Elsevier

Ophthalmology

Volume 111, Issue 8, August 2004, Pages 1464-1469
Ophthalmology

Original article
Long-term outcomes in asians after acute primary angle closure

Presented at: Association for Research in Vision and Ophthalmology Annual Meeting, May, 2003; Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2003.12.061Get rights and content

Abstract

Purpose

To determine the long-term outcome of Asian eyes with an acute attack of primary angle closure (APAC) and to identify risk factors at presentation associated with the development of glaucomatous optic nerve damage.

Design

Cross-sectional observational case series.

Participants

Ninety individuals who were initially seen with APAC 4 to 10 years previously at 2 Singapore hospitals.

Methods

All subjects underwent a complete eye examination, including visual acuity, visual field testing, dilated eye examination, and optic nerve head photography. The optic discs were judged clinically and photographically as to whether there was glaucomatous optic neuropathy present, and visual fields were assessed for corresponding visual field loss. All visual fields and optic nerve photographs underwent a second evaluation by an experienced, but masked, glaucoma specialist, who assessed whether the changes were compatible with glaucoma.

Main outcome measures

The main outcome measures were blindness (defined as best-corrected visual acuity worse than 6/60 and/or central visual field of less than 20° in the attack eye) and glaucomatous optic neuropathy (GON).

Results

A total of 90 of 170 eligible subjects (65.2%) were examined. All subjects were Asian and were predominantly Chinese (78 subjects [86.7%]). There were 61 females (67.8%), and the age of the subjects was 62.0±9.0 years (mean ± standard deviation) at the time of APAC, with a mean duration of 6.3±1.5 years from the time of the APAC episode to the study examination. Sixteen (17.8%) subjects were blind in the attack eye; half of the cases of blindness were caused by glaucoma. Forty-three subjects (47.8%) had GON, with 13 eyes (15.5%) having markedly cupped optic discs (cup-to-disc ratio >0.9). Thirty-eight eyes (58%) had best-corrected vision worse than 6/9, with cataract responsible for close to half the cases of poor vision. There were no identifiable risk factors related to the APAC episode that were significantly associated with the presence of GON.

Conclusions

Several years after being seen with APAC, 17.8% of subjects examined were blind in the attack eye, and almost half had glaucomatous optic nerve damage. Vision was also reduced in a large number of individuals, largely from unoperated cataract. Subjects with APAC would benefit from regular follow-up to monitor for visual field decline and glaucoma development.

Section snippets

Materials and methods

Written informed consent was obtained from study subjects, and the study protocol had the approval of the Ethics Committees of the Singapore National Eye Centre, the National University Hospital, Singapore, and the Wilmer Institute, Johns Hopkins University.

The first part of the study was a systematic review of the charts of consecutive patients who were seen with APAC at the National University Hospital, Singapore, from 1990 to 1995 and at the Singapore National Eye Centre in 1996.

The

Results

There were a total of 170 subjects who were seen with APAC at the National University Hospital, Singapore, from 1990 to 1995 and at the Singapore National Eye Centre in 1996. Thirty-two subjects were deceased before the time of the examination. Of the remaining 138 eligible subjects, 22 (15.9%) could not be contacted, and 26 subjects (18.8%) refused or were medically unwell to come for an examination, leaving a total of 90 subjects who participated in the study (65.2% response rate). The mean

Discussion

This is the first study to investigate the long-term visual outcome several years after an episode of APAC in Asians. With a mean interval of 6 years from presentation to the time of examination, one fifth of APAC subjects were found to be blind in the attack eye, with glaucoma being the cause of blindness in 50% of them. Almost half of all subjects were found to have glaucomatous optic neuropathy, and a third of those with glaucoma had severely cupped optic discs (C/D ratio > 0.9).

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  • Cited by (0)

    Manuscript no. 230350.

    Supported by a grant from Johns Hopkins Singapore PTE Ltd. Dr Aung is partly supported by the National Medical Research Council of Singapore.

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