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Darkroom prone provocative testing in primary angle closure suspects and those with open angles
  1. David S Friedman1,2,3,
  2. Dolly Shuo-Teh Chang1,
  3. Yuzhen Jiang3,
  4. Shengsong Huang3,
  5. Xiangbin Kong3,
  6. Beatriz Munoz1,
  7. Tin Aung4,
  8. Paul J Foster5,
  9. Mingguang He3
  1. 1 Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  4. 4 Singapore National Eye Centre and National University of Singapore, Singapore, Singapore
  5. 5 National Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, England
  1. Correspondence to Professor David S Friedman, Wilmer Eye Institute and Johns Hopkins Bloomberg School of Public Health, Baltimore 21287-0005, Maryland, USA; david.friedman{at}


Purpose To describe the results of darkroom prone provocative testing (DRPPT) in primary angle closure suspects (PACS) and to compare the findings to controls with open angles.

Methods 889 subjects with PACS in the Zhongshan Angle Closure Prevention Trial (a randomised controlled trial to compare prophylactic laser iridotomy to no treatment in PACS) and 89 with open angles in the 5-year follow-up of Liwan Eye Study were placed in a darkroom face down for 15 min. Intraocular pressure (IOP) was measured immediately before and after DRPPT.

Results PACS participants were of similar age than controls (59.3 vs 60.5), more often female (82.9% vs 58.4%) and had lower IOP (14.3 vs 15.2 mm Hg). The average IOP increases after DRPPT was 4.3±3 mm Hg in PACS and 5.2±2.8 in controls (p<0.05). 20.5% of controls and 13.9 % of those with PACS developed an IOP spike ≥8 mm Hg after DRPPT (p<0.05). Among PACS, 15.8 % of those with all four quadrants closed had an IOP elevation of ≥ 8 mm Hg as opposed to 10.0%–12.4 % with two or three closed quadrants (p<0.05). DRPPT failed to predict who would reach a clinical trial endpoint over 6-year follow-up of those with PACS.

Conclusions A modified DRPPT failed to separate PACS from those with open angle. Although the test resulted in greater IOP elevation among those PACS participants with all four quadrants closed than in those with two or three closed quadrants, it did not offer any insight into the risk of developing acute or chronic angle closure disease over 6-year follow-up.

  • glaucoma

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  • Contributors DSF, PJF and MH conceived and designed the trial. MH, PJF, DF and TA were the chief investigators and oversaw the trial throughout. YJ, SH and XK were trial examiners. BM and DSC monitored the data and performed analyses and provided critical feedback to study design and activities. All authors contributed to the interpretation of data, drafting of the report and decided on its content. All authors approved the final version.

  • Funding This work is supported by the Fight for Sight (grant no. 1655) (United Kingdom), the Sun Yat-sen University 5010 Project Fund (grant no. 2007033) (China), the National Natural Science Foundation of China (grant no. 81420108008) (China) and Fundamental Research Funds of the State Key Laboratory in Ophthalmology (China). Professor He receives support from the University of Melbourne Research at Melbourne Accelerator Program Professorship. The Centre for Eye Research Australia receives operational infrastructural support from the Victorian government. Dr. Jiang and Professor Foster supported by a grant from the British Council for Prevention of Blindness (UK). Professor Foster received additional support from the National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, London, United Kingdom (NIHR-BRC2 009; Moorfields/UCL-IOO), Special Trustees of Moorfields Eye Hospital (since renamed Moorfields Eye Charity) and the Richard Desmond Charitable Foundation (via Fight for Sight UK). These funding sources did not play any role in the design and conduct of the study; in the collection, management, analysis or interpretation of the data; or in the preparation, review, approval of the manuscript, or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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