Primary Angle Closure Suspect Guidance May Require Screening Changes

Primary angle closure suspect guidance, issued by the Royal College of Ophthalmologists, does not recommend prophylactic treatment or referral for treatment for individuals with the disorder who do not have additional risk factors, according to a study published in Eye. Since these individuals may not receive active treatment, community optometric services may need to assume monitoring duties, according to the report.

Researchers conducted a retrospective cohort study that included patients (N=612; mean age, 68.5 years) who were previously treated with yttrium aluminum garnet peripheral iridotomy (YAG PI) between 2015 and 2019. The team stratified participants according to angle closure status and determined the existence of additional risk factors, which include the existence of only 1 functioning eye, individuals who may not report ocular symptoms, a family history of significant angle closure disease, high hypermetropia (>+6.00 diopters [D]), pathologic conditions requiring regular pupil dilation, anticholinergic medication use, and living in a remote location.

Stratified according to angle closure status, 390 (63.7%) patients were primary angle closure suspects, 102 (16.6%) had primary angle closure and 120 (19.7%) had primary angle closure glaucoma. Among participants who were primary angle closure suspects, 159 (40.8%) did not have any of the above-mentioned additional risk factors, 181 (40.2%) had 1 additional risk factor, and 19.7% had 2 or more additional risk factors.

Since a considerable number of participants who were primary angle closure suspects did not have any of the additional risk factors, the report suggests that decreases in referrals and prophylactic treatments may increase a need for community screening and monitoring among these individuals.

“The new guidelines will transform the management of [primary angle closure suspects],
reducing [hospital eye service] referrals for prophylactic YAG PI and consequently [increase] the demand for community screening,” the study authors explain. “It is imperative that community awareness, community optometry training in gonioscopy and accessibility to community screening is optimized to support the change in practice as a result of the new guidance.”

Study limitations include a retrospective nature and single center design.