Clear lens extraction is not necessarily right for every patient, but surgeons should have this discussion with their primary angle closure (PAC) or primary angle-closure glaucoma (PACG) patients.
Reviewed by Paul J. Harasymowycz, MD
A three-year follow-up to the landmark EAGLE study in patients with primary angle closure confirms initial findings that primary lens extraction produces better clinical outcomes and better quality of life compared with standard care with laser peripheral iridotomy plus topical medical treatment.
Clear lens extraction is more cost-effective than primary iridotomy and should be considered as an option for first-line treatment, said Paul J. Harasymowycz, MD.
“Based on the evidence, one should not jump straight to iridotomy when a patient presents with narrow angles,” said Dr. Harasymowycz, chief of glaucoma, University of Montreal, and director, Montreal Glaucoma Institute.
“Clear lens extraction is not necessarily right for every patient, but ophthalmologists should be having this discussion about clear lens extraction with their primary angle closure (PAC) or primary angle-closure glaucoma (PACG) patients.”
Dr. Haraymowycz discussed the three-year, follow-up analysis of EAGLE patients. The initial study, published in The Lancet in 2016, concluded that clear lens extraction was both more effective than primary laser iridotomy and more cost effective. Follow-up analysis focusing on long-term visual acuity was published in The British Journal of Ophthalmology in 2018.
The findings that favor clear lens extraction follow World Glaucoma Association angleclosure staging criteria that divide angle closure into three categories:
- Primary angle closure suspect, (PACS), with 180° of appositional closure;
- Primary angle closure (PAC) with peripheral anterior synechiae (PAS) or high IOP shows trabecular meshwork dysfunction; and
- Primary angle-closure glaucoma (PACG), shows signs of structural of functional glaucoma damage.
The EAGLE trial randomly assigned 419 PAC and PACG patients with an IOP of 30 mm Hg or higher to either clear lens extraction or standard care. Of the group, 155 patients had PAC and 263 had PACG. None of the patients had existing cataracts and all were age 50 and older.
Paul J. Haraymowycz, MD
P: 514/781-0483 E: [email protected]
This article was adapted from Dr. Haraymowycz’s presentation during Glaucoma Subspecialty Day at the 2018 meeting of the American Academy of Ophthalmology. He is a speaker/consultant with Aerie Pharmaceuticals, Alcon Laboratories, Allergan, Bausch + Lomb, Glaukos, Ivantis, Johnson & Johnson Vision, and Novartis.