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Editors Selection IGR 24-4

Risk Factors: Risk factors for progression of angle-closure suspect eyes

Xiulan Zhang
Deming Wang

Comment by Xiulan Zhang & Deming Wang on:

116739 Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect, Yuan Y; Xiong R; Wang W et al., JAMA ophthalmology, 2024; 142: 216-223


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Primary angle-closure suspect (PACS) represents an initial condition within the continuum of angle-closure diseases, which may evolve into primary angle closure (PAC) and eventually primary angle-closure glaucoma (PACG)1. PACS is defined by the presence of iridotrabecular contact across at least 180 degrees without elevation of intraocular pressure (IOP) or optic nerve damage.1,2 Elucidating the progression from PACS to PAC is pivotal in clinical settings to facilitate the identification of risk factors and structural predictors, thereby enabling timely intervention strategies.3-5

In their 14-year longitudinal study, Yuan et al. examined and analyzed 377 PACS patients from the Zhongshan Angle Closure Prevention trial.2 They discovered that during the follow-up period, 25% of the subjects advanced from PACS to PAC. Notable predictors of this progression included higher IOP, reduced anterior chamber depths, and anatomical parameters measurable via anterior segment optical coherence tomography (AS-OCT), such as the trabecular-iris space area and angle recess area. These findings underscore the importance of structural biomarkers in risk stratification and the customization of management for PACS, providing valuable guidance for the monitoring and prevention strategies in high-risk individuals.2,6

This study offers valuable insights into the progression from PACS to PAC, with several areas for future improvement. A more comprehensive temporal analysis of progression could yield deeper understanding of how the importance of risk factors evolves over time. Future research could also benefit from broadening the inclusion criteria to encompass eyes that have received treatment, thereby enhancing the generalizability of the results. Considering that the cohort predominantly consisted of urban Southern Chinese residents, replicating this study across a variety of demographic groups would be valuable for verifying its wider relevance. Continuing to explore these aspects is crucial for advancing our comprehension of PACS progression and improving clinical approaches for diverse patient populations.

References

  1. Gedde SJ, Chen PP, Muir KW, et al. Primary Angle-Closure Disease Preferred Practice Pattern®. Ophthalmology. 2021;128(1):30-70.
  2. Yuan Y, Xiong R, Wang W, et al. Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect. JAMA Ophthalmol. 2024;142(3):216-23.
  3. Zhang Y, Zhang Q, Thomas R, et al. Development of angle closure and associated risk factors: The Handan eye study. Acta Ophthalmol. 2022;100(1):e253-e61.
  4. Thomas R, George R, Parikh R, et al. Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study. Br J Ophthalmol. 2003;87(4):450-454.
  5. Zhang Y, Thomas R, Zhang Q, et al. Progression of Primary Angle Closure Suspect to Primary Angle Closure and Associated Risk Factors: The Handan Eye Study. Invest Ophthalmol Vis Sci. 2021;62(7):2.
  6. Nolan WP, See JL, Chew PT, et al. Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes. Ophthalmology. 2007;114(1):33-39.

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