Primary Angle-closure Glaucoma: An Update for Optometrists

of individuals with European ancestry.2 Recent estimates suggest that PACG affects about 1.6 million people in Europe and 581,000 people of European descent in the US.2 Among patients of African descent, PACG prevalence is lower, but the severity is often worse.3 As the global population expands and ages, the number of individuals affected by PACG is expected to reach 23 million by 2020 and 32 million by 2040.4 The disease can have significant morbidity: about 25% of patients with PACG are blind in both eyes, a higher rate than is associated with primary open-angle forms of glaucoma.5 Gonioscopy, the most important diagnostic tool for assessing PACG risk, is vastly underused, resulting in a great many cases of PACG going undetected or being misdiagnosed as open-angle glaucoma. In a chart review of patients in treatment for primary open-angle glaucoma (POAG) in a communitybased setting, only half had undergone gonioscopy to rule out a narrow angle at their initial visit.6 This is unfortunate, since every undetected narrow angle is a missed opportunity to potentially treat the underlying glaucoma cause. Optometrists see a large number of patients with glaucoma, many who have not yet undergone baseline gonioscopy and may have undetected angle closure. Optometrists play a vital role to identify patients with narrow angles, refer to specialists in a timely manner, manage acute episodes of angle closure, and co-manage patients with established chronic angle closure (see Box, “Optometrists’ Role...”).