted odds ratio was used in the meta-analysis. A relative risk was generated when an adjusted odds ratio was not reported and raw data were available.

The relationship between family history of glaucoma and OAG was investigated in five studies. Only four presented data sufficiently similar to allow for quantitative synthesis. However, the Rotterdam Study was removed from the analysis because their uptake rate was low (<75 %). The prevalence of OAG among participants with a positive family history varied from 4.2 to 8.6 %, with a pooled estimate of 6.7 % (95 % CI 5.0 to 8.4). The meta-analysis showed that a family history of glaucoma is associated with a three-fold excess age-adjusted risk of OAG (RR 3.14, 95 % CI 2.32 to 4.25). These results should be interpreted with caution, as these studies are methodologically weak because family history of glaucoma was based solely on participant self-report of family history. This method is suboptimal as it relies on the imperfect knowledge among participants (a form of recall bias). This association remained statistically significant when data from the Rotterdam Study135 were also considered (RR 3.23, 95 % CI 2.40 to 4.37). This study investigated the relationship of OAG with family history by means of a nested case–control study and was initially excluded from this analysis because of the high degree of uncertainty surrounding the results owing to its small sample size. However, it was the only study that ascertained a positive family history by examining first-degree relatives of patients with glaucoma and control subjects from the population-based Rotterdam Study.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Systemaattinen katsaus 2

Structured Medline (January 1950 – January 2013) search and a hand search of references and citations of retrieved articles yielding 57 articles from 41 studies were included in the systematic review «Hollands H, Johnson D, Hollands S ym. Do findings ...»2.

The summary prevalence of glaucoma in the highest-quality studies was 2.6 % (95 % CI, 2.1 %-3.1 %). Among risk factors evaluated family history increased the risk of glaucoma (OR, 3.3; 95 % CI, 2.0-5.6).

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Systemaattinen katsaus 3

The objective of the analysis of this systematic review «Health Quality Ontario. Routine eye examinations f...»3 was to determine the strength of association between age, gender, ethnicity, family history of disease and refractive error and the risk of developing glaucoma. The medical advisory secretariat conducted a computerized search of literature in English-language articles, published from January 2000 to March 2006. In addition, a search was conducted for published guidelines, health technology assessments, and policy decisions. Bibliographies of references of relevant papers were searched for additional references.

Studies including participants ≥ 20 years old, population-based prospective cohort studies, population-based cross-sectional studies when prospective cohort studies were unavailable or insufficient and studies determining and reporting the strength of association or risk- specific prevalence or incidence rates were included in the review. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to summarize the overall quality of the body of evidence.

A total of 498 citations for the period January 2000 through February 2006 were retrieved and an additional 313 were identified when the search was expanded to include articles published between 1990 and 1999. An additional 6 articles were obtained from bibliographies of relevant articles. Of these, 36 articles were retrieved for further evaluation. Upon review, 1 meta-analysis and 15 population-based epidemiological studies were accepted for this review

Three cross-sectional studies investigated the association between family history of glaucoma and prevalent POAG. These data suggest a 2.5 to 3.0 fold increase in the odds having POAG in persons with a family history (any first-degree relative) of POAG. The quality of the evidence is moderate.


  1. Burr JM, Mowatt G, Hernández R ym. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess 2007;11:iii-iv, ix-x, 1-190 «PMID: 17927922»PubMed
  2. Hollands H, Johnson D, Hollands S ym. Do findings on routine examination identify patients at risk for primary open-angle glaucoma? The rational clinical examination systematic review. JAMA 2013;309:2035-42 «PMID: 23677315»PubMed
  3. Health Quality Ontario. Routine eye examinations for persons 20-64 years of age: an evidence-based analysis. Ont Health Technol Assess Ser 2006;6:1-81 «PMID: 23074485»PubMed