Increased incidence of acute primary angle closure during the COVID-19 outbreak in China: A retrospective analysis.

This study aimed to investigate the incidence and clinical characteristics of acute primary angle closure (APAC) during the Coronavirus Disease 2019 (COVID-19) pandemic in China. This was a retrospective study of patients diagnosed with APAC in a glaucoma clinic over a 5-year period. We compared the number of APAC cases during the COVID-19 outbreak (December 7, 2022 to January 7, 2023) with those during the same period in previous years and 2 months prior to the outbreak. We also collected data on the demographic and clinical features of APAC patients, such as age, sex, disease course, visual acuity, intraocular pressure (IOP), and lens opacity. We included 95 eyes of 88 patients with APAC were included. Of these, 65 were female and 23 were male. The mean age was 68.0 ±â€…8.1 years. The median disease course was 10.8 ±â€…9.5 days. There was a significant increase in the number of APAC cases during the COVID-19 outbreak compared with the same months over a 5-year period (44 vs 51, P < .001). A higher proportion of women developed APAC during the outbreak period than during the non-outbreak period (P < .001). Eyes with APAC in the outbreak period had a lower mean IOP than those in the preceding 6 months (40.5 ±â€…8.8 mm Hg vs 46.1 ±â€…10.1 mm Hg; P = .043). No significant differences were observed in disease duration, lens opacity, or bilateral or unilateral onset between the 2 groups. Our study suggests a potential correlation between APAC and COVID-19, marked by a significant surge in APAC cases concurrent with the COVID-19 outbreak. However, the underlying mechanisms and preventive strategies remain to be elucidated.

Population-based survey of the prevalence and types of glaucoma in Bangladesh.

BACKGROUND: To delineate the epidemiological landscape of glaucoma using a population-based sample representative of Bangladesh. METHODS: Using multistage stratified cluster random sampling, households were selected to identify individuals ≥35 years across all 8 divisions of Bangladesh. Sampling frames were derived from the 2011 national census. Fifty-eight study examination sites were set up for comprehensive eye evaluations, including intraocular pressure, gonioscopy and visual field testing when indicated. International Society for Geographic and Epidemiological Ophthalmology definitions were used to define glaucoma and glaucoma suspect cases. RESULTS: One hundred forty clusters (89 rural and 51 urban) were randomly selected, and 13 791 residential households were visited. We invited 17 002 individuals ≥35 years for on-site examination, of which 12 000 (71%) complied, with a male-to-female ratio of 1:1. The prevalence of glaucoma was 3.2% (95% CI 2.79% to 3.64%), and glaucoma suspect was 10.1% (95% CI 9.05% to 11.12%). The majority (78%) had primary open-angle glaucoma (POAG), while angle closure was seen in 16%. Of the POAG, 83% (n=251) were normal-tension glaucoma. Multivariable logistic regression showed increasing age (OR=1.01 for every 5-year increment, 95% CI 1 to 1.01) and male gender (OR=1.43, 95% CI 1.15 to 1.77) to be associated with an increased risk of glaucoma. CONCLUSIONS: The prevalence of glaucoma in Bangladesh is 3.2% in ≥35-year-old individuals with older men most at risk. Extrapolating the results, we estimate about 2 million patients with glaucoma. Though normal-tension variety was the most common type, caution should be exercised in generalising these results to other populations.

Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis.

PURPOSE: To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States. DESIGN: Retrospective cross-sectional study. METHODS: Eligible patients from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); and 3) no history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤20/200) at first diagnosis of PACG. RESULTS: Among 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (odds ratios [ORs] 1.42 and 1.21, respectively; P < .001) and bilateral (ORs 2.04 and 1.53, respectively; P < .001) blindness compared with non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred a higher risk of blindness (OR > 1.28; P ≤ .01). CONCLUSIONS: Blindness affects 1 of 9 patients with newly diagnosed PACG in the IRIS Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among patients with PACG and the need for improved disease awareness and detection methods.

Genetic and Environmental Contributions of Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma: A Nationwide Study in Taiwan.

