Primary Angle-Closure Glaucoma: A Comprehensive Meta-Narrative Review
DOI:
https://doi.org/10.15353/cjo.v87i3.6526Keywords:
primary angle-closure glaucoma, gonioscopy, anterior segment optical coherence tomography, pupillary block, plateau iris, angle-closure continuum, laser peripheral iridotomy, cataract extractionAbstract
Absract
Primary angle-closure glaucoma, while less common than primary open-angle glaucoma, carries a 4- to 5-fold greater risk of severe visual morbidity. The identification of individuals at high risk of the disease enables proactive rather than reactive intervention, which helps mitigate the possibility of potentially serious consequences. Recognition is facilitated by careful case history, clinical examination, and ancillary imaging, while management is an evolving paradigm, informed by a number of relatively recent investigations, that may involve medications, laser procedures, surgery, or a combination thereof. This series of 4 papers, drawing upon relevant peer-reviewed literature, will endeavour to provide a comprehensive yet focused synthesis and synopsis of the contemporary diagnosis and management of primary angle-closure glaucoma.
References
1. Quigley HA. The number of people with glaucoma worldwide. Br J Ophthalmol 1996;80:389-93.
2. He M, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. Lancet 2019;393:1609-18.
3. Shan S, et al. Global incidence and risk factors for glaucoma: a systematic review and meta-analysis of prospective studies. J Glob Health 2014;14:04252.
4. Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol 2001;85:1277-85.
5. Tham YC, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040. A systematic review and meta-analysis. Ophthalmology 2014;121:2081-90.
6. Thomas R, Walland MJ. Management algorithms for primary angle closure disease. Clin Exp Ophthalmol 2013;41:282-92.
7. Xu BY, et al. Ocular biometric risk factors for progression of primary angle closure disease. The Zhongshan Angle Closure Prevention Trial. Ophthalmology 2022;129:267-75.
8. Tarongoy P, et al. Angle-closure glaucoma: the role of the lens in the pathogenesis, prevention, and treatment. Surv Ophthalmol 2009;54:211-25.
9. Nongpiur ME, et al. Angle closure glaucoma: a mechanistic review. Curr Opin Ophthalmol 2011a;22:96-101.
10. Sun X, et al. Primary angle closure glaucoma: what we know and what we don’t know. Prog Ret Eye Res 2017;58:26-45.
11. Coleman AL, et al. Use of gonioscopy in Medicare beneficiaries before glaucoma surgery. J Glaucoma 2006;15:486-93.
12. Smith SD, et al. Evaluation of the anterior chamber angle in glaucoma. A report by the American Academy of Ophthalmology. Ophthalmology 2013;120:1985-97.
13. Varma DK, et al. Proportion of undetected narrow angles or angle closure in cataract surgery referrals. Can J Ophthalmol 2017a;52:366-72.
14. Scheie HG. Width and pigmentation of the angle of the anterior chamber: a system of grading by gonioscopy. AMA Arch Ophthalmol 1957;58:510-2.
15. Shaffer RN. Primary glaucomas, gonioscopy, ophthalmoscopy and perimetry. Trans Am Acad Ophthalmol Otolaryngol 1960;62:112-27.
16. Spaeth GL. The normal development of the human anterior chamber angle: a new system of descriptive grading. Trans Ophthalmol Sci UK 1971;91:709-39.
17. Radhakrishnan S, Chen L. Diagnosis and monitoring of primary angle closure. Curr Ophthalmol Rep 2015;3:51-7.
18. He M, et al. Angle-closure glaucoma in East Asian and European people: different diseases? Eye 2006a;20:3-12.
19. Nongpiur ME, et al. Lens vault, thickness and position in Chinese subjects with angle closure. Ophthalmology 2011b;118:474-9.
20. Riva I, et al. Anterior chamber angle assessment techniques: a review. J Clin Med 2020;9:3814.
21. Pavlin CJ, et al. Ultrasound biomicroscopy in plateau iris syndrome. Am J Ophthalmol 1992;113:390-5.
22. Foo LL, et al. Determinants of angle width in Chinese Singaporeans. Ophthalmology 2012;119:278-82.
23. Jones LW, et al. (2018). Diagnostic instruments. In N. Efron (Ed.), Contact Lens Practice (3rd ed., pp. 327-45). Elsevier.
24. Porporato N, et al. Role of anterior segment optical coherence tomography in angle-closure disease: a review. Clin Exp Ophthalmol 2018;46:147-57.
25. Ritch R. Plateau iris is caused by abnormally positioned ciliary processes. J Glaucoma 1992;1:23-6.
26. American Academy of Ophthalmology Glaucoma Panel. Preferred Practice Pattern Guidelines. Primary Angle Closure. San Francisco: AAO; 2015.
