Journal of Current Glaucoma Practice

Register      Login

VOLUME 17 , ISSUE 1 ( January-March, 2023 ) > List of Articles


Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese

FP Neoh, Y Azhany, AH Siti Azrin, AT Liza-Sharmini

Keywords : Angle-closure glaucoma, Angle measurement, Anterior chamber angle

Citation Information : Neoh F, Azhany Y, Azrin AS, Liza-Sharmini A. Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese. J Curr Glaucoma Pract 2023; 17 (1):3-8.

DOI: 10.5005/jp-journals-10078-1391

License: CC BY-NC 4.0

Published Online: 13-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Objective: To compare anterior segment biometry parameters in progress and non-progress primary angle closure glaucoma (PACG) among Malay and Chinese patients. Materials and methods: A cross-sectional study was conducted between November 2015 and December 2016 involving 75 patients with PACG (43 Malays and 32 Chinese) who were recruited from a single glaucoma center in Malaysia. Ocular examination included anterior segment biometry measurements on the selected eye. Axial length (AL) and anterior chamber depth (ACD) measurement was done using a noncontact partial coherence interferometer (IOL Master, Carl Zeiss, Germany). Anterior chamber angle (ACA) was measured by Anterior Segment-OCT (Spectralis Heidelberg, Germany). Humphrey visual field (HVF) 24-2 analysis of the same eye was conducted and compared with the HVF when diagnosis was made. Progression of PACG patients was assessed according to the Hodapp, Parrish and Anderson's (HPA) classification, they were then divided into progress and non-progress groups. Comparison of anterior segment biometry parameters between Malay and Chinese PACG patients with and without progression was analyzed using independent T test. Multivariate ANOVA analysis was used to compare the anterior segment parameters between progress and non-progress PACG patients, with adjustment for age, gender, lens status, family history and presence of diabetes mellitus. Results: Chinese PACG patients have significant shorter AL (22.18 mm ± 0.76) and narrower ACA (11.96° ± 6.00) compared to Malay PACG patients. Among the progress group, Chinese PACG patients have significant shorter AL, shallower ACD and narrower ACA compared to Malays. However, after controlling for confounding factors, there was significant difference in ACA between Malay and Chinese PACG. There was also no significant difference of ocular biometry measurement between Chinese and Malay patients in progress and non-progress group. Conclusion: There was racial influence in ocular biometry measurement in PACG patients. Chinese have significant narrower ACA compared to Malays. Serial AS-OCT monitoring is important in management of PACG.

