Cambridge Ophthalmological Symposium
Eye (2005) 19, 1119–1124. doi:10.1038/sj.eye.6701970
Can we prevent angle-closure glaucoma?
Paper previously presented at the Cambridge Ophthalmological Symposium 16th September 2004
G J Johnson1,2 and P J Foster1
- 1Department of Epidemiology and International Eye Health, Institute of Ophthalmology, UCL, Summertown, Oxford OX2 7QB, UK
- 2International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Summertown, Oxford OX2 7QB, UK
Correspondence: GJ Johnson, 17 Lucerne Road, Summertown, Oxford OX2 7QB, UK. Tel: +44 1865 556513; Fax: +44 1865 310941; E-mail: g.j.johnson@ btopenworld.com
Received 29 April 2004; Accepted 2 May 2005.
Abstract
Purpose
Glaucoma is the second cause, after cataract, of world blindness. Approximately half is thought to be primary angle-closure glaucoma (ACG). This review asks whether ACG can be prevented on a population basis.
Methods and populations
Review of published information from the Inuit of Greenland, Canada and Alaska, and descriptions of recent studies in Asian populations in Mongolia, China and South-East Asia.
Results
The Greenland Inuit have the shallowest anterior chamber depths (ACDs) so far recorded. The proportion of blindness due to ACG was reduced from 64% to 9% over 37 years by systematic optical measurement of central ACD and the van Herick test in the older Inuit, followed by gonioscopy and prophylactic iridectomy or laser iridotomy when indicated. In Mongolia, ultrasound measurement of central ACD had good sensitivity and specificity as a screening test. A randomized controlled trial of screening and prophylactic laser is being completed. In China and South-East Asia, the mechanism of angle closure appears to be more varied and complex and its detection may require more elaborate imaging.
Conclusions
The mechanism of angle closure and potential for prevention by screening are likely to have to be determined specifically for each population at risk.
Keywords:
glaucoma, angle closure, epidemiology, blindness, biometry
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