Racial, Demographic Factors Can Affect Narrow Angle Detection

Optometrist examining patient's eyes - wearing face mask
Optometrist examining patient’s eyes – wearing face mask
Patients who are Black, men, or older than 80 were less likely to have been diagnosed with anatomically narrow angles prior to developing primary angle closure glaucoma, a study shows.

Most Americans with primary angle closure glaucoma (PACG) are not previously diagnosed with anatomical narrow angles (ANA); however, certain sociodemographic factors make it even less likely ANA will be identified, according to the results of a study published in Ophthalmology Glaucoma. The research shows that patients who are Black, men, or are older than 80 years, are at the highest risk of late detection. Patients who reside in the Southern or Pacific regions of the United States are also at elevated risk (P <.001)

Researchers reviewed the cases of 31,044 eligible participants. The proportion of PACG cases without a prior ANA diagnosis was 75.2% overall. However, the proportion was higher for men (78.2%) than it was for women (73.4%). This was also the case for patients who are Black (79.3%) compared with those who are non-Hispanic White (75.0%), Asian (73.3%), or Hispanic (72.1%).

Across demographic groups, patients between the ages of 70 and 79 years had a late detection in 73.34% of cases, while those older than 80 had a proportion of 78.95%, despite the fact that advanced age is a known risk factor for PACG. “This highlights the importance of routine eyecare in aging populations and prompt removal of cataracts when clinically indicated,” investigators suggest.

Researchers also speculate that the high rates of PACG without a prior ANA diagnosis across all groups could be due to treatment protocols in the US, where most high-risk cases of ANA are detected and treated before the development of high intraocular pressure and glaucomatous optic neuropathy

Gonioscopy before PACG diagnosis was strongly correlated with a decreased risk of late detection. 

Limitations of the study include broad definitions of ANA and PACG, which may not concur with epidemiologic definitions, as well as an inability to compensate for ophthalmologist-per-capita density when assessing regional data. This latter step could have helped explain the regional differences in the proportion of PACG without previous ANA diagnosis.

“There is an urgent need to develop more accessible tools for detecting patients at risk for PACG. However, as most patients with angle closure on gonioscopy are at low risk of developing PACG, there is also a need to develop more precise methods to identify high-risk individuals,” according to the report.


Apolo G, Bohner A, Pardeshi A, et al. Racial and sociodemographic disparities in the detection of narrow angles prior to primary angle closure glaucoma in the United States. Ophthalmol Glaucoma. Published online on January 24, 2022. doi:10.1016/j.ogla.2022.01.001