High Prevalence of Narrow Angles Among Chinese-American Glaucoma and Glaucoma Suspect Patients (original) (raw)

Angle-closure glaucoma in East Asian and European people. Different diseases?

Eye, 2005

In contrast to the pattern of disease in Europeans, primary angle closure has a higher prevalence and tends to be asymptomatic in East Asians. The higher prevalence is attributed to differences in anterior chamber and angle anatomy. Several studies suggest that central anterior chamber depth is shallower in East Asians than in Europeans, although this is not universally accepted. It is debated whether pupil block is the predominant mechanism of angle closure in Asian people. Meaningful comparison between studies is currently hindered by differences in patient selection, examination technique, and case definition; however, the major scientific deficiency is the paucity of prospective followup data to give an insight into natural history of the disease. This review examines the data on prevalence, risk factors, and mechanism of angle closure. Special consideration is given to limitations of methodology in research to date, with the intention of developing more robust data in future studies.

Issues in the epidemiology and population-based screening of primary angle-closure glaucoma

Survey of Ophthalmology, 1992

Among Caucasians, it is well known that 75-95% of primary glaucoma is due to openangle glaucoma (POAG), with angle-closure (PACG) comprising only a very small minority of cases. These figures are reversed among other groups such as Asians and Eskimos, where PACG makes up 80-90% of primary glaucoma. Among Eskimos, the prevalence of PACG has been reported as 2-8%, as compared to 0.1% among Caucasians. It appears that a population tendency toward shallow anterior chambers may explain the excess burden of PACG morbidity. Among Asians, the prevalence of PACG is intermediate between Caucasians and Eskimos. Existing biometrical data do not show a clear tendency toward shallower anterior chambers among Asians. PACG may be screened for on a population basis by means of various techniques that estimate axial or limbal anterior chamber depth, measure intraocular pressure, or evaluate the optic disc or visual fields. Demographic information and medical and family history will also be of great importance in screening for PACG in large populations. Groups at increased risk for the disease include women, individuals over 50, first-degree relatives ofPACG probands, and hyperopes. (Surv Ophthalmol 36:411-423, 1992)

Risk Factors for Glaucoma Suspicion in Healthy Young Asian and Caucasian Americans

Journal of Ophthalmology, 2014

Purpose.To determine the prevalence of certain risk factors for glaucoma in a healthy, young population and to compare these risk factors between Asian Americans and Caucasians.Methods.120 healthy graduate students (mean age24.8±3.0years) underwent a comprehensive ophthalmic examination. Regression analyses controlling for age, sex, and refraction, comparing glaucoma risk factors in Asians (n=54) and Caucasians (n=41), were performed. Outcome variables included family history, intraocular pressure (IOP), spherical equivalent, central corneal thickness (CCT), mean deviation (MD) and pattern standard deviation (PSD), and disc and retinal nerve fiber layer (RNFL) parameters.Results.61% of subjects were female; the mean spherical equivalent was-3.81±3.2 D; and the mean axial length (AL) was25.1±1.7 mm. Regression analysis showed race affected spherical equivalent (P<0.001), AL (P=0.0073), IOP (P<0.001), and cup to disc area ratio (CDAR) (P=0.012). Family history, CCT, MD, and PSD ...

Five-year incidence of angle closure among glaucoma health examination participants

Graefe's Archive for Clinical and Experimental Ophthalmology, 2013

Background and aim To investigate incidence of angle closure (AC) and its associated factors through a community-based longitudinal study over a 5-year period. Methods Japanese residents aged 40 years or over who underwent two glaucoma health examinations held in 2005 and 2010 were enrolled. Of the participants of the first glaucoma health examination (first examination), those who satisfied exclusion criteria such as having eyes with angle closure, glaucoma, incisional ocular surgery, or other conditions that could influence the results were eliminated from the second glaucoma health examination (second examination). In addition to routine ophthalmic examination, a scanning peripheral anterior chamber depth analyzer (SPAC) was employed to investigate the anterior chamber configuration. The incidence of angle closure over the 5-year period and its associated factors were investigated. Results Of the 754 participants of the first examination, 569 participants were invited for the second examination and 331 participants (87 males and 244 females, age: 62.6±12.7 years), or 619 eyes, were analyzed after eliminating eyes matching exclusion criteria. In the 5-year period, the incidence of AC was 5.4 % (95 % CI: 3.5-8.4 %) of participants or 5.5 % (95 % CI: 4.0-7.6 %) of eyes, including eight eyes (1.3 %) with primary angle-closure glaucoma. Eyes that developed AC had a much smaller SPAC grade at the first examination and a greater decrease in SPAC grade than those that did not develop AC, whereas age and sex were not associated. Conclusions AC was developed by 5.4 % of senior Japanese residents over the 5-year period. The shallow anterior chamber and the marked decrease in anterior chamber depth were associated with AC development.

