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Editors Selection IGR 21-3

Epidemiology: Prevalence of angle-closure in European populations

Comment by Tin Aung & Arun Narayanaswamy on:

50460 The prevalence of primary angle closure glaucoma in European derived populations: a systematic review, Day AC; Baio G; Gazzard G et al., British Journal of Ophthalmology, 2012; 96: 1162-1167

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This meta-analysis by Day et al. adds valuable information to the prevalence of PACG in European-derived populations. The higher prevalence of angle-closure glaucoma in the Asian populations is well known, and this paper justifiably shifts this focus and raises awareness about the prevalence of PACG amongst subjects of European descent.

The meta-analysis was robust with stringent criteria used for inclusion/ exclusion and it standardized glaucoma definitions. Of note, the estimated prevalence of PACG in European-derived populations from this meta-analysis was 0.4 %, which was much higher than the previously estimated numbers of 0.1- 0.2%. The authors provide current estimates of PACG amongst European-derived subjects to be in the range of 0. 5 million to 1.6 million, depending on geographic location, and this has been projected to increase by a proportion ranging from 9-19 % over the next decade.

Clinicians should exit the comfort zone of assuming POAG to be the predominant form of glaucoma amongst European-derived subjects, and arrive at this diagnosis only after performing a gonioscopy to exclude the possibility of PACG

PACG is an aggressive disease with potential for rapid progression; thus appropriate identification of individuals at presentation is crucial. The resounding message from this publication is the importance of performing gonioscopy for all subjects with glaucoma. Clinicians should exit the comfort zone of assuming POAG to be the predominant form of glaucoma amongst European- derived subjects, and arrive at this diagnosis only after performing a gonioscopy to exclude the possibility of PACG.

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