PDF Share
  1. European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol 2014;101:1–72. DOI: 10.1136/bjophthalmol-2016-EGSguideline.003
  2. He M, Foster PJ, Ge J, et al. Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan District, Guangzhou. Invest Ophthalmol Vis Sci 2006;47(7):2782–2788. DOI: 10.1167/iovs.06-0051
  3. Sawaguchi S, Sakai H, Iwase A, et al. Prevalence of primary angle closure and primary angle-closure glaucoma in a southwestern rural population of Japan: the Kumejima Study. Ophthalmol 2012;119(6):1134–1142. DOI: 10.1016/j.ophtha.2011.12.038
  4. Foster PJ, Baasanhu J, Alsbirk PH, et al. Glaucoma in Mongolia. A population-based survey in Hövsgöl province, Northern Mongolia. Arch Ophthalmol 1996;114(10):1235–1241. DOI: 10.1001/archopht.1996.01100140435011
  5. Bourne R, Sukudom P, Foster P, et al. Prevalence of glaucoma in Thailand: a population based survey in Rom Klao District, Bangkok. Br J Ophthalmol 2003;87(9):1069–1074. DOI: 10.1136/bjo.87.9.1069
  6. Thapa SS, Paudyal I, Khanal S, et al. A population-based survey of the prevalence and types of glaucoma in Nepal: the Bhaktapur glaucoma study. Ophthalmol 2012;119(4):759–764. DOI: 10.1016/j.ophtha.2011.10.021
  7. Foster PJ, Devereux JG, Alsbirk PH, et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol 2000;84(2): 186–192. DOI: 10.1136/bjo.84.2.186
  8. Shen SY, Wong TY, Foster PJ, et al. The prevalence and types of glaucoma in Malay people: the Singapore Malay eye study. Investi Ophthalmol Vis Sci 2008;49(9):3846–3851. DOI: 10.1167/iovs.08-1759
  9. Liza-Sharmini AT, Ng GF, Nor-Sharina Y, et al. Clinical presentation, severity and progression of primary angle closure in Malay and Chinese patients. Med J Malaysia 2014;69(6):245–251. PMID: 25934953.
  10. Liza-Sharmini AT, Yin NY, Lee SS, et al. Mean target intraocular pressure and progression rates in chronic angle-closure glaucoma. J Ocul Pharmacol Ther 2009;25(1):71–76. DOI: 10.1089/jop.2008.0061
  11. Liza-Sharmini AT, Sharina YN, Dolaboladi AJ, et al. Clinical presentation, severity and progression of primary angle closure in Malays. Med J Malaysia 2014;69(1):21–26. PMID: 24814624.
  12. Quek DTL, Koh VT, Tan GS, et al. Blindness and long-term progression of visual field defects in Chinese patients with primary angle-closure glaucoma. Am J Ophthalmol 2011;152(3):463–469. DOI: 10.1016/j.ajo.2011.02.023
  13. Cheng JW, Zong Y, Zeng YY, et al. The prevalence of primary angle closure glaucoma in adult Asians: a systematic review and meta-analysis. PloS One 2014;9(7):e103222. DOI: 10.1371/journal.pone.0103222
  14. Vithana EN, Khor CC, Qiao C, et al. Genome-wide association analyses identify three new susceptibility loci for primary angle closure glaucoma. Nat Genet 2012;44(10):1142–1146. DOI: 10.1038/ng.2390
  15. Foster PJ. The epidemiology of primary angle closure and associated glaucomatous optic neuropathy. Semin Ophthalmol 2002;17(2):50–58. DOI: 10.1076/soph.
  16. 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 Ophthalmol 1970;54(3):161–169. DOI: 10.1136/bjo.54.3.161
  17. Seah SK, Foster PJ, Chew PT, et al. Incidence of acute primary angle-closure glaucoma in Singapore. An island-wide survey. Arch Ophthalmol 1997;115(11):1436–1440. DOI: 10.1001/archopht.1997.01100160606014
  18. Sherpa D, Badhu BP. Association between axial length of the eye and primary angle closure glaucoma. Kathmandu Univ Med J 2008;6(3):361–363. DOI: 10.3126/kumj.v6i3.1712
  19. Wong TY, Foster PJ, Seah SK, et al. Rates of hospital admissions for primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore. Br J Ophthalmol 2000;84(9):990–992. DOI: 10.1136/bjo.84.9.990
  20. Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002;86(2):238–242. DOI: 10.1136/bjo.86.2.238
