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Protocol - Personal and Family History of Eye Disease and Treatments

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Description:

Questions are asked to determine personal and family history of glaucoma, macular degeneration, cataract, and diabetic retinopathy. Questions are also asked to determine the participant's history of laser and/or eye surgery for cataract, glaucoma and diabetic retinopathy.

Protocol:

1. At the present time, would you say your eyesight using both eyes (with glasses or contact lenses, if you wear them) is:

(READ CATEGORIES)

[ ] 1 excellent

[ ] 2 good

[ ] 3 fair

[ ] 4 poor

[ ] 5 very poor

[ ] 6 completely blind

[ ] 8 refused

[ ] 9 DK

CATARACT-RELATED QUESTIONS:

2. Has a doctor ever told you that you had cataracts in either eye?

[ ] 1 yes

[ ] 2 no (skip to Q4)

[ ] 8 refused (skip to Q4)

[ ] 9 DK (skip to Q4)

3. Did you ever have cataract surgery?

[ ] 1 yes

[ ] 2 no

[ ] 8 refused

[ ] 9 DK

4. Do or did any of your relatives have cataracts?

[ ] 1 yes

[ ] 2 no (skip to Q5)

[ ] 8 refused (skip to Q5)

[ ] 9 DK (skip to Q5)

4a. Which relative(s)? We are only interested in blood relatives.

(READ CATEGORIES AND CODE ALL THAT APPLY)

[ ] 01 mother

[ ] 02 father

[ ] 03 sister (ask Q4b)

[ ] 04 brother (ask Q4b)

[ ] 05 daughter (ask Q4b)

[ ] 06 son (ask Q4b)

[ ] 07 maternal grandmother

[ ] 08 maternal grandfather

[ ] 09 paternal grandmother

[ ] 10 paternal grandfather

[ ] 11 mother's sister (ask Q4b)

[ ] 12 mother's brother (ask Q4b)

[ ] 13 father's sister (ask Q4b)

[ ] 14 father's brother (ask Q4b)

[ ] 15 other relative

[ ] 98 refused

[ ] 99 DK

4b. How many of your [RELATIVE(S)] have, had, or were suspected of having cataracts?

(CODE REFUSED AS "98", DON'T KNOW AS "99")

__ sisters

__ brothers

__ daughters

__ sons

__ mother's sisters

__ mother's brothers

__ father's sisters

__ father's brothers

[ ] 98 refused

[ ] 99 DK

GLAUCOMA-RELATED QUESTIONS:

5. Has a doctor ever told you that you had glaucoma, that is, high pressure in the eyes, in either eye?

[ ] 1 yes

[ ] 2 no (skip to Q9)

[ ] 8 refused (skip to Q9)

[ ] 9 DK (skip to Q9)

6. Have you ever been treated for your glaucoma?

[ ] 1 yes

[ ] 2 no (skip to Q9)

[ ] 8 refused (skip to Q9)

[ ] 9 DK (skip to Q9)

7. In the past 12 months, how many times have you seen an eye doctor for your glaucoma?

__ # times

[ ] 98 refused

[ ] 99 DK

8. What treatment or treatments are you receiving or did you receive for your glaucoma:

(READ CATEGORIES AND CODE ALL THAT APPLY)

8a. eye drops?

[ ] 1 yes

[ ] 2 no

[ ] 8 refused

[ ] 9 DK

8b. Laser?

[ ] 1 yes

[ ] 2 no

[ ] 8 refused

[ ] 9 DK

8c. Surgery?

[ ] 1 yes

[ ] 2 no

[ ] 8 refused

[ ] 9 DK

8d. Other?

[ ] 1 yes (specify________)

[ ] 2 no

[ ] 8 refused

[ ] 9 DK

9. Do or did any of your relatives have glaucoma?

[ ] 1 yes

[ ] 2 no (skip to Q10)

[ ] 8 refused (skip to Q10)

[ ] 9 DK (skip to Q10)

9a. Which relative(s)? We are only interested in blood relatives.

(READ CATEGORIES AND CODE ALL THAT APPLY)

[ ] 01 mother

[ ] 02 father

[ ] 03 sister (ask Q9b)

[ ] 04 brother (ask Q9b)

[ ] 05 daughter (ask Q9b)

[ ] 06 son (ask Q9b)

[ ] 07 maternal grandmother

[ ] 08 maternal grandfather

[ ] 09 paternal grandmother

[ ] 10 paternal grandfather

[ ] 11 mother's sister (ask Q9b)

[ ] 12 mother's brother (ask Q9b)

[ ] 13 father's sister (ask Q9b)

[ ] 14 father's brother (ask Q9b)

[ ] 15 other relative

[ ] 98 refused

[ ] 99 DK

9b. How many of your [RELATIVE] have, had, or were suspected of having glaucoma?