PURPOSE: To estimate the familial risks of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) and assess the relative contributions of environmental and genetic factors to these risks. DESIGN: Retrospective, population-based cohort study. METHODS: We used the 2000-2017 Taiwan National Health Insurance Program database to construct 4,144,508 families for the 2017 population (N = 23,373,209). We used the polygenic liability model to estimate glaucoma's heritability and familial transmission. The degree of familial aggregation of glaucoma was obtained from the adjusted relative risk for individuals whose first-degree relatives had glaucoma using Cox's model. RESULTS: PACG and POAG prevalence rates for individuals whose first-degree relatives had PACG or POAG were 0.95% and 2.40%, higher than those of the general population (0.61% and 0.40%, respectively). The relative risk of PACG in individuals whose first-degree relatives had PACG was 2.44 (95% CI = 2.31-2.58). The relative risk of POAG in individuals whose first-degree relatives had POAG was 6.66 (95% CI = 6.38-6.94). The estimated contributions to PACG and POAG phenotypic variances were 19.4% and 59.6% for additive genetic variance, 19.1% and 23.2% for common environmental factors shared by family members, and 61.5% and 17.2% for nonshared environmental factors, respectively. CONCLUSIONS: These data highlight the relative importance of genetic contribution to POAG and environmental contribution to PACG. Therefore, future work may need to focus on finding more novel environmental determinants of PACG.

Prevalence and Severity of Glaucoma in the California Medicare Population.

PURPOSE: To examine the prevalence of glaucoma by type and severity in the 2019 California (CA) Medicare population, and to identify associated demographic and systemic factors. DESIGN: Retrospective cross-sectional design. METHODS: The study population included all 2019 CA Medicare beneficiaries ≥65 years of age with Part A and Part B coverage. Outcomes included prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma (ACG). Covariates included age, sex, race and ethnicity, Charlson Comorbidity Index (CCI) score, pseudophakia, and age-related macular degeneration. Logistic regression modeling was used to examine multivariable predictors of each type of glaucoma. RESULTS: Of 5,856,491 beneficiaries in the 2019 California Medicare population, there were 220,662 (3.8%) with any glaucoma, 171,988 (2.9%) with POAG, 8,827 (0.2%) with SOAG, and 12,978 (0.2%) with ACG. The largest proportion of beneficiaries had moderate to severe glaucoma (68,553 of 220,662 [31.0%] for any glaucoma moderate stage, 3,168 of 12,978 [24.4%] for ACG severe stage). Multivariable predictors of any glaucoma included age ≥85 years vs 65 to 69 years (adjusted odds ratio [aOR] = 2.03, 95% CI = 2.00, 2.06), female vs male sex (aOR = 1.03, 95% CI = 1.02, 1.04), Black vs non-Hispanic White race and ethnicity (aOR = 1.70, 95% CI = 1.67, 1.73), and CCI ≥5 vs 0 (aOR = 5.59, 95% = 5.51, 5.67). CONCLUSIONS: In the 2019 CA Medicare population, multiple demographic and systemic factors were associated with increased likelihood of glaucoma, and beneficiaries with glaucoma had a high prevalence of moderate to severe disease. Strategies are needed to improve early screening and diagnosis for elderly individuals at risk for glaucoma in California.

Prevalence Ratio of Primary Angle-Closure and Primary Open-Angle Glaucoma in Asian Population: A Meta-Analysis and Multiple Meta-Regression Analysis.

PURPOSE: To investigate the prevalence ratio of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in the Asian population. METHODS: Systematic searches of PubMed, Embase, and Cochrane databases for population-based studies in Asia published until August 5, 2022. We conducted a meta-analysis for PACG to POAG prevalence ratio using inverse variance-weighted random-effects meta-analyses so as to combine the study-specific measures of association. Between-study outcome variation (i.e., heterogeneity) was quantified with the I2 statistic. The multiple meta-regression analyses were performed in order to further account for the reasons for heterogeneity. RESULTS: Twenty studies, with a total study population of 52,522 individuals, had been conducted in 13 countries. The pooled PACG to POAG prevalence ratio was 2.204 (95% confidence interval, 1.617-3.004) with high heterogeneity (p < 0.001). In multiple meta-regression model, prevalence of POAG is the most important predictor for heterogeneity (model importance, 0.954), followed continent (0.508), and publication year (0.222). For every additional elevation of POAG prevalence (i.e., increase of 1.0%), the PACG to POAG prevalence ratio is expected to rise by 0.471. CONCLUSIONS: We estimated the pooled PACG to POAG prevalence ratio in the Asian population. The POAG prevalence is the most important factor to determine the PACG to POAG prevalence ratio.

