Imaging Studies

Spectral-domain optical coherence tomography

In patients with glaucoma, analysis of serial retinal nerve fiber layer thickness (RNFL) maps generated with spectral-domain optical coherence tomography (OCT) can aid in the detection of RNFL progression.^[13]

Other Tests

Intraocular pressure (IOP) assessment

Goldmann applanation tonometry remains the gold standard for IOP assessment.

The accuracy of the measurement may be affected by the central corneal thickness, so the measurement of the corneal thickness (usually via ultrasound pachymetry) is important.

Gonioscopy

Static and dynamic (indentation) gonioscopy is used to evaluate and document the extent, the nature (appositional versus synechial), and the cause of the angle closure.

Optic nerve head and RNFL assessments

Qualitative: Slit-lamp biomicroscopy examination using noncontact lenses (eg, 90-D lens) or contact lenses (eg, central lens in Goldmann 3-mirror lens); green filter (red-free light) may aid in the identification of RNFL thinning; fundus photography for documentation (stereoscopic or nonstereoscopic)

Quantitative: GDx VCC nerve fiber analyzer; Heidelberg retinal tomography (HRT); OCT

Visual fields ^[43]

Threshold testing by automated perimetry

Special programs, such as SWAP, may help identify early visual field losses.

Further investigations to delineate the mechanism of angle closure

Ultrasound biomicroscopy examination^{[44, 45]}

Anterior segment OCT (AS-OCT)^[46]

Histologic Findings

Peripheral anterior synechiae (PAS) across chamber angle, pigment deposition in trabecular meshwork

Staging

There is no formal staging for primary angle-closure glaucoma (PACG), but grading systems (eg, Shaffer, Spaeth) exist to allow a more objective documentation of the openness of the drainage angle.

Treatment & Management

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Author

Clement Chee-yung Tham, MBBCh, MA, FRCS(Glasg) SH Ho Professor of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Honorary Chief-of-Service, Hong Kong Eye Hospital; Secretary General, Asia-Pacific Academy of Ophthalmology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Consultancy: Alcon Laboratories Inc; Allergan, Inc; Bausch & Lomb; IOPtima Ltd.; Merck & Co Inc; Pfrizer Inc; Santen Pharmaceutical Co Ltd; Sensimed;C-MER Eye Care Holdings Ltd<br/>Serve(d) as a speaker or a member of a speakers bureau for: Lectures Fees: Alcon Laboratories Inc; Merck & Co Inc, Pfizer Inc; Santen Pharmaceutical Co, Ltd.<br/>Received research grant from: Aeon Astron Corporation; Alcon Laboratories Inc; AMO Asia Ltd; Icare Finland; Pfizer Inc; Santen Pharmaceutical Co Ltd; Sensimed; <br/>Travel Support for: Alcon Laboratories Inc; Allergan Inc; Merck & Co Inc; Pfizer Inc; Santen Pharmaceutical Co Ltd.

Coauthor(s)

Noel C Y Chan, MBChB, FRCSEd, FCOphth(HK), FHKAM(Ophth) Consultant Ophthalmologist, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital; Honorary Clinical Assistant Professor, Department of Ophthalmology and Visual Sciences, Honorary Clinical Assistant Professor, Clinical Skills Learning Center, The Chinese University of Hong Kong, China

Disclosure: Nothing to disclose.

Robert Ritch, MD, FACS, FARVO Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, Professor of Ophthalmology, Surgeon Director Emeritus, New York Eye and Ear Infirmary of Mount Sinai

Robert Ritch, MD, FACS, FARVO is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Received none from Sensimed for board membership; Received none from iSonic Medical for board membership; Received consulting fee from Aeon Astron for consulting; Received honoraria from Pfizer for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Ministry of Health of Kuwait for speaking and teaching; Received honoraria from Aeon Astron for speaking and teaching; Received royalty from Ocular Instruments for other.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew I Rabinowitz, MD Director of Glaucoma Service, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, American Society for Laser Medicine and Surgery, American Academy of Ophthalmology, American Medical Association

Disclosure: Nothing to disclose.