Protocol - Personal and Family History of Eye Disease and Treatments
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.
Specific Instructions:
In the following protocol "DK" equals "don't know".
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:
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 Category | Required |
---|---|
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.
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
Standard | Name | ID | Source |
---|---|---|---|
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 VariablesVariable Name | Variable ID | Variable Description | Version | dbGaP 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 |
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