Abstract
While primary open angle glaucoma is the most prevalent subtype of glaucoma, primary angle closure glaucoma has a higher risk of causing blindness, especially in East and South Asia. Primary angle closure includes a spectrum ranging from angle closure without trabecular or optic nerve damage to angle closure with glaucomatous optic neuropathy. Iridotrabecular contact is the hallmark in all stages and can be detected by gonioscopy. Since most patients with angle closure are asymptomatic, early detection, and timely treatment is important to prevent progression.
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Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol. 2001;85:1277–82.
Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–7.
Day AC, Baio G, Gazzard G, et al. The prevalence of primary angle closure glaucoma in European derived populations: a systematic review. Br J Ophthalmol. 2012;96:1162–7.
Coleman AL, Yu F, Evans SJ. Use of gonioscopy in Medicare beneficiaries before glaucoma surgery. J Glaucoma. 2006;15:486–93.
Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002;86:238–42.
American Academy of Ophthalmology Glaucoma Panel. Preferred Practice Pattern Guidelines. Primary Angle Closure. San Francisco: American Academy of Ophthalmology; 2010.
Thomas R, George R, Parikh R, et al. Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study. Br J Ophthalmol. 2003;87:450–4.
Jiang Y, Friedman DS, He M, et al. Design and methodology of a randomized controlled trial of laser iridotomy for the prevention of angle closure in southern China: the Zhongshan angle Closure Prevention trial. Ophthalmic Epidemiol. 2010;17:321–32.
He M, Foster PJ, Ge J, et al. Prevalence and clinical characteristics of glaucoma in adult Chinese: a population based study in Liwan District, Guangzhou. Invest Ophthalmol Vis Sci. 2006;47:2782–8.
Yip JL, Foster PJ, Gilbert CE, et al. Incidence of occludable angles in a high-risk Mongolian population. Br J Ophthalmol. 2008;92:30–3.
Aung T, Ang LP, Chan SP, et al. Acute primary angle-closure: long-term intraocular pressure outcome in Asian eyes. Am J Ophthalmol. 2001;131:7–12.
Wang N, Wu H, Fan Z. Primary angle closure glaucoma in Chinese and Western populations. Chin Med J (Engl). 2002;115:1706–15.
Quigley HA. Angle-closure glaucoma-simpler answers to complex mechanisms: LXVI Edward Jackson Memorial Lecture. Am J Ophthalmol. 2009;148:657–69.
Ritch R, Chang BM, Liebmann JM. Angle closure in younger patients. Ophthalmology. 2003;110:1880–9.
He M, Foster PJ, Johnson GJ, et al. Angle-closure glaucoma in East Asian and European people. Different diseases? Eye. 2006;20:3–12.
Wang D, He M, Wu L, et al. Differences in iris structural measurements among American Caucasians, American Chinese and mainland Chinese. Clin Experiment Ophthalmol. 2012;40:162–9.
Leung CK, Palmiero PM, Weinreb RN, et al. Comparisons of anterior segment biometry between Chinese and Caucasians using anterior segment optical coherence tomography. Br J Ophthalmol. 2010;94:1184–9.
Guzman CP, Gong T, Nongpiur ME, et al. Anterior segment optical coherence tomography parameters in subtypes of primary angle closure. Invest Ophthalmol Vis Sci. 2013;54:5281–6.
Mizoguchi T, Ozaki M, Wakiyama H, et al. Peripheral iris thickness and association with iridotrabecular contact after laser peripheral iridotomy in patients with primary angle-closure and primary angle-closure glaucoma. Clin Ophthalmol. 2014;8:517–22.
Kong X, Foster PJ, Huang Q, et al. Appositional closure identified by ultrasound biomicroscopy in population-based primary angle-closure glaucoma suspects: the Liwan eye study. Invest Ophthalmol Vis Sci. 2011;52:3970–5.
Nolan WP, See JL, Chew PTK, et al. Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes. Ophthalmology. 2007;114:33–9.
Pavlin CJ, Harasiewicz K, Foster FS. Ultrasound biomicroscopy of anterior segment structures in normal and glaucomatous eyes. Am J Ophthalmol. 1992;113:381–9.
Pavlin CJ, Ritch R, Foster FS. Ultrasound biomicroscopy in plateau iris syndrome. Am J Ophthalmol. 1992;113:390–5.
Bell NP, Feldman RM, Zou Y, et al. New technology for examining the anterior segment by ultrasonic biomicroscopy. J Cataract Refract Surg. 2008;34:121–5.
