Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease.

Aparna Rao,Sarada Sarangi,Debananda Padhy,Gopinath Das,Sanjoy Bhattacharya

doi:10.1371/journal.pone.0160209

Abstract

PurposeTo evaluate the angle closure scoring system (ACSS) for stratifying primary angle course disease.MethodsThis observational cross sectional institutional study included patients with primary open angle glaucoma suspects (n = 21) and primary angle closure disease (primary angle closure, PAC, n = 63 and primary angle course glaucoma, PACG, n = 58 (defined by International society of Geographical and Epidemiological Ophthalmology, ISGEO). Two independent examiners blinded to clinical details, graded good quality pre-laser goniophotographs of the patients incorporating quadrants of peripheral anterior synechieae (PAS), non-visibility of posterior trabecular meshwork (PTM) and blotchy pigments (ranging from 1–4 quadrants), iris configuration, angle recess (sum of above depicting ACSSg) and lens thickness/axial length ratio (LT/AL), cup disc ratio and baseline intraocular pressure (IOP) to give total score (ACSSt).ResultThere were significant differences in ACSSg scores within the same ISGEO stage of PAC and PACG between eyes that required nil or >1medicines after laser iridotomy, p<0.001. The ACSSg was associated with need for >1 medicines in both PAC and PACG eyes, p<0.001. An ACSSg score>12 and 14 in PAC (odds ratio = 2.7(95% CI-1.7–5.9) and PACG (Odds ratio = 1.6(95%CI-1.19–2.2) predicted need for single medicines while ACSSg scores >14 and 19 predicted need for ≥2 medicines in PAC and PACG eyes, respectively. The LT/Al ratio, IOP score or cup disc score did not influence the need for medical treatment independently.ConclusionThe ACSS can be a useful clinical adjunct to the ISGEO system to predict need for medicines and prognosticate each stage more accurately.

Highlights

Angle closure disease is a matrix of disease comprising of several stages proceeding from normal to gradual loss of optic nerve function.The biennial congress of the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) group proposed a generalised classification system wherein the former stages without optic nerve dysfunction were termed as primary angle closure suspects (PACS) or primary angle closure (PAC), while those with established optic neuropathy, were termed as primary angle closure glaucoma (PACG).[1,2]
It is known that roughly 1/3rd of PACS progress to PAC and roughly a 1/3rd of PAC eyes progress to PACG over long term follow up.[7,8,9]
Of 693 PAC and 1097 PACG seen during the period, 232 glaucoma patients with good quality goniophotographs, capturing clearly discernible details of all angle structures using a thin small beam with no light falling on the pupil, were obtained from hospital diagnostic database

Summary

Introduction

Angle closure disease is a matrix of disease comprising of several stages proceeding from normal (yet potentially prone to damage) to gradual loss of optic nerve function.The biennial congress of the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) group proposed a generalised classification system wherein the former stages without optic nerve dysfunction were termed as primary angle closure suspects (PACS) or primary angle closure (PAC), while those with established optic neuropathy, were termed as primary angle closure glaucoma (PACG).[1,2] This classification has gained worldwide acceptance owing to its applicability across epidemiological surveys It falls short in various ways while prognosticating the disease based on this classification, which identifies only three stages, includes eyes with acute angle closure attacks into PAC eyes.[3,4,5] Our earlier study identified that roughly 1/3rd of PAC eyes require medical treatment after laser peripheral iridotomy, LPI and roughly 1/3rd of these require surgery for IOP control over long term follow up.[6] It is known that roughly 1/3rd of PACS progress to PAC and roughly a 1/3rd of PAC eyes progress to PACG over long term follow up.[7,8,9]. This study evaluated the applicability of this scoring system in clinical use while incorporating anterior segment biometric parameters in angle closure disease

Methods

Results

Conclusion