Prevalence of glaucoma types, clinical profile and disease severity at presentation: Tertiary Institute based cross-sectional study from South India.

Purpose: To describe the clinical profile and relative prevalence of subtypes of glaucoma presenting to a tertiary care center in India. Methods: This cross-sectional hospital-based study included 6,120 new patients (>16 years) presenting between January 2016 and December 2017. The data were collected using an electronic medical record system. Results: A total of 11,016 eyes of 6,120 new patients were diagnosed with glaucoma. Sixty-one percent were male and 79% had a bilateral affliction. Primary glaucoma was present in 4,352 (71.1%) and secondary glaucoma in 1,063 (17.4%) subjects. Glaucoma was primary open-angle (POAG) in 4,015 (36.4%) eyes and primary angle closure disease (PACD) in 3,806 (34.5%) eyes. Commonest among secondary glaucoma was post-cataract surgery glaucoma (3.1%), neovascular glaucoma (2.4%), pseudoexfoliation glaucoma (PXG) (2.1%), and steroid-induced glaucoma (SIG) (1.4%). Patients with primary glaucoma were older than secondary (56.6 ± 0.2 vs 54.1 ± 0.4; P < 0.0001). Mean IOP was higher in secondary glaucoma compared to primary (26.9 ± 0.3 vs 18.9 ± 0.1; P < 0.0001). Secondary glaucoma had greater mean CDR compared to primary glaucoma (0.77 ± 0.007 vs 0.70 ± 0.003; P < 0.0001). The prevalence of blindness (visual acuity <20/200) was 16.2% of eyes. Mean deviation (MD) 20db or worse was noted in 39.5% of eyes at presentation including 47.8% of PACG, 37.3% of POAG, 51% of JOAG, 58% of PXG, and 45% of SIG, suggesting disease severity. Conclusion: At the presentation to a tertiary care center, 40% of all eyes with glaucoma had advanced disease with MD worse than - 20D. PACG and JOAG had the worse disease among primary; among secondary, PXG and SIG had the worse disease at presentation.

Risk Factors for Primary Angle-closure Glaucoma: A Systematic Review and Meta-analysis of 45 Studies.

SIGNIFICANCE: This study summarized primary angle-closure glaucoma (PACG)-related factors across different dimensions. OBJECTIVES: This review aimed at systematically summarizing the associated factors of PACG in published literatures. METHODS: A systematic review and meta-analysis were conducted by searching the electronic databases including PubMed, EMBASE, and Web of Science from their inception to November 2021. The pooled risk estimates of continuous and categorical variables were calculated using weighted mean difference (WMD) and odds ratio (OR; 95% confidence intervals [CIs]), respectively. RESULTS: We included 45 studies in this review. In the meta-analysis, intraocular pressure (WMD, 3.13; 95% CI, 2.37 to 3.89), anterior chamber depth (WMD, -0.52; 95% CI, -0.70 to -0.34), axial length (WMD, -0.77; 95% CI, -1.26 to -0.28), retinal nerve fiber layer (WMD, -21.23; 95% CI, -30.21 to -12.25), and spherical equivalent (WMD, 1.02; 95% CI, 0.66 to 1.38) were the most common ophthalmic anatomic factors, and lower body weight (WMD, -3.65; 95% CI, -6.48 to -0.82) was the most significant general morphological indicators. The presence of cataract (OR, 3.77; 95% CI, 3.46 to 4.11) and hyperlipidemia (OR, 1.10; 95% CI, 1.02 to 1.20) were significantly associated with PACG. Increased level of triglyceride (WMD, 0.17; 95% CI, 0.06 to 0.27) was associated with PACG. In addition, an association between short-term antidepressant exposure (OR, 1.36; 95% CI, 1.08 to 1.70) and acute angle-closure glaucoma was observed. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: This review identified a few consistent factors related to PACG, providing important information for primary care physicians, general ophthalmologists, and public health professionals to counsel their patients on PACG risks.

PACS plus criteria: a retrospective cohort review of 612 consecutive patients treated with bilateral YAG peripheral iridotomies.