(CODE REFUSED AS "98", DON'T KNOW AS "99")

__ sisters

__ brothers

__ daughters

__ sons

__ mother's sisters

__ mother's brothers

__ father's sisters

__ father's brothers

[ ] 98 refused

[ ] 99 DK

MACULAR DEGENERATION-RELATED QUESTIONS:

10. Has a doctor ever told you that you had macular degeneration — sometimes called hardening of the arteries — in the back of the eye, damage to the back part of your eye, the retina, or senile macular degeneration?

[ ] 1 yes

[ ] 2 no

[ ] 8 refused

[ ] 9 DK

11. Do or did any of your relatives have macular degeneration?

[ ] 1 yes

[ ] 2 no (skip to Q12)

[ ] 8 refused (skip to Q12)

[ ] 9 DK (skip to Q12)

11a. Which relative(s)? We are only interested in blood relatives.

(READ CATEGORIES AND CODE ALL THAT APPLY)

[ ] 01 mother

[ ] 02 father

[ ] 03 sister (ask Q11b)

[ ] 04 brother (ask Q11b)

[ ] 05 daughter (ask Q11b)

[ ] 06 son (ask Q11b)

[ ] 07 maternal grandmother

[ ] 08 maternal grandfather

[ ] 09 paternal grandmother

[ ] 10 paternal grandfather

[ ] 11 mother's sister (ask Q11b)

[ ] 12 mother's brother (ask Q11b)

[ ] 13 father's sister (ask Q11b)

[ ] 14 father's brother (ask Q11b)

[ ] 15 other relative

[ ] 98 refused

[ ] 99 DK

11b. How many of your [RELATIVE] have, had, or were suspected of having macular degeneration?

(CODE REFUSED AS "98", DON'T KNOW AS "99")

__ sisters

__ brothers

__ daughters

__ sons

__ mother's sisters

__ mother's brothers

__ father's sisters

__ father's brothers

[ ] 98 refused

[ ] 99 DK

DIABETIC RETINOPATHY-RELATED QUESTIONS:

12. Has a medical doctor ever told you that diabetes has affected blood vessels in your eyes or that you had diabetic retinopathy or diabetic eye disease?

[ ] 1 yes

[ ] 2 no (skip to end)

[ ] 8 refused (skip to end)

[ ] 9 DK (skip to end)

13. Did you ever have laser treatment or surgery for your diabetic eye disease?

[ ] 1 yes, laser treatment

[ ] 2 yes, surgery

[ ] 3 yes, both

[ ] 4 no (skip to end)

[ ] 8 refused (skip to end)

[ ] 9 DK (skip to end)

13a. How many different times have you had laser treatment or surgery for diabetic eye disease?

___ # times

[ ] 98 refused

[ ] 99 DK

Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews.

Equipment Needs

While the source instrument was developed to be administered by computer, the PhenX Working Group acknowledges these questions can be administered in a non-computerized format (i.e. pencil and paper instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Adult

Participants:

Adults aged ≥ 40 years*

* While this protocol was used in a study of adults aged ≥ 40 years, the Ocular Working Group suggests that the same methodology can be used for individuals aged 18 years or older.

Specific Instructions:

In the following protocol "DK" equals "don't know".

Selection Rationale

Questions asking about family history of ocular conditions need to accurately assess the occurrence of disease in family members and also need to accurately identify the relationships between family members. This protocol was chosen because both of these requirements were met using a relatively short questionnaire.

Language

English, Spanish

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Eye Disorder Family Medical History Text 3007655 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Pers fam hx eye disease proto 62727-3 LOINC
Derived Variables

None

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

University of Southern California, Los Angeles Latino Eye Study (LALES). 2000-2003 Section D: Ocular Disease History

Question numbers: 1 (question 1), 2 (question 2), 3 (question 3), 4 (question 4), 4a (question 4a), 4b (question 4b), 5 (question 5), 6 (question 6), 7 (question 7), 8a (question 8a), 8b (question 8b), 8c (question 8c), 8d (question 8d), 10 (question 9), 10a (question 9a), 10b (question 9b), 11 (question 10), 12 (question 11), 12a (question11a), 12b (question 11b), 21 (question 12), 22 (question13), 22a (question 13a)

General References

Varma R, Paz SH, Azen SP, Klein R, Globe D, Torres M, Shufelt C, Preston-Martin S; Los Angeles Latino Eye Study Group. (2004). The Los Angeles Latino Eye Study: design, methods, and baseline data. Ophthalmology, 111(6):1121-31.

