Baseline predictors can forecast long-term risk and progression in PACS

A recent cohort study suggests that higher intraocular pressure (IOP), shallower central and limbal anterior chamber depths (ACDs), and smaller trabecular-iris space area (TISA) at 500 μm and light-room angle recess area (ARA) at 750 μm may serve as baseline predictors for the 14-year risk of progression to primary angle closure (PAC) in primary angle closure suspect (PACS) eyes. Evaluating these factors can aid in customizing PACS management, according to researchers.

Proper management is essential for PACS eyes at risk of angle closure. However, the risk of progression and its prediction are understudied. A recent cohort study of data from the Zhongshan Angle Closure Prevention trial included 377 PACS eyes (377 participants). The mean patient age at baseline was 58.28 years with 317 females. Logistic regression models that included baseline IOP and central and limbal ACDs had moderate performance in predicting 14-year risk of progression from PACS to PAC. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, IOP > 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up.

At the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP, shallower central ACD, and shallower limbal ACD at baseline were associated with an increased 14-year risk of progression from PACS to PAC. Considering AS-OCT measurements, smaller light-room TISA at 500 μm from the scleral spur, smaller light-room angle recess area (ARA) at 750 μm from the scleral spur, and smaller dark-room TISA at 500 μm at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model’s performance.

Reference
Yuan Y, Xiong R, Wang W, et al. Long-term risk and prediction of progression in primary angle closure suspect. JAMA Ophthalmol. Published online January 18, 2024. doi:10.1001/jamaophthalmol.2023.5286