INTRODUCTION: With an ageing population and better life expectancy, the prevalence of angle closure disease is expected to increase by 20% per decade. In 2022, the Royal College of Ophthalmologists (RCOphth) issued a guideline on managing angle closure disease. Hospital eye service (HES) referral and prophylactic treatment are recommended only for primary angle closure suspect (PACS) with "Plus" features only. We aimed to examine patients previously treated with YAG peripheral iridotomies (YAG PI) for the presence of "PACS Plus" features. METHODS: A retrospective cohort study of consecutive patients treated with YAG PI between 2015 and 2019 at a tertiary referral NHS eye centre was reviewed. Cases were examined to identify and classify patients into Primary Angle Closure (PAC), PACS, and Primary Angle Closure Glaucoma (PACG). Patients with PACS were studied for "Plus" features. RESULTS: Six hundred twelve patients with gonioscopy-confirmed angle closure (defined as a minimum 180 degrees iridotrabecular contact) treated with YAG PI from years 2015 to 2019 were included in the analysis. The mean age of patients presenting with angle closure disease was 68.5 years (SD 11.3). There were 390 (63.7%) patients with PACS, 102 (16.6%) with PAC and 120 (19.7%) with PACG. Of the PACS patients, 159(40.8%) patients had no "Plus" features. 181 (40.2%) patients had 1 "Plus" feature, 37 (9.5%) had 2 "Plus" features and 13 (3.3%) patients had 3 "Plus" features. CONCLUSION: In our cohort, a considerable proportion (40.8%) of PACS patients treated with YAG PI did not have Plus features and therefore that would not meet the proposed criteria for HES referral and YAG PI. With the proposed guidance, we expect a considerable reduction in HES referrals. Nonetheless, community optometry services should be supported and trained to provide monitoring for patients with PACS not referred to the HES.

The surge of acute angle-closure glaucoma during the outbreak of Omicron in a tertiary hospital in Shanghai.

BACKGROUND: Since December 2022, China has eliminated the compulsory nucleic acid screening, which led to a new pandemic of Omicron. We observed a surge of primary angle-closure glaucoma (PACG) at a largest tertiary hospital in Shanghai. We evaluated the potential relationship between the infection of Omicron and the occurrence of PACG. METHODS: In this retrospective cross-sectional study, we identified 41 patients diagnosed with PACG from 523 individuals registered in ophthalmic emergency from December 2022 to January 2023. We compared the proportion of PACG patients in all the patients registered at the ophthalmic emergency department in the corresponding period (December and January) from 2018 to 2023. RESULTS: The proportion of PACG patients rose to 6.74% and 9.13%, nearly a five-fold increase compared to the previous 1.90%. The proportion of PACG patients throughout 2022 also increased in the recent 2 months. All PACG patients in our center from Dec. 21st 2022 to Jan. 27th 2023 had positive nucleic acid tests at their initial visits. The peak of glaucoma came around Dec. 27th 2022, while the peak of the internal medicine emergency came around Jan. 5th 2023. CONCLUSIONS: The behavior pattern of the infected people and anxiety mood would induce the PACG attack. Some ophthalmic advice should be added to the Chinese treatment guidelines for COVID-19. Also, a shallow anterior chamber and narrow angle need to be ruled out when necessary. Further studies on larger populations are needed to explore the relationship between PACG and Covid.

Glaucoma in rural China (the Rural Epidemiology for Glaucoma in China (REG-China)): a national cross-sectional study.

OBJECTIVE: This study aimed to investigate the prevalence of glaucoma with associated factors in the rural populations of 10 provinces in China. DESIGN: A population-based cross-sectional study. METHODS: All participants aged 6 years or older from 10 provinces completed visual acuity testing, slit-lamp examination, ophthalmoscopy and non-contact tonometry. Glaucoma suspects underwent fundus photography, Goldmann applanation tonometry, visual field testing and gonioscopy. Glaucoma was determined according to the International Society of Geographical and Epidemiological Ophthalmology classification scheme. Associations of demographics and medical factors with glaucoma were assessed using multiple logistic regression models. RESULTS: From June 2017 to October 2018, 48 398 of 52 041 participants were included in the final analyses. The age-standardised prevalence of glaucoma was 1.7% (95% CI 1.55% to 1.78%) among the participants older than 6 years, which was 2.1% (95% CI 1.93% to 2.23%) in participants aged over 40 years. The constituent ratios of glaucoma were: 44.4% primary angle-closure glaucoma (PACG), 34.7% primary open-angle glaucoma, 2.6% congenital glaucoma and 18.3% other types of glaucoma. Increasing age, smoking, cerebral stroke, type 2 diabetes, higher education (college or more) and higher personal income were significant risk factors for PACG. The unilateral and bilateral blindness rates in the entire study population were 4.692% and 1.068%, respectively. A family history of glaucoma was a significant risk factor for the prevalence of glaucoma and blindness in at least one eye. CONCLUSIONS: Rural populations have a high prevalence of glaucoma, which should be included in chronic disease management programmes in China for long-term care.

