Determinants and characteristics of angle-closure disease in an elderly Chinese population

Abstract

Purpose: To determine factors associated with angle-closure disease, particularly in those with structural or functional damage to the eyes, in an elderly Chinese population.

Methods: A total of 460 individuals aged over 72 years were recruited. The association of angle-closure diseases, including primary angle-closure suspect (PACS), primary angle-closure (PAC) and primary angle-closure glaucoma (PACG), with various systemic and ocular characteristics was evaluated using multivariate logistic regression analyses.

Results: Of 374 phakic subjects, 199 (53.2%) had angle-closure disease, including 135 PACS, 46 PAC, and 18 PACG. The majority of those with untreated PACG (10/13, 76.9%) had presenting intraocular pressure (IOP) < 20 mmHg. Independent risk factors for angle-closure disease were lower Van Herick grading, shallower central anterior chamber depth (ACD), and higher post-mydriatic IOP (all p < 0.05). Central and peripheral ACD estimation correlated weakly, only 60.8% of angle-closure eyes had generalized narrowing of ACD as a Van Herick grading ≤ 2 and central ACD ≤ 2.83 mm. A criterion considering either central or peripheral ACD identified 91% of angle-closure eyes, including all PACG. A higher post-mydriatic IOP was associated with a diagnosis of PAC or PACG among angle-closure eyes (p = 0.002).

Conclusion: Both central and peripheral ACD should be evaluated and shallowing of either one should be an indication for gonioscopic examination to maximize detection of angle-closure disease in elderly Chinese persons. PAC and PACG were associated with higher post-mydriatic IOP than PACS, although subjects with PACG frequently presented with normal IOP.

Keywords: Angle-closure glaucoma; anterior chamber depth; elderly; intraocular pressure; mydriasis.