Proportion of Undetected Narrow Angles or Angle Closure in Cataract Surgery Referrals
To identify the proportion of patients referred for cataract surgery consultation that had undetected narrow angles (primary angle closure suspect (PACS)), primary angle closure (PAC), or primary angle closure glaucoma (PACG).
Phakic patients referred by eye care providers (optometrists and ophthalmologists) for assessment and management of cataracts only between July 1, 2010 and June 30, 2012 were retrospectively identified and reviewed. Patients with pre-existing diagnoses of glaucoma, angle closure, angle closure glaucoma, or with a history of peripheral iridotomy or other glaucoma laser procedures were excluded. Demographic, referral, and specialist assessment information, as well as biometric data, including anterior segment OCT, were collected. In referrals that did not report on glaucoma or angle status, these parameters were assumed to be found normal or missed by the referring doctor.
976 patients were included. Mean age was 67.0 +/- 13.2 years. 52.6% of patients were female, and 47.4% were male. Of the sample population, the proportion of underlying PACS was 9.4%, PAC was 0.5%, and PACG was 0.2%. Overall, 10.1% of patients had missed narrow angles or angle closure. Mean anterior chamber depth was 3.16 +/- 0.47 mm versus 2.64 +/- 0.48 mm (p<0.001) in patients with open versus narrow angles or angle closure, respectively. Mean axial length was 24.04 +/- 1.80 mm versus 22.89 +/- 1.21 mm (p<0.001) in patients with open versus narrow angles or angle closure, respectively.
A significant number of patients referred for cataract surgery were found to have undetected narrow angles or angle closure. These results imply that gonioscopy may not be adequately performed in this patient population, and possibly in general.