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Original Investigation
February 9, 2017

Association of Baseline Anterior Segment Parameters With the Development of Incident Gonioscopic Angle Closure

Author Affiliations
  • 1Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
  • 2Duke-NUS Medical School, Singapore
  • 3Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
  • 4ICARE Eye Hospital and Post Graduate Institute, NCR, India
  • 5Federal University of Parana, Curitiba, Brazil
  • 6Xiamen Eye Center, Xiamen University, Xiamen, China
  • 7Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland
  • 8Yong Loo Lin School of Medicine, National University of Singapore
JAMA Ophthalmol. Published online February 9, 2017. doi:10.1001/jamaophthalmol.2016.5847
Key Points

Question  What quantitative anterior segment optical coherence tomography imaging parameters are associated with the development of incident gonioscopic angle closure at 4-year follow-up in eyes with gonioscopically open angles at baseline?

Findings  In this community-based observational study, a smaller angle opening distance at 750 µm and a larger lens vault were associated with development of incident gonioscopic angle closure at four year follow-up. These findings were statistically significant.

Meaning  Anterior segment optical coherence tomography imaging parameters may be associated with the development of future incident gonioscopic angle closure. Angle opening distance 750 µm and lens vault measurements may serve as effective screening tools to identify eyes at risk of angle-closure glaucoma prior to the onset of a clinically significant disease.

Abstract

Importance  Baseline anterior segment imaging parameters associated with incident gonioscopic angle closure, to our knowledge, are unknown.

Objective  To identify baseline quantitative anterior segment optical coherence tomography parameters associated with the development of incident gonioscopic angle closure after 4 years among participants with gonioscopically open angles at baseline.

Design, Setting, and Participants  Three hundred forty-two participants aged 50 years or older were recruited to participate in this prospective, community-based observational study. Participants underwent gonioscopy and anterior segment optical coherence tomography imaging at baseline and after 4 years. Custom image analysis software was used to quantify anterior chamber parameters from anterior segment optical coherence tomography images.

Main Outcomes and Measures  Baseline anterior segment optical coherence tomography measurements among participants with gonioscopically open vs closed angles at follow-up.

Results  Of the 342 participants, 187 (55%) were women and 297 (87%) were Chinese. The response rate was 62.4%. Forty-nine participants (14.3%) developed gonioscopic angle closure after 4 years. The mean age (SD) at baseline of the 49 participants was 62.9 (8.0) years, 15 (30.6%) were men, and 43 (87.8%) were Chinese. These participants had a smaller baseline angle opening distance at 750 µm (AOD750) (0.15 mm; 95% CI, 0.12-0.18), trabecular iris surface area at 750 µm (0.07 mm2; 95% CI, 0.05-0.08), anterior chamber area (30 mm2; 95% CI, 2.27-3.74), and anterior chamber volume (24.32 mm2; 95% CI, 18.20-30.44) (all P < .001). Baseline iris curvature (-0.08; 95% CI, -0.12 to -0.04) and lens vault (LV) measurements (-0.29 mm; 95% CI, -0.37 to -0.21) were larger among these participants ( all P < .001). A model consisting of the LV and AOD750 measurements explained 38% of the variance in gonioscopic angle closure occurring at 4 years, with LV accounting for 28% of this variance. For every 0.1 mm increase in LV and 0.1 mm decrease in AOD750, the odds of developing gonioscopic angle closure was 1.29 (95% CI 1.07-1.57) and 3.27 (95% CI 1.87-5.69), respectively. In terms of per SD change in LV and AOD750, this translates to an odds ratio of 2.14 (95% CI, 2.48-12.34) and 5.53 (95% CI, 1.22-3.77), respectively. A baseline LV cut-off value of >0.56 mm had 64.6% sensitivity and 84.0% specificity for identifying participants who developed angle closure.

Conclusions and Relevance  These findings suggest that smaller AOD750 and larger LV measurements are associated with the development of incident gonioscopic angle closure after 4 years among participants with gonioscopically open angles at baseline.

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