27. Wang N, et al. Primary angle closure glaucoma in Chinese and Western populations. Chin Med J 2002;115:1706-15.
28. Foster PJ, et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002;86:238-42.
29. Thomas R, et al. Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study. Br J Ophthalmol 2003a;87:450-4.
30. Thomas R, et al. Five year risk of progression of primary angle closure to primary angle closure glaucoma: a population based study. Acta Ophthalmol Scand 2003b;81:480-5.
31. Day AC, Gazzard G. Missed opportunities in preventing acute angle closure – needlessly blind? JAMA Ophthalmol 2022;140:604-5.
32. Baskaran M, et al. The Singapore Asymptomatic Narrow Angles Laser Iridotomy Study. Five-year results of a randomized controlled trial. Ophthalmology 2022;129:147-58.
33. Robin AL, Pollack IP. Argon laser peripheral iridotomies in the treatment of primary angle closure glaucoma. Arch Ophthalmol 1982;100:919-23.
34. Tham CC, et al. Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataracts. Ophthalmology 2009;116:725-31.
35. Wright C, et al. Primary angle-closure glaucoma: an update. Acta Ophthalmol 2016;94:217-25.
36. Jacobi PC, et al. Primary phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma. Ophthalmology 2002;109:1597-1603.
37. Lam DSC, et al. Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure. Ophthalmology 2008;115:1134-40.
38. Azuara-Blanco A, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomized controlled trial. Lancet 2016;388:1389-97.
39. Chan PP, Tham CC. Commentary on effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE). Ann Eye Sci 2017;2:21.
40. Song MK, et al. Glaucomatous progression after lens extraction in primary angle closure disease spectrum. J Glaucoma 2020;29:711-7.
41. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7.
42. Weinreb RN, et al. The pathophysiology and treatment of glaucoma: a review. JAMA 2014;311:1901-11.
43. Barkan O. Glaucoma classification: causes and surgical control. Am J Ophthalmol 1938a;21:1099-1113.
44. Jonas JB, et al. Glaucoma. Lancet 2017;390:2183-93.
45. Castaneda-Diez R, et al. (2011). Current Diagnosis and Management of Angle-Closure Glaucoma. In P. Gunvant (Ed.), Glaucoma - Current Clinical and Research Aspects (pp. 145-168). IntechOpen. https://doi.org/10.5772/662
46. Shah SN, et al. Prevalence and risk factors of blindness among primary angle closure patients in the United States: an IRIS® Registry analysis. Ophthalmology 2024;259:131-40.
47. Azuara-Blanco A. Use of biometric data after laser peripheral iridotomy – individualized monitoring strategy for angle closure prevention. JAMA Ophthalmol 2023;141:524.
48. Fremont AM, et al. Patterns of care for open-angle glaucoma in managed care. Arch Ophthalmol 2003;121:777-83.
49. Varma DK, et al. Undetected angle closure in patients with a diagnosis of open-angle glaucoma. Can J Ophthalmol 2017b;52:373-8.
50. Day AC, et al. The prevalence of primary angle closure glaucoma in European derived population: a systematic review. Br J Ophthalmol 2012;96:1162-7.
51. Zhang H, et al. Clinical characteristics, rates of blindness, and geographic features of primary angle-closure disease in hospitals of the Chinese Glaucoma Study Consortium. Can J Ophthalmol 2021;56:299-306.
52. Zhang N, et al. Prevalence of primary angle closure glaucoma in the last 20 years: a meta-analysis and systematic review. Front Med 2021;7:624179.
53. Vijaya L, et al. Six-year incidence of angle-closure disease in a South Indian population: the Chennai Eye Diseases Incidence Study. Am J Ophthalmol 2013;156:1308-15.
54. Wong TY, et al. Rates of hospital admissions from primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore. Br J Ophthalmol 2000;85:900-2.
55. Salmon JF. Predisposing factors for chronic angle-closure glaucoma. Prog Ret Eye Res 1998;18:121-32.
56. Congdon NG, et al. Biometry and primary angle-closure glaucoma among Chinese, white and black populations. Ophthalmology 1997;104:1489-95.
57. Ritch R, et al. Angle closure in younger patients. Ophthalmology 2003;110:1880-9.
58. Stieger R, et al. Prevalence of plateau iris syndrome in young patients with recurrent angle closure. Clin Exp Ophthalmol 2007;35:409-13.
59. Xu Y, et al. The ocular biometry characteristics of young patients with primary angle-closure glaucoma. BMC Ophthalmol 2022;22:150.
60. Lowe RF. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthlamol 1970;54:161-9.
61. Lee DA, et al. Anterior chamber dimensions in patients with narrow angles and angle-closure glaucoma. Arch Ophthalmol 1984;102:46-50.
62. Nolan WP, et al. Screening for primary angle closure in Mongolia: a randomised controlled trial to determine whether screening and prophylactic treatment will reduce the incidence of primary angle closure glaucoma in an east Asian population. Br J Ophthalmol 2003;87:271-4.
