PT - JOURNAL ARTICLE AU - David S Friedman AU - Dolly Shuo-Teh Chang AU - Yuzhen Jiang AU - Shengsong Huang AU - Xiangbin Kong AU - Beatriz Munoz AU - Tin Aung AU - Paul J Foster AU - Mingguang He TI - Darkroom prone provocative testing in primary angle closure suspects and those with open angles AID - 10.1136/bjophthalmol-2018-313362 DP - 2019 Dec 01 TA - British Journal of Ophthalmology PG - 1834--1839 VI - 103 IP - 12 4099 - http://bjo.bmj.com/content/103/12/1834.short 4100 - http://bjo.bmj.com/content/103/12/1834.full SO - Br J Ophthalmol2019 Dec 01; 103 AB - 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.