Older age, shallow anterior chamber depth increase risk for primary angle-closure disease
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Increasing age, higher IOP and shallower anterior chamber depth were linked with elevated risk for primary angle-closure disease, according to a study in Ophthalmology.
Late posterior subcapsular cataract appeared to lower the risk.
“The lack of longitudinal data on [primary angle-closure disease] precludes our understanding on disease development and progression and the factors associated with it,” Zhen Ling Teo, MBBS, MRCSEd, of the Singapore National Eye Centre, and colleagues wrote. “This is crucial information for clinicians to formulate an appropriate course of action for suspect cases and for policy administrators to plan for screening or intervention initiatives.”
To determine incidence and risk factors for primary angle-closure disease (PACD), Teo and colleagues analyzed 5,298 adults aged 40 years and older at risk for primary angle-closure glaucoma (PACG) and 5,060 at risk for PACD. Participants were of Malay, Indian and Chinese ethnicities.
Researchers conducted standardized examinations, which included slit-lamp biomicroscopy, indentation gonioscopy, IOP measurement and static automated perimetry, with baseline data collected from 2004 to 2010 and 6-year follow-ups visits performed from 2011 to 2017.
For the purposes of the study, researchers classified PACD as a combination of primary angle-closure suspect (PACS), primary angle-closure (PAC) and PACG.
After adjusting for age, researchers reported the 6-year incidence for PACD was 3.5%, and incidences for PACS, PAC and PACG as 2.54%, 0.46% and 0.29%, respectively.
In addition, increasing age per decade (OR = 1.35), higher IOP (OR = 1.04) and shallower anterior chamber depth (OR = 1.11) at baseline were linked to a higher risk for PACD. However, a lower risk for PACD was found in those with late posterior subcapsular cataract (OR = 0.6).
“These findings may aid clinicians in patient counseling and deciding the frequency of monitoring or urgency of treatment, as well as for policy administrators to ensure adequate resources are allocated to screening and intervention initiatives to address angle-closure glaucoma-related vision impairment,” Teo and colleagues wrote.
Perspective
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PAC and PACG, while less common than open angle glaucoma, carries a threefold risk of severe bilateral vision loss. These conditions combined with PACS are referred to as PACD. There is little epidemiologic data on PACD disease, and Teo and colleagues in this paper have aided in our understanding of this important glaucoma type in a multi-ethnic Asian population.
They found the 6-year incidence of PACD in a general population to be 3.26%. Not surprisingly, older adults and patients with shallow anterior chambers were more likely to develop PACD. Interestingly, the risk of PACS patients developing PAC or PACG over the 6-year period was 9.38%. Because PACS patients were referred to ophthalmologists after the baseline visit for possible intervention, this figure is likely an underestimate. This finding runs counter to other research suggesting a low rate of conversion from PACS to PAC or PACG (Lancet. 2019 Apr 20;393(10181):1609-1618).
Do PACS patients need laser peripheral iridotomy or cataract surgery? As someone who has witnessed the ravages of PACG, I’m erring on the side of treatments that are proven to reduce or eliminate this possibility for our at-risk patients.
Reference:
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Teo ZL, et al. Ophthalmology. 2022;doi:10.1016/j.ophtha.2022.03.009.
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