Globe DR, Schoua-Glusberg A, Paz S, Yu E, Preston-Martin S, Azen S, Varma R. (2002). Using focus groups to develop a culturally sensitive methodology for epidemiological surveys in a Latino population: findings from the Los Angeles Latino Eye Study (LALES). Ethn Dis, 12(2):259-66.

Doshi V, Ying-Lai M, Azen SP, Varma R; Los Angeles Latino Eye Study Group. (2008). Sociodemographic, family history, and lifestyle risk factors for open-angle glaucoma and ocular hypertension. The Los Angeles Latino Eye Study. Ophthalmology, 115(4):639-647.

Protocol ID:

110901

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX110901_Both_Eyes_Eyesight PX110901010000 At the present time, would you say your eyesight using both eyes (with glasses or contact lenses, if you wear them) is: 4 Variable Mapping
PX110901_Cataract_Brother PX110901040204 Do or did any of his/her brother have cataracts? 4 N/A
PX110901_Cataract_Daughter PX110901040205 Do or did any of his/her daughter have cataracts? 4 N/A
PX110901_Cataract_Ever PX110901020000 Has a doctor ever told you that you had cataracts in either eye? 4 Variable Mapping
PX110901_Cataract_Father PX110901040202 Do or did his/her father have cataracts? 4 N/A
PX110901_Cataract_Fathers_Brother PX110901040214 Do or did any of his/her father's brother have cataracts? 4 N/A
PX110901_Cataract_Fathers_Sister PX110901040213 Do or did any of his/her father's sister have cataracts? 4 N/A
PX110901_Cataract_Maternal_Grandfather PX110901040208 Do or did his/her maternal grandfather have cataracts? 4 N/A
PX110901_Cataract_Maternal_Grandmother PX110901040207 Do or did his/her maternal grandmother have cataracts? 4 N/A
PX110901_Cataract_Mother PX110901040201 Do or did his/her mother have cataracts? 4 N/A
PX110901_Cataract_Mothers_Brother PX110901040212 Do or did any of his/her mother's brother have cataracts? 4 N/A
PX110901_Cataract_Mothers_Sister PX110901040211 Do or did any of his/her mother's sister have cataracts? 4 N/A
PX110901_Cataract_Number_Brothers PX110901040303 How many of your brothers have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Brothers_Coded PX110901040304 How many of your brothers have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Daughters PX110901040305 How many of your daughters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Daughters_Coded PX110901040306 How many of your daughters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Fathers_Brothers PX110901040315 How many of your father's brothers have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Fathers_Brothers_Coded PX110901040316 How many of your father's brothers have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Fathers_Sisters PX110901040313 How many of your father's sisters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Fathers_Sisters_Coded PX110901040314 How many of your father's sisters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Mothers_Brothers PX110901040311 How many of your mother's brothers have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Mothers_Brothers_Coded PX110901040312 How many of your mother's brothers have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Mothers_Sisters PX110901040309 How many of your mother's sisters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Mothers_Sisters_Coded PX110901040310 How many of your mother's sisters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Sisters PX110901040301 How many of your sisters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Sisters_Coded PX110901040302 How many of your sisters have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Sons PX110901040307 How many of your sons have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Number_Sons_Coded PX110901040308 How many of your sons have, had, or were suspected of having cataracts? 4 N/A
PX110901_Cataract_Other_Relative PX110901040215 Do or did any of his/her other relative have cataracts? 4 N/A
PX110901_Cataract_Paternal_Grandfather PX110901040210 Do or did his/her paternal grandfather have cataracts? 4 N/A
PX110901_Cataract_Paternal_Grandmother PX110901040209 Do or did his/her paternal grandmother have cataracts? 4 N/A
PX110901_Cataract_Relative PX110901040100 Do or did any of your relatives have cataracts? 4 N/A
PX110901_Cataract_Sister PX110901040203 Do or did any of his/her sister have cataracts? 4 N/A
PX110901_Cataract_Son PX110901040206 Do or did any of his/her son have cataracts? 4 N/A
PX110901_Cataract_Surgery_Ever PX110901030000 Did you ever have cataract surgery? 4 Variable Mapping
PX110901_Diabetic_Retinopathy_Ever PX110901120000 Has a medical doctor ever told you that diabetes has affected blood vessels in your eyes or that you had diabetic retinopathy or diabetic eye disease? 4 Variable Mapping
PX110901_Diabetic_Retinopathy_Laser_Surgery_Ever PX110901130000 Did you ever have laser treatment or surgery for your diabetic eye disease? 4 Variable Mapping
PX110901_Diabetic_Retinopathy_Laser_Surgery_Times PX110901140000 How many different times have you had laser treatment or surgery for diabetic eye disease? 4 Variable Mapping