Prevalence, ethnic differences and risk factors of primary angle-closure glaucoma in a multiethnic Chinese adult population: the Yunnan Minority Eye Study.

PURPOSE: To describe the prevalence and risk factors of primary angle-closure glaucoma (PACG) and to explore nationality difference in Chinese. METHODS: The Yunnan Minority Eye Study was conducted in a rural multiethnic area in Yunnan province and included 6546 participants aged over 50 years. PACG was diagnosed based on International Society of Geographical and Epidemiologic Ophthalmology criteria by experienced ophthalmologists. Multivariate regression modelling was conducted to examine risk factors for PACG. Principal component analyis (PCA) was performed to evaluate the effects of ethnicity on PACG. RESULTS: The overall prevalence of PACG was 0.7% (95% CIs: 0.5% to 0.9%). PCA indicated that ethnicity is significantly related to the presence of PACG (p<0.001) after controlling for other risk factors. In addition, higher PACG prevalence was also correlated with older age (60-69 years group (OR: 3.47; 95% CI: 1.11 to 10.84; p<0.05) and 70-79 years group (OR: 4.71; 95% CI: 1.40 to 15.86; p<0.05) as compared with 50-59 years group), higher intraocular pressures (OR: 1.26; 95% CI: 1.17 to 1.36; p<0.001), shorter axial lengths (OR: 0.42; 95% CI: 0.32 to 0.56; p<0.001) and thinner central corneal thicknesses (OR: 0.89; 95% CI: 0.81 to 0.99; p<0.05). CONCLUSIONS: This multiethnic study on Chinese adults living in the same geographical location indicated that ethnicity is a significant risk factor for PACG. However, there were still some of the effects of ethnic differences on the prevalence of PACG that could not be explained and further studies should take culture and lifestyle factors into account.

Determinants of late presentation of glaucoma in Hong Kong.

BACKGROUND: Glaucoma is the commonest cause of irreversible blindness worldwide. As it is typically asymptomatic until advanced, the risk of blindness from late presentation is higher than other eye diseases. This study aims to investigate the risk factors for late presentation of primary glaucoma patients. METHODS: We undertook a hospital-based case-control study of a random sample of glaucoma patients from a hospital in Hong Kong. Structured questionnaires and existing information from the electronic patient record were used, and the odds of presenting late were analysed by logistic regression. RESULTS: Of 210 recruited participants, 83 (39.5%) presented with advanced glaucoma unilaterally or bilaterally. The mean age of participants was 61.1 ± 11.9 years, with 110 males (52.4%). Univariate analysis revealed that male sex and primary angle-closure glaucoma (PACG) have 3.06 (CI95:1.71-5.48; P < 0.001) and 2.47 (CI95:1.11-5.49; P = 0.03) times higher odds of late presentation, respectively. Multivariate analysis revealed late presenters were 3.54 (CI95:1.35-9.35; P = 0.01) times more likely to have PACG than primary open-angle glaucoma (POAG). Patients with elevated baseline intraocular pressure (IOP) also had 1.06 times higher odds of presenting with advanced glaucoma (CI95:1.02-1.11; P = 0.002). Linear regression revealed that PACG patients present with 7.12 mmHg higher IOP than POAG patients (CI95:4.23-10.0; P < 0.001). CONCLUSION: In conclusion, a high proportion of glaucoma patients present late in Hong Kong, with gender and type of glaucoma being significant determinants. Our study shows that PACG presents with higher IOP and, along with male gender, are more likely to have advanced disease than POAG.

Rates and Patterns of Diagnostic Conversion from Anatomical Narrow Angle to Primary Angle-Closure Glaucoma in the United States.

