Acute Angle Closure Crisis Preventable With Better Exam Emphasis

Close-up of a man undergoing an eye examination. During thispart of the exam, a gonio lens is being applied to the eye. Gonioscopy allows the practitioner to examine the structure of the angle, a part of the eye where the iris meets the co rnea. This procedure is vital in the detection and management of glaucoma.
Among patients who underwent a comprehensive eye exam 2 years before a diagnosis of AACC, most did not receive gonioscopy evaluation, study shows.

Preventative gonioscopy exams can help clinicians diagnose anatomic narrow angles and potentially avert acute angle-closure crisis (AACC), a population-based retrospective cohort study published in JAMA Ophthalmology shows. The research identifies multiple opportunities for intervention to AACC.

Data for this study were sourced from the Medicare Parts A and B fee-for-service database. The research took into account 1179 patients (mean age 66.7±11.8 years, 65.0% women, 67.1% White) who received an AACC diagnosis between 2001 and 2015 and underwent laser peripheral iridotomy, cataract extraction, or incision glaucoma surgery within 1 week of the diagnosis. Patients with open-angle glaucoma (OAG) or suspected OAG accounted for 39.4% of the participants, and 35.1% had received 1 or more medications associated with AACC risk.

Among patients with 1 or more eye care visits in the preceding 2 years before AACC (n=796), 33.2% received gonioscopy. Diagnosis of an atomic narrow angle was more common among patients who received gonioscopy (42.8% vs 12.0%).

Among the cohort of patients who had an eye care visit and received gonioscopy (n=264), the visits occurred 1 day (1.9%), 2 to 7 days (15.2%), 1 to 4 weeks (34.5%), 1 to 6 months (23.9%), 6 to 12 months (6.8%), and 1 to 2 years (17.8%) prior to AACC.

During the 2-year lookback period, a total of 66 patients (5.6%) were evaluated by anterior segment optical coherence tomography or ultrasonographic biomicroscopy.

This study was limited by the lack of access to clinical information, such as best-corrected visual acuity, intraocular pressure, and gonioscopic findings.

“There appear to have been multiple opportunities for interventions that may have averted crisis. Addressing risk factors associated with the underuse of eye care, coupled with the increased use of gonioscopy to identify patients with eyes at risk and the performance of prophylactic LPI when indicated, is a step in the right direction for preventing patients from developing AACC,” according to investigators. 

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosure


Wu AM, Stein JD, Shah M. Potentially missed opportunities in prevention of acute angle-closure crisis. JAMA Ophthalmol. Published online May, 12 2022. doi:10.1001/jamaophthalmol.2022.1231