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The incidence of acute angle closure in Scotland: a prospective surveillance study
  1. Paul Y Chua1,
  2. Alexander C Day2,3,
  3. Ken L Lai4,
  4. Nikki Hall5,
  5. Lai L Tan6,
  6. Kamran Khan7,
  7. Lik Thai Lim8,
  8. Barny Foot9,
  9. Paul J Foster2,3,
  10. Augusto Azuara-Blanco10
  1. 1 Department of Ophthalmology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
  2. 2 The NIHR Biomedical Research Centre, Moorfields Eye Hospital, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
  3. 3 Glaucoma Service, Moorfields Eye Hospital, London, UK
  4. 4 Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK
  5. 5 Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, Scotland, UK
  6. 6 Ophthalmology, Ninewells Hospital, Dundee, Scotland, UK
  7. 7 Ophthalmology, Raigmore Hospital, Inverness, Scotland, UK
  8. 8 Department of Ophthalmology, University Malaysia, Kota Samarahan, Sarawak, Malaysia
  9. 9 British Ophthalmic Surveillance Unit, The Royal College of Ophthalmologists, London, UK
  10. 10 Centre for Vision and Vascular Science, Queen’s University, Belfast, Northern Ireland, UK
  1. Correspondence to Professor Augusto Azuara-Blanco, Centre for Vision and Vascular Science, Queen’s University Belfast, Institute of Clinical Science, Royal Victoria Hospital, Belfast BT7 1NN, UK; a.azuara-blanco{at}


Purpose To estimate the incidence, and describe the clinical features and short-term clinical outcomes of acute angle closure (AAC).

Methods Patients with newly diagnosed AAC were identified prospectively over a 12-month period (November 2011 to October 2012) by active surveillance through the Scottish Ophthalmic Surveillance Unit reporting system. Data were collected at case identification and at 6 months follow-up.

Results There were 114 cases (108 patients) reported, giving an annual incidence of 2.2 cases (95% CI 1.8 to 2.6) or 2 patients (95% CI 1.7 to 2.4) per 1 00 000 in the whole population in Scotland. Precipitating factors were identified in 40% of cases. Almost one in five cases was associated with topical dilating drops. Best-corrected visual acuity (BCVA) at presentation ranged from 6/6 to perception of light. The mean presenting intraocular pressure (IOP) was 52 mm Hg (SD 11). Almost 30% cases had a delayed presentation of 3 or more days. At 6 months follow-up, 75% had BCVA of 6/12 or better and 30% were found to have glaucoma at follow-up. Delayed presentation (≥3 days) was associated with higher rate of glaucoma at follow-up (22.6% vs 60.8%, p<0.001), worse VA (0.34 vs 0.74 LogMAR, p<0.0001) and need for more topical medication (0.52 vs 1.2, p=0.003) to control IOP.

Conclusion The incidence of AAC in Scotland is relatively low compared with the Far East countries, but in line with previous European data. Almost one in five cases were associated with pupil dilation for retinal examination.

  • epidemiology
  • glaucoma
  • public health

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  • Contributors PJF, ACD, BF, PYC and AA-B designed the study and were involved in data analysis and interpretation. PJC, KLL, NH, LLT, KK and LTL were responsible for data acquisition. All coauthors were involved in the drafting and revising of the paper and approved the final version, and agreed to be accountable for all aspects of the work.

  • Funding Ross Foundation.

  • Competing interests None declared.

  • Ethics approval North East Scotland Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.