Day, AC; (2013) Primary Angle Closure: Epidemiology and Ocular Biometric Associations in European Populations. Doctoral thesis (PhD), UCL (University College London).

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Abstract

Aims: To describe the epidemiology, biometric characteristics and risk factors for primary angle closure disease (PAC & PACG) in European people. Methods: 1.Systematic reviews of PACG prevalence and acute angle closure (AAC) incidence studies; with prevalence modelling, and incidence trend analysis. 2.Analyses of EAGLE study data to investigate for differences in presenting characteristics by diagnosis , ethnicity and PACG severity. 3.Quantification of risk factors associated with PAC/ PACG by case-control analysis using EAGLE, EPIC-Norfolk and Liwan Eye Study data. 4.Genotype-phenotype correlation study of SNPs recently associated with PACG, and ocular biometry in participants of the EPIC-Norfolk Eye Study. 5.Investigation into the epidemiology and characteristics of EPIC-Norfolk participants with nanophthalmos: the “angle closure phenotype.” Results: 1.PAGC prevalence was estimated as 0.4% in those ≥40 years old. AAC incidence appears to be reducing, equivalent to halving over the past decade. 2.EAGLE participants with PACG were older, had longer axial length (AL) and thinner CCT than those with PAC. Chinese ethnicity was associated with a shallower anterior chamber depth (ACD), less hyperopia and thinner CCT. PACG severity was associated with IOP, ACD and Chinese ethnicity. 3.The odds of PAC/ PACG were 33 times and 15 times higher per 1mm shallower ACD for non-Chinese andChinese people respectively. For each 1mm less AL, the odds of PAC/ PACG were 2.7and 1.8 times higher for non-Chinese and Chinese respectively . 4.PACG risk locus, rs1015213, may exert at least part of its effect through an association with ACD in European populations. 5.There is no standardized definition for nanophthalmos. Small eyes were more common than expected and associated with visual impairment. Conclusions: PACG appears to have been historically under-recognised in populations of European descent. This series of work provides a basis for future angle closure disease risk models.

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