Screening for angle-closure disease in the community: A review

Abstract

Primary angle-closure glaucoma (PACG) has a higher risk of association with blindness compared to primary open-angle glaucoma. Early determination of PAC disease (PACD) before progression to PACG can help prevent loss of vision. Although gonioscopy is the gold standard for the determination of angle status, it requires more training and experience and may not be feasible to use for screening. We reviewed the performance of other modalities of angle assessment in population studies in comparison with gonioscopy. Assessment of limbal anterior chamber depth, biometric parameters such as central anterior chamber depth, lens thickness, axial length measurements, and anterior segment optical coherence tomography were used to qualitatively and quantitatively assess the angle structures in these studies. The sensitivity, specificity, and predictive values varied widely due to the use of varying techniques and definitions. A combination of more than 1 parameter was found to give better results in comparison with gonioscopy in some studies. Individual or combination tests most appropriate for screening need to be determined and reassessed by further well-controlled studies with uniform criteria.