  21. Foster PJ, Oen FT, Machin D, et al. The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol 2000;118(8):1105–1111. DOI: 10.1001/archopht.118.8.1105
  22. Thapa SS, Paudyal I, Khanal S, et al. Comparison of axial lengths in occludable angle and angle-closure glaucoma—the Bhaktapur glaucoma study. Optome Visi Sci 2011;88(1):150–154. DOI: 10.1097/OPX.0b013e318205e320
  23. Choi JS, Kim YY. Relationship between the extent of peripheral anterior synechiae and the severity of visual field defects in primary angle-closure glaucoma. Korean J Ophthalmol 2004;18(2):100–105. DOI: 10.3341/kjo.2004.18.2.100
  24. Sharon Y, Friling R, Luski M, et al. Uveitic glaucoma: long-term clinical outcome and risk factors for progression. Ocul Immunol Inflamm 2016;25(6):740–747. DOI: 10.1080/09273948.2016.1255341
  25. Hall AB, Thompson JR, Deane JS, et al. LOCS III versus the oxford clinical cataract classification and grading system for the assessment of nuclear, cortical and posterior subcapsular cataract. Ophthalmic Epidemiol 1997;4(4):179–194. DOI: 10.3109/09286589709059192
  26. Bonomi L, Marchini G, Marraffa M, et al. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology 2000;107(7):1287–1293. DOI: 10.1016/s0161-6420(00)00138-x
  27. Dandona L, Dandona R, Mandal P, et al. Angle-closure glaucoma in an urban population in Southern India: the Andhra Pradesh eye disease study. Ophthalmol 2000;107(9):1710–1716. DOI: 10.1016/s0161-6420(00)00274-8
  28. Lavanya R, Wong TY, Friedman DS, et al. Determinants of angle closure in older Singaporeans. Arch Ophthalmol 2008;126(5):686–691. DOI: 10.1001/archopht.126.5.686
  29. Lowe RF. Causes of shallow anterior chamber in primary angle-closure glaucoma. Ultrasonic biometry of normal and angle-closure glaucoma eyes. Am J Ophthalmol 1969;67(1):87–93. DOI: 10.1016/0002-9394(69)90012-9
  30. Lowe RF. Primary angle closure glaucoma: a review of ocular biometry. Aus J Opthalmol 1977;5(1):9–17. DOI: 10.1111/j.1442-9071.1977.tb01728.x
  31. Nongpiur ME, He M, Amerasinghe N, et al. Lens vault, thickness, and position in Chinese subjects with angle closure. Ophthalmol 2011;118(3):474–479. DOI: 10.1016/j.ophtha.2010.07.025
  32. Saito Y, Ohmi G, Kinoshita S, et al. Transient hyperopia with lens swelling at initial therapy in diabetes. Br J Ophthalmol 1993;77(3):145–148. DOI: 10.1136/bjo.77.3.145
  33. Sonmez B, Bozkurt B, Atmaca A, et al. Effect of glycemic control on refractive changes in diabetic patients with hyperglycemia. Cornea 2005;24(5):531–537. DOI: 10.1097/01.ico.0000151545.00489.12
  34. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomized controlled trial. The Lancet 2016;388(10052):1389–1397. DOI: 10.13039/501100012617
  35. Congdon N, Wang F, Tielsch JM. Issues in the epidemiology and population-based screening of primary angle-closure glaucoma. Surv Ophthalmol 1992;36(6):411–423. DOI: 10.1016/s0039-6257(05)80022-0
  36. Congdon NG, Youlin Q, Quigley H, et al. Biometry and primary angle-closure glaucoma among Chinese, white, and black populations. Ophthalmol 1997;104(9):1489–1495. DOI: 10.1016/s0161-6420(97)30112-2
  37. Nolan WP, Aung T, Machin D, et al. Detection of narrow angles and established angle closure in Chinese residents of Singapore: potential screening tests. Am J Ophthalmol 2006;141(5):896–901. DOI: 10.1016/j.ajo.2005.12.008
  38. Friedman DS. (2008). Novel approaches to assessing the anterior chamber angle to determine risk factors for angle closure glaucoma: The Johns Hopkins University.
  39. Leung CK, Palmiero P, Weinreb R, et al. Comparisons of anterior segment biometry between Chinese and Caucasians using anterior segment optical coherence tomography. Br J Ophthalmol 2010;94(9):1184–1189. DOI: 10.1136/bjo.2009.167296
