Close follow-up vital to patients with acute attack ofprimary-angle closure

Patients with acute attack of primary-angle closure (APAC) need much closer follow-up, since it may result in severe vision loss in the affected eye in a substantial number of patients, said David Friedman, MD, MPH, associate professor at the Wilmer Eye Institute, Baltimore. He added, though, that the risk of vision problems is low in the contralateral eyes.

Dr. Friedman and colleagues studied the natural history of APAC in Singapore, re-examining charts from an island-wide registry and also looking at patients diagnosed with APAC at a hospital. They ultimately located and examined 90 patients. Their mean age at the time of the attack was 62; 68% were female; and 87% of the study population was Chinese.

"Acute attack can result in severe vision loss in a substantial proportion of individuals," Dr. Friedman said. "About 10% of these eyes are blind with glaucoma and many more with low vision and blindness from cataract. Contralateral eyes in comparison do quite well. Some had glaucoma at presentation, but fewer than 10% had or required trabeculectomy to control eye pressure."

The main cause of decreased vision in the contralateral eyes was unoperated cataract; one patient had corneal decompensation.

An estimated 100,000 cases per year occur in China, but this could triple by 2050 as a large cohort of the population ages, Dr. Friedman said. The condition is rare in individuals under the age of 40.