Presenting features of primary angle-closure glaucoma in patients of mixed ethnic background

The relative frequency with which patients++ present with acute or chronic angle-closure glaucoma depends on their ethnic background. In order to examine the presenting features and effects of primary angle-closure glaucoma in people of mixed ethnicity, we reviewed all 'coloured' patients who presented to Groote Schuur Hospital with this diagnosis during a 5-year period. Of the 92 patients, 33 (36%) presented with acute angle-closure glaucoma and 59 (64%) with chronic angle-closure glaucoma. The level of intra-ocular pressure on presentation correlated well with the number of quadrants of angle closure (correlation coefficient: r = 0.73, P < 0.001). When individual eyes were assessed, a mean cup/disc ratio of > or = 0.8 was present in 35% (65/184) and glaucomatous visual field loss was present in 56.5% (104/184). Total uni-ocular blindness secondary to chronic angle-closure glaucoma, was found in 16 (17%) patients. This study indicates that 'coloured' patients with primary angle-closure glaucoma are more likely to present with chronic symptoms and signs, and that the disease may result in devastating ocular damage and visual loss. In patients of mixed ethnic background with signs of primary glaucoma, chronic angle-closure should be excluded by careful gonioscopic evaluation of the drainage structures of the eye.