Nongpiur ME, Ku JY, Aung T. Angle closure glaucoma: a mechanistic review. Curr Opin Ophthalmol. 2011;22:96–101.
•• Nongpiur ME, Haaland BA, Perera SA et al. Development of a score and probability estimate for detecting angle closure based on anterior segment optical coherence tomography. Am J Ophthalmol. 2014;157:32–8. In this study a stepwise logistic regression model, derived from ASOCT-based parameters measured from a single scan, was used to generate a score to estimate probability of angle closure as defined by gonioscopy. The score was validated through an independent second sample and performed well with an area under the receiver operating characteristic curve of 0.94. The results are promising for a simple image-based screening tool for detection of gonioscopically-defined angle closure.
Radhakrishnan S, Yarovoy D. Development in anterior segment imaging for glaucoma. Curr Opin Ophthalmol. 2014;25:98–103.
Perera SA, CL Ho, Aung T, et al. Imaging of the iridocorneal angle with the RTVue spectral domain OCT. Invest Ophthalmol Vis Sci. 2012;53:1710–3.
Quek DT, Narayanaswamy AK, Tun TA, et al. Comparison of two spectral domain optical tomography devices for angle-closure assessment. Invest Ophthalmol Vis Sci. 2012;53:5131–6.
Day AC, Garway-Heath DF, Broadway DC, et al. Spectral domain optical coherence tomography imaging of the aqueous outflow structures in normal participants of the EPIC-Norfolk Eye Study. Br J Ophthalmol. 2013;97:189–95.
Alsbirk PH. Anatomical risk factors in primary angle-closure glaucoma. A ten year follow up survey based on limbal and axial anterior chamber depths in a high risk population. Int Ophthalmol. 1992;16:265–72.
Wilensky JT, Kaufman PL, Frohlichstein D, et al. Follow-up of angle-closure glaucoma suspects. Am J Ophthalmol. 1993;115:338–46.
• Thomas R, Walland MJ. Management algorithms for primary angle closure disease. Clin Experiment Ophthalmol. 2013;41:282–92. This review provides a useful framework for management of primary angle closure disease based on available data and the authors’ personal experience. The authors highlight the lack of data from randomized controlled trials and acknowledge that some of their recommendations may be contested.
He M, Friedman DS, Ge J, et al. Laser peripheral iridotomy in primary angle-closure suspects: biometric and gonioscopic outcomes: the Liwan Eye Study. Ophthalmology. 2007;114:494–500.
•• Jiang Y, Chang DS, Zhu H, et al. Longitudinal changes of angle configuration in primary angle-closure suspects: the Zhongshan Angle-Closure Prevention Trial. Ophthalmology. 2014;121:1699–705. This paper is highlighted especially for the study design. In the ZAP study, the right and left eyes of Chinese PACS patients are randomly assigned to intervention (laser iridotomy) versus no intervention (control eye). This trial provides a unique opportunity to evaluate the effect of iridotomy on the natural history of PACS eyes. The findings of this particular paper emphasize the need for periodic gonioscopy in PACS eyes even if an iridotomy has been performed.
Lee KS, Sung KR, Shon K, et al. Longitudinal changes in anterior segment parameters after laser peripheral iridotomy assessed by anterior segment optical coherence tomography. Invest Ophthalmol Vis Sci. 2013;54:3166–70.
Ramani KK, Mani B, George RJ, et al. Follow-up of p rimary angle closure suspects after laser peripheral iridotomy using ultrasound biomicroscopy and A-scan biometry for a period of 2 years. J Glaucoma. 2009;18:521–7.
Pandav SS, Kaushik S, Jain R, et al. Laser peripheral iridotomy across the spectrum of primary angle closure. Can J Ophthalmol. 2007;42:233–7.
Nolan WP, Foster PJ, Devereux JG, et al. YAG laser iridotomy treatment for primary angle closure in east Asian eyes. Br J Ophthalmol. 2000;84:1255–9.
Weinreb RN, Friedman DS, editors. Angle Closure and Angle-Closure Glaucoma. World Glaucoma Association Consensus Series, vol. 3. The Netherlands: Kugler Publications; 2006.
Thomas R, Parikh R, Muliyil J, et al. Five-year risk of progression of primary angle closure to primary angle closure glaucoma: a population-based study. Acta Ophthalmol Scand. 2003;81:480–5.