PURPOSE: To assess rates of diagnostic conversion from anatomical narrow angle (ANA) to primary angle-closure glaucoma (PACG) in the United States and identify factors associated with diagnostic conversion. DESIGN: Retrospective case-control study. PARTICIPANTS: Patients diagnosed with ANA between the years 2007 and 2019 were identified based on International Classification of Diseases (ICD) codes in the Optum Clinformatics Data Mart Database. Inclusion was limited to newly diagnosed ANA, defined as the following: (1) continuous enrollment during a 2-year look back period and 6-year study period from index (first) date of ANA diagnosis; (2) diagnosis by an ophthalmologist or optometrist and record of gonioscopy; and (3) no history of intraocular pressure (IOP)-lowering drops, laser peripheral iridotomy (LPI), or intraocular surgery. METHODS: Cox proportional hazards models were developed to assess factors associated with diagnostic conversion, defined as a change in ICD code from ANA to PACG. MAIN OUTCOME MEASURES: New diagnosis of PACG within the 6-year study period recorded after an index diagnosis of ANA. RESULTS: Among 3985 patients meeting inclusion criteria, 459 (11.52%) had detected diagnostic conversion to PACG within the study period. The conversion rate was stable at 3.54% per year after the first 6 months of ANA diagnosis. In the Cox proportional hazards model, age > 70 years and early (within 6 months of ANA diagnosis) need for LPI or IOP-lowering drops were positively associated with diagnostic conversion (hazard ratio [HR] > 1.59; P < 0.02). Cataract surgery at any time and late (after 6 months of ANA diagnosis) need for IOP-lowering drops appeared protective against diagnostic conversion (HR < 0.46; P < 0.004). CONCLUSIONS: Annual risk of diagnostic conversion from ANA to PACG is relatively low overall; elderly patients are at higher risk whereas patients receiving cataract surgery are at lower risk. The utility of long-term monitoring seems low for most patients with ANA, highlighting the need for improved clinical methods to identify patients at higher risk for PACG. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Prevalence and Ocular Biometric Characteristics of Myopia in Primary Angle Closure Disease in Rural China: The Handan Eye Study.

Purpose: The purpose of this study was to determine the prevalence of myopia among patients with primary angle closure disease (PACD) in rural China and their ocular biometric characteristics. Methods: Study subjects were recruited from the Handan Eye Study. A/B-mode scan (Cine Scan, Quantel Medical, Cedex, France) was used to measure the axial length, anterior chamber depth (ACD), and lens thickness (LT). PACD was defined as the anterior chamber angle being considered closed when 180 degrees or more of the posterior pigmented trabecular meshwork were not visible on the gonioscopy. Myopia was defined as a spherical equivalent (SE) refractive error ≤-0.5 diopter (D). Persons who did not meet PACD definition were classified as the open-angle (OA) group. Results: The overall prevalence of myopia in persons with PACD was 13.7% (11.6% in primary angle closure suspect [PACS], 21.6% in primary angle closure [PAC], 62.5% in primary angle closure glaucoma [PACG]). The age-specific prevalence of myopia in PACD eyes was 41.7% at 30 to 39 years old, 12.3% at 40 to 49 years old, 8.7% at 50 to 59 years old, 10.7% at 60 to 69 years old, and 31.7% at age 70 years and over. PACD had shorter AL (22.2 ± 0.8 vs. 22.9 ± 0.9 mm, P < 0.001), shallower ACD (2.3 ± 0.3 vs. 2.8 ± 0.4 mm, P < 0.001), and greater LT (5.0 ± 0.5 vs. 4.7 ± 0.5 mm, P < 0.001). PACD had even thicker lenses and deeper ACD with age than those with OA (all P ≤ 0.025) from 30 years to 70 years of age and over. Conclusions: Myopia was common among persons with PACD who were less than 40 years of age in this rural Chinese population, and over half of those with PACG were myopic.

Prevalence of Glaucoma and Its Systemic Risk Factors in a General Japanese Population: The Hisayama Study.