  40. Radhakrishnan S, Goldsmith J, Huang D, et al. Comparison of optical coherence tomography and ultrasound biomicroscopy for detection of narrow anterior chamber angles. Arch Ophthalmol 2005;123(8):1053–1059. DOI: 10.1001/archopht.123.8
  41. Bhargava SK, Leighton DA, Phillips CI. Early angle-closure glaucoma: distribution of iridotrabecular contact and response to pilocarpine. Arch Ophthalmol 1973;89(5):369–372. DOI: 10.1001/archopht.1973.01000040371003
  42. Mishima K, Tomidokoro A, Suramethakul P, et al. Iridotrabecular contact observed using anterior segment three-dimensional oct in eyes with a shallow peripheral anterior chamber. Invest Ophthalmol Vis Sci 2013;54(7):4628–4635. DOI: 10.1167/iovs.12-11230
  43. Fan NW, Hwang DK, Ko YC, et al. Risk factors for progressive visual field loss in primary angle-closure glaucoma: a retrospective cohort study. PloS One 2013;8(7):e69772. DOI: 10.1371/journal.pone.0069772
  44. Loewen NA, Liu JH, Weinreb RN. Increased 24-hour variation of human intraocular pressure with short axial length. Invest Ophthalmol Vis Sci 2010;51(2):933–937. DOI: 10.1167/iovs.09-4218
  45. Wilson LB, Quinn GE, Ying GS, et al. The relation of axial length and intraocular pressure fluctuations in human eyes. Invest Ophthalmol Vis Sci 2006;47(5):1778–1784. DOI: 10.1167/iovs.05-0869
  46. Agarwal R, Gupta SK, Agarwal P, et al. Current concepts in the pathophysiology of glaucoma. Indian J Ophthalmol 2009;57(4):257–266. DOI: 10.4103/0301-4738.53049
  47. Downs JC, Roberts MD, Burgoyne, CF. The mechanical environment of the optic nerve head in glaucoma. Optom Vis Sci 2008;85(6):425–435. DOI: 10.1097/OPX.0b013e31817841cb
  48. Baskaran M, Kumar RS, Govindasamy CV, et al. Diurnal intraocular pressure fluctuation and associated risk factors in eyes with angle closure. Ophthalmol 2009;116(12):2300–2304. DOI: 10.1016/j.ophtha.2009.06.010
  49. Sihota R, Lakshmaiah NC, Walia KB, et al. The trabecular meshwork in acute and chronic angle closure glaucoma. Indian J Ophthalmol 2001;49(4):255–259. PMID: 12930118.
  50. Hashemi H, KhabazKhoob M, Mehravaran S, et al. The distribution of anterior chamber depth in a Tehran population: the Tehran eye study. Ophthalmic Physiol Opt 2009;29(4):436–442. DOI: 10.1111/j.1475-1313.2009.00647.x
  51. He M, Huang W, Zheng Y, et al. Anterior chamber depth in elderly Chinese: the Liwan eye study. Ophthalmology 2008;115(8):1286–1290. DOI: 10.1016/j.ophtha.2007.12.003
  52. Salmon JF, Mermoud A, Ivey A, et al. The prevalence of primary angle closure glaucoma and open angle glaucoma in Mamre, Western Cape, South Africa. Arch Ophthalmol 1993;111(9):1263–1269. DOI: 10.1001/archopht.1993.01090090115029
  53. Xu L, Cao WF, Wang YX, et al. Anterior chamber depth and chamber angle and their associations with ocular and general parameters: the Beijing eye study. Am J Ophthalmol 2008;145(5):929–936. DOI: 10.1016/j.ajo.2008.01.004
  54. Hu CN. An epidemiologic study of glaucoma in Shunyi County, Beijing. Zhonghua yan ke za zhi 1989;25(2):115–119. PMID: 2507254.
  55. Luntz MH. Primary angle-closure glaucoma in urbanized South African caucasoid and negroid communities. Br J Ophthalmol 1973;57(7):445–456. DOI: 10.1136/bjo.57.7.445
  56. Salmon JF. Primary angle-closure glaucoma in Cape people of mixed ethnic background with special emphasis on chronic angle-closure glaucoma. 1993
  57. Wong T, Foster PJ, Ng TP, et al. Variations in ocular biometry in an adult Chinese population in Singapore: the Tanjong Pagar survey. Invest Ophthalmol Vis Sci 2001;42(1):73–80. PMID: 11133850.
  58. Wang N, Wu H, Fan Z. Primary angle closure glaucoma in Chinese and Western populations. Chin Med J 2002;115(11):1706–1715. PMID: 12609093.
  59. Susanna R Jr, Vessani RM. Staging glaucoma patient: why and how? Open Ophthalmol J 2009;3(2):59–64. DOI: 10.2174/1874364100903020059
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.