PX110901_Diabetic_Retinopathy_Laser_Surgery_Times_Coded PX110901140100 How many different times have you had laser treatment or surgery for diabetic eye disease? 4 N/A
PX110901_Glaucoma_Brother PX110901090204 Do or did any of his/her brother have glaucoma? 4 N/A
PX110901_Glaucoma_Daughter PX110901090205 Do or did any of his/her daughter have glaucoma? 4 N/A
PX110901_Glaucoma_Doctor_Visiting_Times PX110901070000 In the past 12 months, how many times have you seen an eye doctor for your glaucoma? 4 N/A
PX110901_Glaucoma_Doctor_Visiting_Times_Coded PX110901070100 In the past 12 months, how many times have you seen an eye doctor for your glaucoma? 4 N/A
PX110901_Glaucoma_Ever PX110901050000 Has a doctor ever told you that you had glaucoma, that is, high pressure in the eyes, in either eye? 4 Variable Mapping
PX110901_Glaucoma_Father PX110901090202 Do or did his/her father have glaucoma? 4 N/A
PX110901_Glaucoma_Fathers_Brother PX110901090214 Do or did any of his/her father's brother have glaucoma? 4 N/A
PX110901_Glaucoma_Fathers_Sister PX110901090213 Do or did any of his/her father's sister have glaucoma? 4 N/A
PX110901_Glaucoma_Maternal_Grandfather PX110901090208 Do or did his/her maternal grandfather have glaucoma? 4 N/A
PX110901_Glaucoma_Maternal_Grandmother PX110901090207 Do or did his/her maternal grandmother have glaucoma? 4 N/A
PX110901_Glaucoma_Mother PX110901090201 Do or did his/her mother have glaucoma? 4 N/A
PX110901_Glaucoma_Mothers_Brother PX110901090212 Do or did any of his/her mother's brother have glaucoma? 4 N/A
PX110901_Glaucoma_Mothers_Sister PX110901090211 Do or did any of his/her mother's sister have glaucoma? 4 N/A
PX110901_Glaucoma_Number_Brothers PX110901090303 How many of your brothers have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Brothers_Coded PX110901090304 How many of your brothers have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Daughters PX110901090305 How many of your daughters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Daughters_Coded PX110901090306 How many of your daughters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Fathers_Brothers PX110901090315 How many of your father's brothers have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Fathers_Brothers_Coded PX110901090316 How many of your father's brothers have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Fathers_Sisters PX110901090313 How many of your father's sisters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Fathers_Sisters_Coded PX110901090314 How many of your father's sisters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Mothers_Brothers PX110901090311 How many of your mother's brothers have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Mothers_Brothers_Coded PX110901090312 How many of your mother's brothers have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Mothers_Sisters PX110901090309 How many of your mother's sisters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Mothers_Sisters_Coded PX110901090310 How many of your mother's sisters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Sisters PX110901090301 How many of your sisters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Sisters_Coded PX110901090302 How many of your sisters have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Sons PX110901090307 How many of your sons have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Number_Sons_Coded PX110901090308 How many of your sons have, had, or were suspected of having glaucoma? 4 N/A
PX110901_Glaucoma_Other_Relative PX110901090215 Do or did any of his/her other relative have glaucoma? 4 N/A
PX110901_Glaucoma_Paternal_Grandfather PX110901090210 Do or did his/her paternal grandfather have glaucoma? 4 N/A
PX110901_Glaucoma_Paternal_Grandmother PX110901090209 Do or did his/her paternal grandmother have glaucoma? 4 N/A
PX110901_Glaucoma_Relative PX110901090100 Do or did any of your relatives have glaucoma? 4 Variable Mapping
PX110901_Glaucoma_Sister PX110901090203 Do or did any of his/her sister have glaucoma? 4 N/A
PX110901_Glaucoma_Son PX110901090206 Do or did any of his/her son have glaucoma? 4 N/A
PX110901_Glaucoma_Treatment_Ever PX110901060000 Have you ever been treated for your glaucoma? 4 N/A
PX110901_Glaucoma_Treatment_Eye_Drop PX110901080100 What treatment or treatments are you receiving or did you receive for your glaucoma: Eye drops? 4 Variable Mapping
PX110901_Glaucoma_Treatment_Laser PX110901080200 What treatment or treatments are you receiving or did you receive for your glaucoma: Laser? 4 N/A
PX110901_Glaucoma_Treatment_Other PX110901080401 What treatment or treatments are you receiving or did you receive for your glaucoma: Other? 4 N/A
PX110901_Glaucoma_Treatment_Other_Specify PX110901080402 Specify other treatment or treatments you are receiving or you received for your glaucoma. 4 N/A
PX110901_Glaucoma_Treatment_Surgery PX110901080300 What treatment or treatments are you receiving or did you receive for your glaucoma: Surgery? 4 Variable Mapping