Purpose: To estimate the prevalence of glaucoma and its risk factors in a Japanese community. Methods: This study included 3405 Japanese community dwellers who were ≥40 years of age and enrolled in the Hisayama Study. This population-based, cross-sectional study was conducted from 2017 to 2018. A glaucoma screening test was performed using stereo fundus images and swept-source optical coherence tomography. Glaucoma was defined based on the International Society of Geographical and Epidemiological Ophthalmology criteria. Results: The prevalence of glaucoma was 7.6% (95% confidence interval [CI], 6.7-8.6) overall. The prevalence of primary open-angle glaucoma (POAG) was 5.8% (95% CI, 5.0-6.6); that of primary angle-closure glaucoma (PACG) was 0.7% (95% CI, 0.5-1.1); and that of exfoliation glaucoma was 1.1% (95% CI, 0.7-1.4). In addition to aging, lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 1.15; 95% CI, 1.02-1.33), higher intraocular pressure (OR = 1.06; 95% CI, 1.01-1.12), longer axial length (OR = 1.44; 95% CI, 1.31-1.59), and thinner central corneal thickness (CCT) (OR = 1.09; 95% CI, 1.04-1.15) were significant risk factors for POAG. Diabetes (OR = 2.81; 95% CI, 1.19-6.62) was a significant risk factor for PACG, and diabetes (OR = 2.15; 95% CI, 1.03-4.47) and thinner CCT (OR = 1.14; 95% CI, 1.02-1.28) were significant risk factors for exfoliation glaucoma. Conclusions: The prevalence of glaucoma was approximately 8%, probably due to the increase in the Japanese aging population. Not only ocular factors but also lower eGFR for POAG and diabetes for PACG and exfoliation glaucoma were risk factors in a general Japanese population. Translational Relevance: Systemic factors such as eGFR and diabetes must also be considered when implementing preventive measures against glaucoma.

[A meta-analysis on prevalence of primary angle-closure glaucoma in the middle-aged and elderly chinese population].

Objective: To evaluate the prevalence and relevant factors of primary angle-closure glaucoma (PACG) in the middle-aged and elderly (40 years old and above) Chinese population. Methods: Epidemiological literature (of English and/or Chinese language) on prevalence of PACG in China between 2000 and 2022 were retrieved from PubMed, Embase, Web of Science, CNKI, and Wanfang database. Two researchers conducted the process of document retrieval, inclusion, quality assessment and data extraction independently based on inclusion and exclusion criteria. Disagreement was resolved by consensus with a third researcher. The heterogeneity among studies was assessed by using the I2 statistics, and a corresponding model was used for the meta-analysis. Subgroup analysis (gender, age, survey date, place of residence, diagnostic criteria, and temperature zone), as well as sensitivity analysis and publication bias analysis, were conducted. Results: Twenty-three studies were included in this research. Among them, eight were of high-quality and fifteen were of middle-quality. In the past 20 years, the PACG prevalence in middle-aged and elderly (40 years and older) Chinese population was 1.35% (95%CI:1.08% to 1.61%). Chinese women (1.40%) were more likely to have PACG than men (0.96%, P<0.01). The PACG prevalence had a positive correlation with age (P<0.01). The prevalence was similar between urban (1.3%) and rural (1.2%, P=0.61) areas. The PACG prevalence from studies in which the diagnostic criteria of PACG requested the symptom of vision or optic nerve damage (1.1%) was lower than that those without such requirement (1.7%, P<0.01). In mid-temperate zone, the prevalence was higher (1.7%, P=0.02). Conclusions: The PACG prevalence in middle-aged and elderly (40 years old and above) Chinese population was 1.35% in the last 20 years. The prevalence of PACG varies across age, regions, and other variations. This risk is higher in the elderly, women, and people in cold regions among Chinese population.

Association of Drugs With Acute Angle Closure.

Importance: Acute angle-closure (AAC) glaucoma is a sight-threatening disease and can reportedly occur in association with various drugs. Objective: To identify drugs that are associated with AAC glaucoma occurrence and evaluate the risk of AAC associated with each drug. Design, Setting, and Participants: A case-crossover study was conducted using the Health Insurance Review and Assessment Service database, which contains medical information of the entire Korean population. Patients who were first diagnosed with AAC and treated between 2013 and 2019 were identified using diagnostic and procedure codes. All drugs that the study participants were prescribed as well as prescription dates during the period of 1 to 180 days before the onset of AAC were extracted from the database. For each patient, 1 to 30 days before onset was considered the hazard period, and 91 to 180 days before AAC onset was considered the control period. Main Outcomes and Measures: Drugs associated with AAC and odds (calculated as odds ratios [ORs] with 95% CIs) of AAC development associated with each identified drug. Results: A total of 949 drugs that were prescribed to 13 531 patients with AAC (mean [SD] age, 66.8 [10.6] years; 9585 [70.8%] female) during the period of 1 to 180 days before the onset of AAC were analyzed. A total of 61 drugs were found to be associated with AAC, among which sumatriptan (OR, 12.60 [95% CI, 4.13-38.44]) was associated with the highest odds of AAC development, followed by topiramate (OR, 5.10 [95% CI, 2.22-11.70]) and duloxetine (OR, 4.04 [95% CI, 2.95-5.54]). The median (IQR) period from prescription of the drug to the onset of AAC for the 61 drugs was 11.9 days (10.9-12.8). A number of drugs not previously considered to be associated with AAC, including lactulose (OR, 2.81 [95% CI, 1.72-4.61]) and metoclopramide (OR, 2.52 [95% CI, 1.95-3.25]), were identified. Conclusions and Relevance: Results of this case-crossover study suggest a need to consider AAC risk in patients taking any of the 61 drugs found to be associated with AAC.

