Two Decades of Angle-Closure Glaucoma Research

Abstract

Primary angle-closure disease (PACD) remains a significant cause of visual morbidity globally, particularly in Asia, where >18.5 million will have primary angle-closure glaucoma (PACG) by 2050. Although glaucomatous optic neuropathy is the most widely recognized cause of visual loss, PACD significantly impacts a range of anterior and posterior segment structures and physiological processes, such as corneal endothelial cell loss, trabecular meshwork structural changes and functional derangement, lens opacities, iris ischemia causing a dilated pupil and consequent degradation in vision, retinal vein occlusions, rapidly evolving pressure-related retinal ischemia, and increased surgical morbidity including aqueous misdirection and zonulopathy. In many cases, the management of the condition will draw on cornea, cataract, refractive, glaucoma, medical, and surgical retina expertise and techniques. Collaboration between the authors and their research networks has led to a series of seminal studies that have redefined the management of angle-closure, with a reduction in the scope of prophylactic laser iridotomy for asymptomatic angle-closure and the emergence of clear lens extraction as the central therapeutic intervention in PACD. Demographic and ocular risk factors are well documented, and the understanding of the molecular genetic mechanisms influencing the risk of PACD is advancing rapidly, offering the prospect of more individualized risk stratification in the near future through the use of polygenic risk scores. These offer clinicians a range of potent tools to deliver improved outcomes for their patients with and persons at risk for PACD.

Financial Disclosure(s)

The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.