Ophthalmological Examination and Imaging Features that Better Predict Risk of Angle Closure in Siblings

Objective

Characteristics of individuals with angle closure may be useful in targeted screening of family members. Here, we assess if findings gathered during examination and imaging of patients with a known angle-closure diagnosis (probands) could better determine the risk of angle closure in the patients’ siblings.

Design

Cross-sectional study of patients with known angle closure and their siblings.

Participants

South Indian patients (probands) 30 years and older with open angles, primary angle-closure suspect (PACS), or primary angle closure/primary angle-closure glaucoma (PAC/PACG) and a biological sibling age 30 years or older (n = 292 proband/sibling pairs).

Methods

Demographic data, relevant ocular history, and a comprehensive ophthalmic examination with anterior segment OCT (AS-OCT) were obtained. Three clinically relevant models were created to analyze the contribution of specific proband factors in predicting sibling angle-closure diagnosis, using demographic (age, sex), ocular examination (gonioscopy, optic nerve examination, visual acuity, intraocular pressure), and AS-OCT features to improve prediction beyond proband diagnosis alone evaluated by log likelihood ratio testing and statistical comparison of receiver operating characteristics (ROCs).

Main Outcome Measures

Sibling angle-closure diagnostic accuracy.

Results

Demographic and ocular examination metrics did not improve the prediction of sibling angle closure for all 3 outcomes (sibling diagnosis: (1) PACS/PAC/PACG vs. OA, (2) PAC/PACG vs. PACS/OA, and (3) PAC/PACG vs. PACS), adding no model improvement when compared to diagnosis alone. Models adding AS-OCT metrics to the prior model including proband diagnosis, demographics, and ocular examination measures led to significantly improved prediction of 2 of the 3 angle-closure outcomes. Specifically, improvement was noted via likelihood ratio testing for prediction of PAC/PACG vs. PACS/OA (P = 0.01) or PAC/PACG vs. PACS (P = 0.001). For all 3 angle-closure outcomes, ROC comparisons demonstrated significant improvement in area under the curve (AUC) between the 3 models predicting sibling outcomes, demonstrating an increase in AUC with each successive nested model across all 3 sibling angle-closure outcomes.

Conclusions

Structural features of eyes with angle closure may assist in stratifying the risk of angle closure in patients’ siblings. Further studies should consider evaluating this approach to achieve more targeted screenings.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.