Page 16 - 21st Century Perspective - Glaucoma Supplement
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The Risks of Undetected Narrow-Angle Glaucoma
Most cases of glaucoma are straightforward, but a large subset of patients develop narrow-angle
glaucoma (Figure 9). These patients tend to be older, hyperopic women with Asian ancestry,
particularly that of Chinese. Screening for this less common expression of glaucomatous optic
neuropathy by expert slit lamp examination is critical. If the angles appear to be Van Herick grade 1
or lower, then gonioscopy should be performed. If the angles are judged to be potentially occludable,
then either laser photoiridotomy must be performed, or clear lens extraction must be considered. For
patients older than 50 years of age with significant hyperopia, the latter would be the preferred
option, as this would provide enhanced visual function and eliminate the risk for angle-closure. For
doctors who have anterior segment OCT technology available, this could either replace gonioscopy
or be adjunctive. Gonioscopy is real-time viewing of in vivo tissues and further allows for quantifying
the degree of angle pigmentation. An image of angles judged to be occludable is seen in Figure 10.
There is a hint of plateau configuration as well.
Figure 9. An eye in acute angle-closure; note the mid-dilated, out-of-round pupil.
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