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Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect.

Yixiong Yuan1,2,3, Ruilin Xiong1,2,3, Wei Wang1,2,3,4

  • 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

JAMA Ophthalmology
|January 18, 2024
PubMed
Summary

Predicting progression from primary angle closure suspect (PACS) to primary angle closure (PAC) is vital. Higher intraocular pressure (IOP) and shallower anterior chamber depth predict increased risk over 14 years.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Anterior Segment Imaging

Background:

  • Identifying primary angle closure suspect (PACS) eyes at risk of progression to primary angle closure (PAC) is crucial for management.
  • Long-term longitudinal studies on PACS progression risk and prediction are limited.

Purpose of the Study:

  • To identify baseline predictors of 14-year progression from PACS to PAC.
  • To develop prediction models for PACS to PAC progression.

Main Methods:

  • A cohort study of 377 untreated PACS eyes from the Zhongshan Angle Closure Prevention trial.
  • Baseline assessments included tonometry, biometry, and anterior segment optical coherence tomography (AS-OCT) under light and dark conditions.
  • Logistic regression models were used to predict 14-year progression risk.

Main Results:

  • 25% of eyes progressed from PACS to PAC over 14 years.
  • Higher intraocular pressure (IOP), shallower central and limbal anterior chamber depths (ACD), and smaller trabecular-iris space area (TISA) and angle recess area (ARA) were associated with increased progression risk.
  • Prediction models using IOP and ACD showed moderate performance; AS-OCT metrics did not significantly improve prediction.

Conclusions:

  • Higher IOP, shallower ACDs, and smaller TISA/ARA may predict PAC progression in PACS eyes.
  • These factors can help customize management strategies for PACS patients.
  • Further research may refine prediction models for better clinical application.