Recent Advances in the Evaluation and Treatment of Primary Angle Closure Disease

Authors

  • Alanna James, MD USC Roski Eye Institute, Los Angeles, CA
  • Benjamin Y. Xu, MD, PhD USC Roski Eye Institute, Los Angeles, CA

Abstract

In the realm of ophthalmology, the clinical management of angle closure remains a disputed topic. An aging population, underperformance of gonioscopy, and a paucity of clear guidelines about management have contributed to the rising number of patients with primary angle closure glaucoma (PACG). The global prevalence of PACG based on a meta-analysis published in 2014 was 0.50%, with the highest prevalence occurring in Asian populations. This study also projected that the number of people with PACG worldwide will increase to 32 million by the year 2040. PACG is a visually devastating disease; around a quarter of individuals worldwide and one out of nine individuals in the United States with newly diagnosed PACG are affected by blindness (visual acuity of 20/200 or less). The rising burden of the visual morbidity associated with untreated PACG highlights the urgent need for more clearly defined, evidence-based practice guidelines in angle closure care. 

Author Biographies

Alanna James, MD, USC Roski Eye Institute, Los Angeles, CA

Dr. Alanna James is a glaucoma fellow at University of Southern California Roski Eye Institute. She completed her ophthalmology residency at Loma Linda University Eye Institute. She received her medical degree from Loma Linda University School of Medicine in Southern California. She has a Bachelor’s of Science in Biochemistry from Andrews University in Southwest Michigan. She has a strong interest in the medical and surgical management of glaucoma in addition to cataract surgery and a passion for both community service and global ophthalmology.

Benjamin Y. Xu, MD, PhD, USC Roski Eye Institute, Los Angeles, CA

Dr. Benjamin Xu received his B.S. from Yale University and M.D. and Ph.D. in neuroscience from Columbia University. He then completed his ophthalmology residency at the LAC+USC Medical Center / USC Roski Eye Institute and glaucoma fellowship at the UCSD Shiley Eye Institute under the mentorship of Dr. Robert N. Weinreb. He is now Chief of the Glaucoma Service at the USC Roski Eye Institute. His NIH‑funded research focuses on developing novel diagnostic tools to care for patients with glaucoma using OCT imaging and artificial intelligence (AI). He also uses epidemiological and electronic healthcare data to study the impact of glaucoma on diverse populations and devise strategies to deliver more effective glaucoma care worldwide.

 

References

Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040. Ophthalmology. 2014;121(11):2081-2090.

Shah SN, Zhou S, Sanvicente C et al. Prevalence and risk factors of blindness among primary angle closure glaucoma patients in the United States: An IRIS® Registry Analysis. Am J Ophthalmol. 2023; S0002-9394(23)00461-0. Advance online publication. https://doi.org/10.1016/j.ajo.2023.11.007

George R, Panda S, Viiaya L. Blindness in glaucoma: primary open-angle glaucoma versus primary angle-closure glaucoma-a meta-analysis. Eye. 2022;36(11):2099-2105.

Foster PJ, Buhrmann R, Quigley HA et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2022;86(2):238-242.

Gedd SJ, Chen PP, Muir KW, et al. Primary angle-closure disease PPP 2020. American Academy of Ophthalmology. 2022, October 5). https://www.aao.org/education/preferred-practice-pattern/primary-angle-closure-disease-ppp

Hertzog LH, Albrecht KG, LaBree L et al. Glaucoma Care and Conformance with Preferred Practice Patterns. Ophthalmology. 1996;103(7):1009-1013.

Coleman AL, Yu F, Evans SJ. Use of gonioscopy in Medicare beneficiaries before glaucoma Surgery. J Glaucoma. 2006;15(6):486-493.

Apolo G, Bohner A, Pardeshi AA, et al. Racial and sociodemographic disparities in the detection of narrow angles before detection of primary angle-closure glaucoma in the United States. Ophthalmology Glaucoma. 2022;5(4):388-395.

Wu AS, Stein JD, Shah M. Potentially missed opportunities in prevention of acute angle-closure crisis. JAMA Ophthalmology. 2022;140(6):598-603.

He M, Jiang Y, Huang S, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. The Lancet. 2019;393(10181):1609-1618.

Yuan Y, Wang W, Xiong R, et al. Fourteen-year outcome of angle-closure prevention with laser iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended follow-up of a randomized controlled trial. Ophthalmology. 2023;130(8):786-794.

Xu BY, Friedman DS, Foster PJ, et al. Ocular biometric risk factors for progression of primary angle closure disease Ophthalmology. 2022;129(3):267-275.

Bao YK, Xu B, Friedman DS, et al. Biometric risk factors for angle closure progression after laser peripheral iridotomy. JAMA Ophthalmology. 2023;141(6):516‑516.

Bolo K, Apolo G, Pardeshi AA, et al. Automated expert-level scleral spur detection and quantitative biometric analysis on the ANTERION Anterior Segment OCT System. Br J Ophthalmol. Published online Oct. 5, 2023.

Steuhl K-P, Marahrens P, Frohn C, et al. Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation. Ophthalmic Surgery, Lasers & Imaging Retina. 1992;23(4):233-237.

Yang CH, Hung PT. Intraocular lens position and anterior chamber angle changes after cataract extraction in eyes with primary angle-closure glaucoma. Journal Cataract Refract Surg. 1997;23(7):1109-1113.

Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology. 2000;107(4):698-703.

Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. The Lancet. 2016;388(10052):1389‑1397.

Man X, Chan NCY, Baig N, et al. Anatomical effects of clear lens extraction by phacoemulsification versus trabeculectomy on anterior chamber drainage angle in primary angle-closure glaucoma (PACG) patients. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2015;253(5):773-778.

Vera V, Naqi A, Belovay GW et al. Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial. Am J Ophthalmol. 2014;157(5):929-935.e2.

Downloads

Published

2024-02-28

How to Cite

1.
James A, Xu BY. Recent Advances in the Evaluation and Treatment of Primary Angle Closure Disease. Can Eye Care Today [Internet]. 2024 Feb. 28 [cited 2024 Jun. 18];3(1):12–17. Available from: https://canadianeyecaretoday.com/article/view/3-1-james_et_al

Issue

Section

Articles