Angle closure and angle‐closure glaucoma: what we are doing now and what we will be doing in the future

Abstract

Primary angle-closure glaucoma (PACG) frequently leads to severe vision loss. Prevalence among older Asian populations is high and given global demographics, the number of persons with PACG will increase dramatically in the coming decades. Improvements in imaging of the anterior segment will help us to identify more of those with angle closure, and important clinical trials that are currently underway will provide important evidence to support screening and treatment approaches for PACG. In this manuscript, we intend to review the existing evidences, to introduce some important on-going studies on PACG and to share the experience and viewpoints of the authors.

New findings in the diagnosis and treatment of primary angle-closure glaucoma

“…A recent study suggested that gonioscopy should be still considered the goldstandard method in detecting PAC and it cannot be replaced by the anterior segment imaging even if both AS-OCT and UBM can be useful in several circumstances (Barkana et al, 2007;Dorairaj et al, 2012;Friedman et al, 2012;Ishikawa et al, 2000;McKee et al, 2013;Pavlin et al, 1992;Pekmezci et al, 2009;Quek et al, 2011;See, 2009). …”

Initial Treatment for Primary Angle-Closure Glaucoma in China

“…Cataract or clear lens removal is being advocated as initial treatment for PAC and PACG. 73,74 Recent randomized controlled trials have demonstrated that in medically controlled and uncontrolled PACG with coexistent cataract, phacoemulsification alone produces statistically comparable IOP lowering compared with phacotrabeculectomy. 75,76 In medically uncontrolled PACG, phacotrabeculectomy did lower IOP more than phacoemulsification alone.…”

Eye disease in older people

“…The other eye is usually treated with a prophylactic peripheral iridotomy as there is significant risk to the fellow eye. 78 Approximately 20% of all individuals with open angle glaucoma have an IOP within the normal range. This is known as normal tension glaucoma (NTG).…”