Differences in Screening Indicator Performance for Primary Angle Closure and Primary Angle Closure Diseases: The Handan Eye Study.

OBJECTIVE

Primary angle closure disease (PACD) has long been the focus of screening, yet most cases are nonprogressive. In contrast, primary angle closure with or without glaucoma (PAC/G) poses greater risk and may deserve more attention. We aimed to compare screening indicator profiles for PACD and PAC/G, highlighting potential differences that may inform a shift in screening priorities.

DESIGN

A population-based cross-sectional study.

PARTICIPANTS

Adults aged ≥35 years who completed standardized eye examinations. Only right eyes were analyzed; eyes with prior laser peripheral iridotomy were excluded.

METHODS

Participants underwent gonioscopy, anterior-segment OCT (AS-OCT), and A-scan ultrasound biometry. Univariable logistic regression and multivariable elastic-net models assessed the association and discriminative performance of AS-OCT parameters for detecting PACD and PAC/G.

MAIN OUTCOME MEASURES

Odds ratios (ORs) and area under the receiver operator characteristic curve (AUROC) values of AS-OCT parameters for detecting PACD and PAC/G.

RESULTS

Of the 4546 eyes analyzed, 3831 had open angles and 715 had PACD, of which 53 had PAC/G. In the univariable logistic regression analysis, the angle opening distance (AOD) at 250 μm (AOD250) and the trabecular-iris space area (TISA) at 500 μm (TISA500) were more strongly associated with PAC/G than with PACD (< 0.05, Wald test), whereas AOD500/750 and TISA750 were not significantly different in association. Additionally, TISA750 exhibited the highest AUROC value (0.88) for detecting PACD, whereas TISA500 had the highest AUROC value (0.91) for detecting PAC/G. Higher iris curvature was significantly associated with increased odds of PACD (OR: 1250.26; 95% confidence interval [CI]: 234.52-2265.99) but not with PAC/G (< 0.05, Wald test). In the multivariable models for detecting PAC/G, a profile characterized by lower iris curvature (OR: 0.06; 95%

CI

0.05-0.08), narrower angle width (AOD500, TISA500, and TISA750), smaller anterior chamber area and volume, and smaller pupil diameter achieved an AUROC of 0.908 (95%

CI

0.858-0.959).

CONCLUSIONS

Angle parameters closer to the scleral spur were underestimated, and curved irises were overestimated when screening for PAC/G versus PACD. Anterior-segment OCT-derived models for PAC/G screening have shown promising feasibility in population-based settings.

FINANCIAL DISCLOSURES

The authors have no proprietary or commercial interest in any materials discussed in this article.