63. Zhang Y, et al. Development of angle closure and associated risk factors: the Handan Eye Study. Acta Ophthalmologica 2022;100:e253-e261.
64. Ng WT, Morgan W. Mechanisms and treatment of primary angle closure: a review. Clin Exp Ophthalmol 2012;40:e218-e228.
65. Cheng JW, et al. The prevalence of primary glaucoma in mainland China: a systematic review and meta-analysis. J Glaucoma 2013;22:301-6.
66. Congdon N, et al. Issues in the epidemiology and population-based screening of primary angle-closure glaucoma. Surv Ophthalmol 1992;36:411-23.
67. Arkell SM, et al. The prevalence of glaucoma among Eskimos of northwest Alaska. Arch Ophthalmol 1987;105:482-5.
68. Song P, et al. National and subnational prevalence and burden of glaucoma in China: a systematic analysis. J Glob Health 2017;7:020705.
69. Casson RJ, et al. Gonioscopy findings and presence of occludable angles in a Burmese population: the Meiktila Eye Study. Br J Ophthalmol 2007;91:856-9.
70. Qu W, et al. Prevalence and risk factors for angle-closure disease in a rural Northeast China population: a population-based survey in Bin County, Harbin. Acta Ophthalmol 2011;89:e515-e520.
71. Mohammadi M, et al. Evaluation of anterior segment parameters in pseudoexfoliation disease using anterior segment optical coherence tomography. Am J Ophthalmol 2022;234:199-204.
72. Lachkar Y, et al. Drug-induced acute angle closure glaucoma. Curr Opin Ophthalmol 2007;18:129-33.
73. Yang MC, Lin KY. Drug-induced acute angle-closure glaucoma: a review. J Curr Glaucoma Pract 2019;13:104-9.
74. Wu A, et al. A review of systemic medications that may modulate the risk of glaucoma. Eye 2020;34:12-28.
75. Na KI, Park SP. Association of drugs with angle closure. JAMA Ophthalmol 2022;140:1055-63.
76. Foster PJ, et al. Association, risk, and causation – examining the role of systemic medications in the onset of acute angle-closure episodes. JAMA Ophthalmol 2022;140:1064-5.
77. van Herick W, et al. Estimation of width of angle of anterior chamber: incidence and significance of the narrow angle. Am J Ophthalmol 1969;68:626-9.
78. Congdon NG, et al. Screening techniques for angle-closure glaucoma in rural Taiwan. Acta Ophthalmol Scand 1996;74:113-9.
79. Johnson TV, et al. Low sensitivity of the Van Herick method for detecting gonioscopic angle closure independent of observer expertise. Am J Ophthalmol 2018;195:63-71.
80. Thompson AC, et al. Risk factors associated with missed diagnoses of narrow angles by the van Herick technique. Ophthalmol Glaucoma 2018;1:108-14.
81. Gispets J, et al. Sources of variability of the van Herick technique for anterior angle estimation. Clin Exp Optom 2014;97:147-51.
82. Friedman DS, He M. Anterior chamber angle assessment techniques. Surv Ophthalmol 2008;53:250-73.
83. Dellaporta A. Historical notes on gonioscopy. Surv Ophthalmol 1975;20:137-49.
84. Alward WLM. A history of gonioscopy. Optom Vis Sci 2011;88:29-35.
85. Lowe RF. Curran, Barkan, and Chandler: a history of pupillary obstruction and narrow angle glaucoma. J Glaucoma 1995;4:419-26.
86. Gloor BR. Hans Goldmann (1899-1991). Eur J Ophthalmol. 2010;20(1):1-11. doi:10.1177/112067211002000101.
87. Wong D, Fishman M. Lee Allen, The Man, The Legend. J Ophthalmic Photogr 1990;12:51-67.
88. Hughes MO, et al. Lee Allen, Ocularist. J Ophthalmic Prosthetics 2009;34:13-25.
89. Forbes M. Gonioscopy with corneal indentation: a method for distinguishing between appositional closure and synechial closure. Arch Ophthalmol 1966;76:488-92.
90. Barkan O. Technic of goniotomy. Arch Ophthalmol 1938b:19:217-23.
91. Fellman RL. (1998). Gonioscopy. In N.T. Choplin & D.C. Lundy (Eds.), Atlas of Glaucoma (1st ed., pp. 39-55.). Martin Dunitz Ltd.
92. Singh P, et al. Gonioscopy: a review. Open J Ophthalmol 2013;3:118-21.
93. Schirmer KE. Gonioscopy and artefacts. Br J Ophthalmol 1967;51:50-3.
94. Phu J, et al. Assessment of angle closure spectrum disease as a continuum of change using gonioscopy and anterior segment optical coherence tomography. Ophthalmic Physiol Opt 2020;40:617-31.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Derek MacDonald
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
