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Testing for angle-closure glaucoma should be based more on physiological factors, expert says
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SAN FRANCISCO — Iris volume change in light and dark conditions could be tested as a "potential predictive factor" to better diagnose angle-closure glaucoma, along with iris dilator insertion by ultrasound biomicroscopy and measurement of provoked choroidal expansion, a clinician said here.
 Harry A. Quigley |
"(We should) replace what are now ineffective provocative tests for angle-closure with tests that actually tell us whom to treat," Harry A. Quigley, MD, said at the opening session of the joint meeting of the American Academy of Ophthalmology and the Pan-American Association of Ophthalmology. "The stakes here are extremely high. In China, we're talking about the difference between treating 5 million people and 50 million people who are at risk for this disease."
In the Jackson Memorial Lecture, Dr. Quigley said that one of the main "puzzles" of angle-closure glaucoma (ACG) is why it is most common among Chinese populations. Because small-sized eyes are predisposed for ACG, it had been supposed that Chinese populations had a higher rate of small eyes. However, research has shown that they do not, he said.
"By looking at anatomy alone, by measuring the size of things, we didn't learn enough about angle-closure. We have to begin thinking about the dynamic processes in the eye," he said.
Dr. Harry Quigley is indeed correct that our current provocative tests for angle-closure are ineffective and do not accurately predict those patients most at risk for devastating glaucoma attacks. His proposed tests (eg, iris volume change, ultrasound biomicroscopy) sound very promising and should be investigated for this prevalent condition.
– James C. Tsai, MD, MBA
OSN Glaucoma
Board Member