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Editors Selection IGR 23-2

Epidemiology: Emergency Presentations of Acute Glaucoma 2008-2017

Comment by Sasan Moghimi on:

104838 Emergency Department Presentations of Acute Primary Angle Closure in the United States from 2008 to 2017, Mehta SK; Mir T; Freedman IG et al., Clinical Ophthalmology, 2022; 16: 2341-2351

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Acute primary angle closure (APAC) is an ophthalmic emergency and a major cause of blindness worldwide. It is most prevalent in Asian populations.¹ However, the data on the epidemiology and clinical characteristics of APAC in the United States are limited.

Mehta et al. in their retrospective large cross-sectional study using the Nationwide Emergency Department Sample (NEDS) reported the ICD-9/10 code-identified cases of APAC presenting to the United States emergency departments over a ten-year period and presented the clinical characteristics of these patients.

The data showed that the incidence of APAC-related ED visits (23,203 APAC, average incidence: 0.73 per 100,000 population), increased in the United States during the study period from 2008 to 2017, posing a risk of greater visual morbidity and healthcare costs.

The increasing incidence of APAC seen in this study may be due to shifting demographics (e.g., age, race) in the United States as well as improvements in ED diagnostics and reporting. Significant seasonal variation was seen regionally and nationally (p < 0.01), with the highest average incidence in December and the lowest in April.

Partially explained by variation in demographics with a greater proportion of Asians in the Northeast and West, these two regions had the highest incidence of ED visits for APAC, followed by the South, and Midwest. Other reasons might be access to emergency care and associations between daily daylight hours, climate, and APAC.² Not surprisingly, females (59.4%, odds ratio :1.46, p < 0.01), those in the lowest income quartile (30.1%, p < 0.01) and those in the seventh decade of life( 24.1%) presented more frequently with APAC.

While the strengths of this study include its large sample size and utilization of the NEDS sampling strategy that allows generation of national level estimates, the results of the study should be interpreted by some limitations. This study only captures patients who presented to the ED with APAC and NEDS lacks data on outpatient ophthalmologic visits. In addition, ethnicity data are not available which is an important piece of information regarding incidence of angle closure.

The results of the present study suggest that ophthalmologists working in the United States should be aware that APAC in the nation is on the rise. There is a significant regional and seasonal trends in the presentation of APAC, and preventive strategies should be developed and targeted toward high-risk groups. Future studies are required to assess the trends in management of angle closure (i.e., early cataract surgery, laser peripheral iridotomy) and the risk of angle closure in different regions.

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