[Contribution of Optical Coherence Tomography in the evaluation of the iridocorneal angle in Cameroon]. / Apport de la tomographie en cohérence optique dans l'évaluation de l'angle irido-cornéen du camerounais.

INTRODUCTION: Our work was aimed at determining the sensitivity and specificity of anterior segment OCT (AS-OCT) in the evaluation of the iridocorneal angle (ICA) in Cameroon. METHODOLOGY: We conducted a cross-sectional, analytical study from January 2 to June 30, 2019 in Yaoundé. One hundred and twenty five patients over 35 years of age underwent three-mirror manual glass gonioscopy and AS-OCT. The angle was defined as occludable on manual gonioscopy if the posterior trabecular meshwork, was not visible and on OCT if there was contact between the iris root and the posterior surface of the peripheral cornea. Quantitative parameters (angle opening distance, angle recess area, and trabecular-iris space area) in the nasal and temporal quadrants were recorded for the analysis. RESULTS: Men accounted for 56.20% of the 96 patients selected (192 eyes). The mean age was 54.78±10 years. The prevalence of occludable angles was 18.75% (18/96 patients) and 28.125% (27/96 patients) on manual and automated gonioscopy respectively. Schaeffer-Etienne grades ≤ 2 were identified in 43/192 (21.94%) nasal quadrants and 33/192 (19.18%) temporal quadrants. The area under the curve (AUC) was maximal for the 500 µm goniometric parameters (> 0.8). An Angle Opening Distance ≤ 333.50 µm was found in 52/192 nasal quadrants (27.10%) and 53/192 (27.60%) temporal. The sensitivity and specificity of AS-OCT in the detection of occludable angles at 500 µm, were 62.8% and 83.2% respectively in the nasal quadrant, and 66.7% and 80.5% respectively in the temporal quadrant. There was a positive correlation between goniometric parameters on AS-OCT and gonioscopy (P=0.01). CONCLUSION: Given its higher specificity, AS-OCT should be a supplemental examination in the analysis of an angle which appears closed on manual gonioscopy.

Association between retinitis pigmentosa and an increased risk of primary angle closure glaucoma: A population-based cohort study.

BACKGROUND: Retinitis pigmentosa (RP) is the most frequent retinal hereditary dystrophy and result in blindness if progresses. Several case reports have revealed the possible association between RP and primary angle-closure glaucoma (PACG). We conducted a population-based study to explore whether RP significantly increased the risk of PACG development. METHODS: Using the Taiwan National Health Insurance Research Database, we enrolled patients with RP into the RP group from 2001 to 2013 and included a comparison group of 1:4 age- and sex-matched individuals without RP. We performed a Cox regression analysis to estimate the crude and adjusted hazard ratios (HRs) of RP for PACG after adjustment for hypertension, diabetes, hyperlipidaemia, chronic kidney disease, and lens subluxation. RESULTS: We enrolled 6223 subjects with RP and 24892 subjects for comparison. The mean age of the cohort was 49.0 ± 18.1 years. The RP group had significantly higher percentages of diabetes mellitus, hypertension, and hyperlipidaemia. The cumulative incidence of PACG in patients with RP was 1.61%, which was significantly higher than that in the comparison group (0.81%, p < 0.0001). According to the univariate Cox regression analysis, the hazard of PACG development was significantly greater in the RP group, with an unadjusted HR of 2.09 (95% confidence interval [CI], 1.64-2.65). The increased risk persisted after adjusting for confounders (adjusted HR = 2.18; 95% CI, 1.76-2.72). CONCLUSION: This nationwide population-based cohort study showed that people with RP are at a significantly greater risk of developing PACG than individuals without RP.