PACS plus stratification of acute angle closure glaucoma cases: a retrospective analysis

To assess the relationship between the PACS Plus criteria and patients who develop primary Acute Angle Closure Glaucoma (AACG).

This was a retrospective single-centre study including adult patients with a diagnosis of primary AACG recorded between 3rd June 2015 and 3rd June 2025. Secondary causes of acute angle closure were excluded. Following the search, electronic records were screened for PACS Plus criteria and graded as 'PACS Plus' or 'PACS Minus'. The number and type of PACS Plus criteria met by each patient were recorded.

The database search found 137 patients with AACG, of which 83 met the inclusion criteria and had sufficient data for grading. 45 patients (54.22%) would have been labelled 'PACS Plus', while 38 patients (45.78%) would have been labelled 'PACS Minus'. On changing the PACS Plus criterion 'a family history of significant angle closure disease' to a modified criterion of 'a 1st degree relative with glaucoma', PACS Plus tool sensitivity was improved, with a significant increase in the number of labelled 'PACS Plus' (60 patients, 72.29%; p < 0.001, McNemar test with Edwards correction).

The results found suggest that the PACS Plus tool could be amended to better identify high-risk PACS patients who go on to develop primary AACG. By broadening the family history criteria to 'a 1st degree relative with glaucoma', sensitivity might be significantly increased and better ascertain high-risk PACS patients for whom LPI would be beneficial.