Early Trabeculectomy Risk Indicated by High Polygenic Risk Score

A higher glaucoma polygenic risk score(PRS) is associated with an increased need for glaucoma surgical intervention at a younger age, according to a study published in Ophthalmology Glaucoma. 

A total of 903 patients (mean age at glaucoma diagnosis, 64.1±9.91 years; 57.3% women; mean highest recorded intraocular pressure (IOP) 28.0±8.66 mmHg) with primary open angle glaucoma (POAG) from the Australian New Zealand Registry of Advanced Glaucoma were enrolled in the study. Investigators calculated PRS and obtained blood samples for genotyping. Age at trabeculectomy, family history of glaucoma, and self-reported sex were recorded. 

Stratified by PRS decile, participants in the top decile were diagnosed at a younger age (mean difference [MD], 5.19; 95% CI, 3.03-7.36 years; P =.001), underwent trabeculectomy 7 years earlier (MD, −7.04; 95% CI, −2.82 to −11.26 years; P =.002), and tended to have a higher maximum IOP (P =.052) compared with individuals in the lowest decile. No relationship between PRS and time between POAG diagnosis and trabeculectomy was observed (P =.143).

Overall, increased PRS was associated with trabeculectomy at a younger age (β, −1.94; 95% CI, −0.41 to −3.47 years/standard deviation [SD]; P =.014) and participants in the top decile were more likely to require surgical intervention with trabeculectomy (odds ratio [OR], 1.41; 95% CI, 1.06-1.91; P =.021).

Researchers highlight the clinical significance of these findings. “For those with disease that may ultimately require surgery, this could mean that trabeculectomy is considered earlier in higher-risk individuals, potentially avoiding vision loss resulting from failed trials of more conservative options. It may also help prevent unnecessary surgery, or delay surgery, in those who are deemed to be low risk,” according to the report.

Study limitations include the exclusion of individuals not requiring surgical intervention and the absence of participants with non-European ancestry.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or clinical research organizations. Please see the original reference for a full list of authors’ disclosures.

Reference

Marshall HN, Hollitt GL, Wilckens K, et al. High polygenic risk is associated with earlier trabeculectomy in primary open-angle glaucoma. Ophthalmol Glaucoma. Published online July 13, 2022. doi:10.1016/j.ogla.2022.06.009