Long-term Outcomes in Fellow Eyes after Acute Primary Angle Closure in the Contralateral Eye

David S Friedman, Paul T K Chew, Gus Gazzard, Leonard P K Ang, Yoke Fong Lai, Harry A Quigley, Steve K L Seah, Tin Aung

Research output: Contribution to journalArticle

Abstract

Purpose: To determine the long-term outcome of the contralateral eye in Asian persons with a unilateral attack of acute primary angle closure (APAC). Design: Cross-sectional observational case series. Participants: Seventy-nine individuals who were examined from 4 to 10 years after a unilateral episode of APAC at 2 Singapore hospitals. Methods: All subjects underwent a complete eye examination. The optic discs were graded clinically and photographically for the presence of glaucomatous optic neuropathy, and automated visual field tests were assessed for damage. All visual fields and optic nerve photographs (when available) underwent a second evaluation by a masked glaucoma specialist, who assessed whether the changes were compatible with glaucoma. Main Outcome Measures: Glaucomatous optic neuropathy, intraocular pressure (IOP), and visual impairment (defined as best-corrected visual acuity of worse than 6/12). Results: Ninety of 138 eligible patients (65.2%) with APAC were examined, 79 with unilateral attacks. Subjects were predominantly Chinese (n = 68; 86%). There were 54 females (68%), and mean age was 68.5±8.9 years (standard deviation) at the time of APAC, with a mean duration of 6.3±1.5 years from the time of the APAC episode to the study examination. The contralateral eyes of 7 patients (8.9%) had definite or probable glaucoma, 2 of whom were felt to have glaucoma in that eye at the time of the attack. Three eyes had markedly cupped optic discs (cup-to-disc ratio ≥ 0.9). Thirteen eyes (16.9%) had best-corrected vision worse than 6/12, due to cataract in almost half the cases. Only 1 eye had vision <6/60, the cause of which was corneal decompensation. One other patient had only a central island remaining with vision of 6/12. Mean IOP of the study participants was 15.7±4.7 mmHg, with 6 subjects (7.6%) having undergone trabeculectomy. Conclusions: Definite or probable glaucoma was present at the time of diagnosis in 2 (2.5%) fellow eyes and developed in an additional 5 (6.5%) with a mean follow-up of 6 years. More than 80% of this cohort retained good vision in the contralateral eye, in contrast to the eye that underwent APAC. Unoperated cataract accounted for most of the visual impairment in this group.

Original languageEnglish (US)
Pages (from-to)1087-1091
Number of pages5
JournalOphthalmology
Volume113
Issue number7
DOIs
StatePublished - Jul 2006

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Glaucoma
Optic Nerve Diseases
Vision Disorders
Optic Disk
Intraocular Pressure
Cataract
Visual Field Tests
Trabeculectomy
Singapore
Optic Nerve
Visual Fields
Islands
Visual Acuity
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Long-term Outcomes in Fellow Eyes after Acute Primary Angle Closure in the Contralateral Eye. / Friedman, David S; Chew, Paul T K; Gazzard, Gus; Ang, Leonard P K; Lai, Yoke Fong; Quigley, Harry A; Seah, Steve K L; Aung, Tin.

In: Ophthalmology, Vol. 113, No. 7, 07.2006, p. 1087-1091.

Research output: Contribution to journalArticle

Friedman, David S ; Chew, Paul T K ; Gazzard, Gus ; Ang, Leonard P K ; Lai, Yoke Fong ; Quigley, Harry A ; Seah, Steve K L ; Aung, Tin. / Long-term Outcomes in Fellow Eyes after Acute Primary Angle Closure in the Contralateral Eye. In: Ophthalmology. 2006 ; Vol. 113, No. 7. pp. 1087-1091.
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abstract = "Purpose: To determine the long-term outcome of the contralateral eye in Asian persons with a unilateral attack of acute primary angle closure (APAC). Design: Cross-sectional observational case series. Participants: Seventy-nine individuals who were examined from 4 to 10 years after a unilateral episode of APAC at 2 Singapore hospitals. Methods: All subjects underwent a complete eye examination. The optic discs were graded clinically and photographically for the presence of glaucomatous optic neuropathy, and automated visual field tests were assessed for damage. All visual fields and optic nerve photographs (when available) underwent a second evaluation by a masked glaucoma specialist, who assessed whether the changes were compatible with glaucoma. Main Outcome Measures: Glaucomatous optic neuropathy, intraocular pressure (IOP), and visual impairment (defined as best-corrected visual acuity of worse than 6/12). Results: Ninety of 138 eligible patients (65.2{\%}) with APAC were examined, 79 with unilateral attacks. Subjects were predominantly Chinese (n = 68; 86{\%}). There were 54 females (68{\%}), and mean age was 68.5±8.9 years (standard deviation) at the time of APAC, with a mean duration of 6.3±1.5 years from the time of the APAC episode to the study examination. The contralateral eyes of 7 patients (8.9{\%}) had definite or probable glaucoma, 2 of whom were felt to have glaucoma in that eye at the time of the attack. Three eyes had markedly cupped optic discs (cup-to-disc ratio ≥ 0.9). Thirteen eyes (16.9{\%}) had best-corrected vision worse than 6/12, due to cataract in almost half the cases. Only 1 eye had vision <6/60, the cause of which was corneal decompensation. One other patient had only a central island remaining with vision of 6/12. Mean IOP of the study participants was 15.7±4.7 mmHg, with 6 subjects (7.6{\%}) having undergone trabeculectomy. Conclusions: Definite or probable glaucoma was present at the time of diagnosis in 2 (2.5{\%}) fellow eyes and developed in an additional 5 (6.5{\%}) with a mean follow-up of 6 years. More than 80{\%} of this cohort retained good vision in the contralateral eye, in contrast to the eye that underwent APAC. Unoperated cataract accounted for most of the visual impairment in this group.",
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AU - Chew, Paul T K