Rao A, Rao HL, Kumar AU, et al. Outcomes of laser peripheral iridotomy in angle closure disease. Semin Ophthalmol. 2013;28:4–8.
Boey PY, Singhal S, Perera SA, et al. Conventional and emerging treatments in the management of acute primary angle closure. Clin Ophthalmol. 2012;6:417–24.
Yang X, Su W, Wang M, et al. Effect of anterior chamber paracentesis on initial treatment of acute angle closure. Can J Ophthalmol. 2013;48(6):553–8.
Lam DS, Lai JS, Tham CC, et al. Argon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma: a prospective, randomized, controlled trial. Ophthalmology. 2002;109:1591–6.
Jacobi PC, Dietlein TS, Lűke C, et al. Primary phacoemulsification and intraocular lens implantation for acute angle closure glaucoma. Ophthalmology. 2002;109:1597–603.
Zhi ZM, Lim AS, Wong TY. A pilot study of lens extraction in the management of acute primary angle-closure glaucoma. Am J Ophthalmol. 2003;135:534–6.
Lam DS, Leung DY, Tham CC, et al. Randomized trial of early Phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure. Ophthalmology. 2008;115:1134–40.
Husain R, Gazzard G, Aung T, et al. Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy. Ophthalmology. 2012;119:2274–81.
Manna A, Foster P, Papadopoulos M, et al. Cyclodiode laser in the treatment of acute angle closure. Eye. 2012;26:742–5.
Aung T, Friedman DS, Chew PT, et al. Long-term outcomes in Asians after acute primary angle closure. Ophthalmology. 2004;111:1464–9.
Tan AM, Loon SC, Chew PT. Outcomes following acute primary angle closure in an Asian population. Clin Experiment Ophthalmol. 2009;37:467–72.
Ho H, Chew PT, Sng C, et al. A comparison of two approaches to managing acute primary angle closure in Asian eyes. Clin Ophthalmol. 2013;7:1205–10.
Ang LP, Aung T, Chew PT. Acute primary angle closure in an Asian population: long-term outcome of the fellow eye after prophylactic laser peripheral iridotomy. Ophthalmology. 2000;107:2092–6.
Alsagoff Z, Aung T, Ang LP, et al. Long-term clinical course of primary angle-closure glaucoma in an Asian population. Ophthalmology. 2000;107:2300–4.
Chen MJ, Cheng CY, Chou CK, et al. The long-term effect of Nd:YAG laser iridotomy on intraocular pressure in Taiwanese eyes with primary angle-closure glaucoma. J Chin Med Assoc. 2008;71:300–4.
Shams PN, Foster PJ. Clinical outcomes after lens extraction for visually significant cataract in eyes with primary angle closure. J Glaucoma. 2012;21:545–50.
Brown RH, Zhong L, Whitman AL, et al. Reduced intraocular pressure after cataract surgery in patients with narrow angles and chronic angle-closure glaucoma. J Cataract Refract Surg. 2014;40:1610–4.
Trikha S, Perera SA, Husain R, et al. The role of lens extraction in the current management of primary angle-closure glaucoma. Curr Opin Ophthalmol. 2015;26:128–34.
Lee CK, Rho SS, Sung GJ, et al. Effect of goniosynechialysis during phacoemulsification on IOP in patients with medically well-controlled chronic angle closure glaucoma. J Glaucoma. 2014. doi:10.1097/IJG.0000000000000043.
Moghimi S, Latifi G, ZandVakil N, et al. Phacoemulsification Versus Combined Phacoemulsification and Viscogonioplasty in Primary Angle-Closure Glaucoma: a Randomized Clinical Trial. J Glaucoma. 2014. doi:10.1097/IJG.0000000000000196.
Disclosure
Dr. Radhakrishnan reports Grants from Glaucoma Research Foundation, during the conduct of the study; other from Netra Systems Inc., outside the submitted work. Dr. Chen reports Grants from Glaucoma Research Foundation, during the conduct of the study.
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This article contains no studies with human or animal subjects performed by the author.
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This article is part of the Topical Collection on Diagnosis and Monitoring of Glaucoma.
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Radhakrishnan, S., Chen, L. Diagnosis and Monitoring of Primary Angle Closure. Curr Ophthalmol Rep 3, 51–57 (2015). https://doi.org/10.1007/s40135-015-0063-y
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DOI: https://doi.org/10.1007/s40135-015-0063-y