Family Screening in Glaucoma: A Scoping Review.

TOPIC

To assess the prevalence of glaucoma among relatives of known glaucoma patients, describe the response rate of relatives in different glaucoma family screening programs, and summarize the barriers to family members' participation in these screening programs.

CLINICAL RELEVANCE

Population-based screening for glaucoma is a challenge since the prevalence in the general population is low. The presence of a positive family history is a known risk factor for glaucoma, but implementing family screening programs has not become standard practice yet. Further, the literature regarding the ideal strategy for implementing targeted glaucoma family screening programs is unclear.

METHODS

Databases including MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, Google Scholar, JBI Database, and Epistemonikos were searched for relevant literature. We included studies describing probands with primary open-angle glaucoma, primary angle closure disease, specifically primary angle closure glaucoma and primary angle closure, pseudoexfoliation glaucoma, and pigmentary glaucoma. The concept of interest was the response rates of family members to the screening programs and the proportion of people with undetected glaucoma identified by these programs. We updated our search in February 2025.

RESULTS

Forty-two studies were included in the data synthesis. The median prevalence of glaucoma among relatives was 11.25% (IQR: 8.1-17.6%), and the median prevalence of glaucoma suspects was 19.45% (IQR: 8.4-28.7%). Further, the median prevalence of glaucoma among offspring, parents, and siblings of probands across studies was 3.4% (IQR: 1.1-8.8%), 31.6% (IQR: 20.9-69.0%), and 16.2% (IQR: 10.4-33.3%), respectively. The response rate of relatives to a screening program is highly variable. Direct contact with relatives, either via letters (median: 74.6%,

IQR

39-82.4%) or telephone (median: 48%,

IQR

38.9-69.8%), yielded better response in contrast to indirect communication through probands as in oral counselling of probands or issuing leaflets or cards to be given to their relatives (median: 12.9%,

IQR

8.6-30.2%).

CONCLUSION

Over 30% of relatives of known primary glaucoma patients either have glaucoma or are diagnosed as suspects. Response rate to screening programs is low. These programs should focus on directly engaging with the relatives. More evidence is required to identify the ideal age at which glaucoma screening needs to commence.