AU - Gazzard, Gus

AU - Ang, Leonard P K

AU - Lai, Yoke Fong

AU - Quigley, Harry A

AU - Seah, Steve K L

AU - Aung, Tin

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N2 - Purpose: To determine the long-term outcome of the contralateral eye in Asian persons with a unilateral attack of acute primary angle closure (APAC). Design: Cross-sectional observational case series. Participants: Seventy-nine individuals who were examined from 4 to 10 years after a unilateral episode of APAC at 2 Singapore hospitals. Methods: All subjects underwent a complete eye examination. The optic discs were graded clinically and photographically for the presence of glaucomatous optic neuropathy, and automated visual field tests were assessed for damage. All visual fields and optic nerve photographs (when available) underwent a second evaluation by a masked glaucoma specialist, who assessed whether the changes were compatible with glaucoma. Main Outcome Measures: Glaucomatous optic neuropathy, intraocular pressure (IOP), and visual impairment (defined as best-corrected visual acuity of worse than 6/12). Results: Ninety of 138 eligible patients (65.2%) with APAC were examined, 79 with unilateral attacks. Subjects were predominantly Chinese (n = 68; 86%). There were 54 females (68%), and mean age was 68.5±8.9 years (standard deviation) at the time of APAC, with a mean duration of 6.3±1.5 years from the time of the APAC episode to the study examination. The contralateral eyes of 7 patients (8.9%) had definite or probable glaucoma, 2 of whom were felt to have glaucoma in that eye at the time of the attack. Three eyes had markedly cupped optic discs (cup-to-disc ratio ≥ 0.9). Thirteen eyes (16.9%) had best-corrected vision worse than 6/12, due to cataract in almost half the cases. Only 1 eye had vision <6/60, the cause of which was corneal decompensation. One other patient had only a central island remaining with vision of 6/12. Mean IOP of the study participants was 15.7±4.7 mmHg, with 6 subjects (7.6%) having undergone trabeculectomy. Conclusions: Definite or probable glaucoma was present at the time of diagnosis in 2 (2.5%) fellow eyes and developed in an additional 5 (6.5%) with a mean follow-up of 6 years. More than 80% of this cohort retained good vision in the contralateral eye, in contrast to the eye that underwent APAC. Unoperated cataract accounted for most of the visual impairment in this group.

AB - Purpose: To determine the long-term outcome of the contralateral eye in Asian persons with a unilateral attack of acute primary angle closure (APAC). Design: Cross-sectional observational case series. Participants: Seventy-nine individuals who were examined from 4 to 10 years after a unilateral episode of APAC at 2 Singapore hospitals. Methods: All subjects underwent a complete eye examination. The optic discs were graded clinically and photographically for the presence of glaucomatous optic neuropathy, and automated visual field tests were assessed for damage. All visual fields and optic nerve photographs (when available) underwent a second evaluation by a masked glaucoma specialist, who assessed whether the changes were compatible with glaucoma. Main Outcome Measures: Glaucomatous optic neuropathy, intraocular pressure (IOP), and visual impairment (defined as best-corrected visual acuity of worse than 6/12). Results: Ninety of 138 eligible patients (65.2%) with APAC were examined, 79 with unilateral attacks. Subjects were predominantly Chinese (n = 68; 86%). There were 54 females (68%), and mean age was 68.5±8.9 years (standard deviation) at the time of APAC, with a mean duration of 6.3±1.5 years from the time of the APAC episode to the study examination. The contralateral eyes of 7 patients (8.9%) had definite or probable glaucoma, 2 of whom were felt to have glaucoma in that eye at the time of the attack. Three eyes had markedly cupped optic discs (cup-to-disc ratio ≥ 0.9). Thirteen eyes (16.9%) had best-corrected vision worse than 6/12, due to cataract in almost half the cases. Only 1 eye had vision <6/60, the cause of which was corneal decompensation. One other patient had only a central island remaining with vision of 6/12. Mean IOP of the study participants was 15.7±4.7 mmHg, with 6 subjects (7.6%) having undergone trabeculectomy. Conclusions: Definite or probable glaucoma was present at the time of diagnosis in 2 (2.5%) fellow eyes and developed in an additional 5 (6.5%) with a mean follow-up of 6 years. More than 80% of this cohort retained good vision in the contralateral eye, in contrast to the eye that underwent APAC. Unoperated cataract accounted for most of the visual impairment in this group.

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