For asymptomatic patients with primary angle-closure suspect, simple eye examination may predict glaucoma
Understanding the risk factors and developing prediction models for the progression from Primary Angle Closure Suspect (PACS) to primary angle closure (PAC) is crucial for effective management. PACS eyes' progression to PAC remains understudied in long-term investigations. Identifying reliable predictors can aid clinicians in assessing the risk of progression and implementing targeted interventions for better patient outcomes.
A recent study was published in JAMA Ophthalmology by Yixiong Yuan and colleagues. A 14-year longitudinal cohort study, based on the Zhongshan Angle Closure Prevention trial, explores baseline predictors to enhance the customization of PACS management. The study involved 377 eyes from the Zhongshan Angle Closure Prevention trial, focusing on untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under light and dark conditions. Logistic regression models were constructed based on baseline covariates to predict the 14-year risk of progression from PACS to PAC.
The key findings of the study were:
By the 14-year follow-up, 25% of PACS eyes had progressed to PAC.
Predictive factors for progression included higher intraocular pressure (IOP), shallower central and limbal anterior chamber depth (ACD), and specific AS-OCT measurements related to trabecular-iris space area (TISA) and angle recess area (ARA).
Prediction models incorporating IOP, central and limbal ACDs exhibited moderate performance (AUC: 0.69), with AS-OCT metrics not significantly improving the predictive ability.
The study identifies baseline factors such as higher IOP, shallower ACDs, and specific AS-OCT metrics as predictors for PACS progression to PAC. These findings emphasize the potential for customization in the management of PACS based on individual risk profiles.
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