The Impact of Central Corneal Thickness on the Risk for Glaucoma in a Large Multiethnic Population

Journal of Glaucoma, 2014

Purpose-To investigate the relationship between central corneal thickness (CCT) and demographics, and determine whether CCT may be a substantial mediator of the relationships between glaucoma and its demographic risk factors. Methods-This cross-sectional study included patients in the Kaiser Permanente Northern California health plan from January 1, 2007 to December 31, 2011 who were 40 years and older and had a documented CCT measurement (N=81,082). Those with any cornea-related diagnoses or a history of corneal refractive surgery were excluded. Demographic characteristics, including age, sex, and race/ethnicity, as well as clinical information including glaucoma-related diagnosis, diabetic status, CCT, and intraocular pressure were gathered from the electronic medical record. Results-Multivariate linear regression analysis indicated that female sex, increased age, and Black race were significantly associated with thinner corneas. A subgroup analysis among Asians revealed that Chinese, Japanese, and Koreans had corneas 6-13 μm thicker than South and Southeast Asians, Filipinos, and Pacific Islanders for each diagnosis (P<.001). In our population, 24.5% (N=19878) had some form of open-angle glaucoma; 21.9% (N=17779) did not have any glaucoma-related diagnosis. Variation in CCT accounted for only 6.68% (95% confidence interval [CI] 6.14-7.24%) of the increased risk of open-angle glaucoma seen with increasing age, but explained as much as 29.4% (95% CI 27.0%-32.6%) of the increased risk of glaucoma seen among Blacks, and 29.5% (95% CI 23.5%-37.0%) of the increased risk of glaucoma seen among Hispanics. Conclusions-CCT appears to explain a substantial portion of the increased risk of glaucoma seen among Blacks and Hispanics.

Assessment of Occludable Angle in Angle Closure Glaucoma Patients Having High Risk

IOSR Journal of Dental and Medical Sciences, 2016

Introduction: At present 12 million Indians were affected by glaucoma accounting for 12.8% of the blindness of the country with 45 to 55% of primary glaucoma being PACG. The screening of patients with a high risk of iridotrabecular contact and subsequently primary angle closure is important. Early diagnosis and treatment is very much essential in dealing with high risk groups for angle closure glaucoma having occludable angle. The main aim of this study is to screen for Angle Closure Glaucoma in high risk groups with the Objectives:1) To know the incidence of occludable angles in high risk groups for angle closure glaucoma. 2) To highlight the importance of screening for angle closure suspects in high risk groups. Methodology: The present longitudinal study was conducted in the Dept. of ophthalmology, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (Dr.PSIMS), Chinoutapalli, Krishna District, Andhra Pradesh with the institutional ethical committee clearance. A sample of 100 selected patients who attended ophthalmology opd as outpatients. Results: Out of 100 cases 18% patients had occludable angles, 72% patients had open angles.Degree of hypermetropia in the occludable angles: Out of 18 cases with occludable angles 4 eyes had hyperopic error between 0.50-1.00D, 9 cases had hyperopic error between 1.25-2.00D,5 cases had hyperopic error between 2.50-3.00D. In the present study, 20% cases were known Diabetics out of them 40% had occludable angles. Conclusion: Measurement of peripheral anterior chamber depth is believed to be useful for glaucoma screening and gonioscopy should make the final assessment. For primary angle closure (PAC) or early primary angle closure glaucoma, case detection presents the unique opportunity to prevent blindness from glaucoma.

Ocular biometry in occludable angles and angle closure glaucoma: a population based survey

British Journal of Ophthalmology, 2003

Aim: To compare ocular biometric values in a population based sample of eyes with occludable angles, angle closure glaucoma, and normal subjects. Method: 2850 subjects from a population based glaucoma prevalence study underwent complete ocular examination including indentation gonioscopy. Ocular biometry was performed in all subjects classified to have occludable angles (n = 143); angle closure glaucoma (n = 22), and a random subgroup of 419 normal subjects. Ocular biometry readings between the groups were compared and statistically analysed using "t," "z," and Mann-Whitney U tests. Results: The mean age among subjects with occludable angles (54.43 (SD 9.53) years) and angle closure glaucoma (57.45 (8.5) years) was significantly higher (p<0.001) than normal subjects (49.95 (9.95) years). Axial length was shorter (p<0.001) in the occludable angle group (22.07 (0.69) mm) compared to the normal group (22.76 (0.78) mm). Anterior chamber depth (ACD) was shallower (p<0.001) among subjects with occludable angles (2.53 (0.26) mm) than normal subjects (3.00 (0.30) mm). Lens thickness (LT) was greater (p<0.001) in people with occludable angles (4.40 (0.53) mm) compared to normal subjects (4.31 (0.31) mm). No significant difference was noted in axial length, ACD (p = 0.451), and LT (p = 0.302) between angle closure glaucoma and occludable eyes. Conclusion: South Indian eyes with angle closure glaucoma and occludable angles seem to have significantly shorter axial lengths, shallower anterior chambers and greater lens thickness compared to the normal group.

Screening techniques for angle-closure glaucoma in rural Taiwan

Acta Ophthalmologica Scandinavica, 2009

562 residents of Jin Shan aged 40 years and above underwent examinations to compare the sensitivity and specificity of oblique flashlight, peripheral slit beam and ultrasonographic evaluation of the anterior chamber depth to gonioscopy in detecting cases of PACG. Among 5441 eligible individuals aged 40 and above, 562 (10.3%) underwent screening for PACG, ofwhom 17 (3.02%) were defined as cases, and 10 (1.78%) as suspects. Home visits indicated that respondents for screening were similar to the population as a whole. Only 35% of PACG cases reported symptoms consistent with acute angle closure, and only 18% were previously diagnosed. When compared to gonioscopy, only ultrasonographic measurement of AC depth provided an adequate mix of sensitivity and specificity. Ultrasonography in combination with tonometry provided a sensitivity of 88% with a specificity of 92%. Sensitivity and specificity for ultrasonography in combination with refractive status were 84% and 83% respectively. Shallower AC depth (p = O.OOOl), shorter axial globe length (p=O.OOl), greater than 2 D of hyperopia (p < 0.001), high grades of nuclear sclerotic cataract (p < 0.0001) and an increased cup-to-disc ratio (p = 0.002) were significantly correlated with a diagnosis of PACG.