PX110901_Macular_Degeneration_Brother PX110901110204 Do or did any of his/her brother have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Daughter PX110901110205 Do or did any of his/her daughter have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Ever PX110901100000 Has a doctor ever told you that you had macular degeneration - sometimes called hardening of the arteries - in the back of the eye, damage to the back part of your eye, the retina, or senile macular degeneration? 4 Variable Mapping
PX110901_Macular_Degeneration_Father PX110901110202 Do or did his/her father have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Fathers_Brother PX110901110214 Do or did any of his/her father's brother have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Fathers_Sister PX110901110213 Do or did any of his/her father's sister have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Maternal_Grandfather PX110901110208 Do or did his/her maternal grandfather have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Maternal_Grandmother PX110901110207 Do or did his/her maternal grandmother have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Mother PX110901110201 Do or did his/her mother have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Mothers_Brother PX110901110212 Do or did any of his/her mother's brother have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Mothers_Sister PX110901110211 Do or did any of his/her mother's sister have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Brothers PX110901110303 How many of your brothers have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Brothers_Coded PX110901110304 How many of your brothers have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Daughters PX110901110305 How many of your daughters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Daughters_Coded PX110901110306 How many of your daughters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Fathers_Brothers PX110901110315 How many of your father's brothers have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Fathers_Brothers_Coded PX110901110316 How many of your father's brothers have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Fathers_Sisters PX110901110313 How many of your father's sisters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Fathers_Sisters_Coded PX110901110314 How many of your father's sisters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Mothers_Brothers PX110901110311 How many of your mother's brothers have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Mothers_Brothers_Coded PX110901110312 How many of your mother's brothers have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Mothers_Sisters PX110901110309 How many of your mother's sisters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Mothers_Sisters_Coded PX110901110310 How many of your mother's sisters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Sisters PX110901110301 How many of your sisters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Sisters_Coded PX110901110302 How many of your sisters have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Sons PX110901110307 How many of your sons have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Number_Sons_Coded PX110901110308 How many of your sons have, had, or were suspected of having macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Other_Relative PX110901110215 Do or did any of his/her other relative have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Paternal_Grandfather PX110901110210 Do or did his/her paternal grandfather have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Paternal_Grandmother PX110901110209 Do or did his/her paternal grandmother have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Relative PX110901110100 Do or did any of your relatives have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Sister PX110901110203 Do or did any of his/her sister have macular degeneration? 4 N/A
PX110901_Macular_Degeneration_Son PX110901110206 Do or did any of his/her son have macular degeneration? 4 N/A
Research Domain Information
Measure Name:

Personal and Family History of Eye Disease and Treatments

Release Date:

February 26, 2010

Definition

This questionnaire assesses personal and family history among adults of glaucoma, macular degeneration, cataract, and diabetic retinopathy, including history of any associated laser or eye surgeries.

Purpose

Glaucoma, macular degeneration, cataract and diabetic retinopathy are the most common forms of blindness in the U.S. and throughout the world. All of these conditions have complex inheritance involving multiple genetic and/or environmental risk factors. Family history of these conditions, especially in first degree relatives, is a significant risk factor for disease.

Keywords

Ocular, Family history of eye disease; Personal history of eye disease, Glaucoma, Macular degeneration, Cataract, Diabetic retinopathy, LALES, Los Angeles Latino Eye Study, Laser treatment, Eye surgery