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Outcomes of newly referred patients with suspected angle closure: do we need to redefine the clinical pathways?

Eye volume 38, pages 514–519 (2024)Cite this article

Subjects

Abstract

Background/objectives

To investigate outcomes of referrals for suspected angle closure and explore whether anterior segment optical coherence tomography (AS-OCT) can be used to tighten triaging criteria in a glaucoma virtual clinic.

Subjects/methods

Retrospectively collected data. The first audit (04/2018-03/2019) identified referrals for suspected angle closure without other glaucoma-related findings (primary angle closure suspect (PACS) referrals). All patients underwent gonioscopy. The second audit (04-08/2019) identified patients with suspected angle closure in a virtual clinic. Management outcomes were assessed, using gonioscopy as reference standard. The outcomes of the second audit were re-audited after changing the triaging criterion from angle width <10° to iridotrabecular contact (ITC) in ≥1 quadrants on AS-OCT.

Results

Out of 1754 glaucoma referrals (first audit), 24.6% (431/1754) were PACS referrals. Of these, only 10.7% (42/393) had an occludable angle on gonioscopy, with 97.6% (41/42) being PACS. Of these, 78% (32/41) underwent laser peripheral iridotomy. Out of 137 referrals in the virtual clinic (second audit), 66.4% (91/137) were triaged to the face-to-face clinic. Of these, 31.9% (29/91) were discharged. AS-OCT had positive and negative predictive value of 74.3% (95% confidence intervals (CI) 57.8–86.0) and 82.1% (95% CI 70.0–90.2%), respectively, in detecting ITC in ≥1 quadrants. In the re-audit 45.9% (45/98) of those with suspected angle closure were triaged for gonioscopy, with 24.4% (11/45) of them being discharged.

Conclusion

PACS referrals represent a substantial burden to hospital-based services and their accuracy is low. ITC in ≥1 quadrants on AS-OCT can be useful in triaging those who need further evaluation with gonioscopy.

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Fig. 1: Clinical audits on the outcomes of glaucoma referrals with suspected angle closure (Glaucoma Service, Moorfields Eye Hospital, London, UK).

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK

    Panayiota Founti, Akshay Narayan, Aneela Raja, Neil Nathwani, Sergio Bordajandi Tur, Rachel Thomas, Andrew Scott, Alessandra Martins & Winifred Nolan

  2. School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panayiota Founti

  3. Save Sight Institute, Discipline of Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia

    Alessandra Martins

  4. National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Moorfields and UCL Institute of Ophthalmology, London, UK

    Winifred Nolan

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Contributions

Design of the study: PF, WN. Data acquisition: AN, AR, NN, SBT. Data analysis: PF, WN, AN, AR, NN, SBT. Interpretation of data: PF, AN, AR, NN, SBT, RT, AS, AM, WN. Drafting the work: PF, WN. Revising the work critically for important intellectual content: PF, AN, AR, NN, SBT, RT, AS, AM, WN Final approval of the version to be published: PF, AN, AR, NN, SBT, RT, AS, AM, WN. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: PF, AN, AR, NN, SBT, RT, AS, AM, WN.

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Correspondence to Panayiota Founti.

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Competing interests

PF and WN received honorarium from Thea. The authors declare no competing financial interests in relation to the work described.

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Founti, P., Narayan, A., Raja, A. et al. Outcomes of newly referred patients with suspected angle closure: do we need to redefine the clinical pathways?. Eye 38, 514–519 (2024). https://doi.org/10.1038/s41433-023-02713-7

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