Angle Closure SIG
May 30, 2019

Angle Closure SIG

SIG Corner Editor: João Barbosa Breda

Chair: John Thygesen
Co-chair: Gus Gazzard

1. Goals and Activities of the SIG The Angle Closure SIG promotes study and research into the epidemiology, pathophysiology, diagnosis, and treatment of Primary Angle Closure Disease and the education of clinicians across Europe through the running of courses and instruction.

2. Provide a relevant breakthrough in the field

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial.
Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, Scotland G, Javanbakht M, Cochrane C, Norrie J; EAGLE study group. Lancet. 2016 Oct 1;388(10052):1389-1397. doi: 10.1016/S0140-6736(16)30956-4

Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial.
He M, Jiang Y, Huang S, Chang DS, Munoz B, Aung T, Foster PJ, Friedman DS. Lancet. 2019 Apr 20;393(10181):1609-1618. doi: 10.1016/S0140-6736(18)32607-2.

Two major landmark trials from the last few years, both published in The Lancet, are likely to have an impact on angle closure management: the Effectiveness in Angle-closure Glaucoma of Lens Extraction (EAGLE) trial and the Zhongshan Angle Closure Prevention (ZAP) Trial. EAGLE found that primary lens extraction – for newly diagnosed established chronic primary angle closure glaucoma or high-pressure angle closure without glaucoma – led to a greater quality of life score with lens extraction instead of the traditional approach of ‘laser iridotomy first, then drops later if needed’.
In contrast, ZAP looked at the mildest form of angle closure – suspects – in Chinese patients. One eye had prophylactic peripheral iridotomy (PI) and the other eye was the control. While there was a significant benefit over 6 years, this was so modest that the researchers suggest that that the intervention was not worthwhile in these low risk cases who had normal IOP, no peripheral anterior synechiae and no glaucoma. Whether this finding is transferrable to a European population, with low risk PIs, remains to be seen.

The search for EGS goal of “Paving the Way to Better Glaucoma Care” continues together with Outcome and other EGS Committees as well as SIGs, i.e. how to promote the best possible well-being and minimal glaucoma-induced visual disability in individuals with glaucoma within affordable healthcare systems. The views expressed are those of the author(s) and are not necessarily those of the EGS.