Singapore National Eye Centre, Singapore, Singapore Eye Research Institute, Singapore.
Singapore National Eye Centre, Singapore, Singapore Eye Research Institute, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Ophthalmology. 2022 Jul;129(7):792-802. doi: 10.1016/j.ophtha.2022.03.009. Epub 2022 Mar 16.
To determine the incidence and risk factors of primary angle-closure disease (PACD) over 6 years in a multi-ethnic Asian population.
Population-based, longitudinal study.
The Singapore Epidemiology of Eye Diseases study is a population-based cohort study conducted among adults aged 40 years or more. The baseline examination was conducted between 2004 and 2010, and the 6-year follow-up visit was conducted between 2011 and 2017. Of 6762 participants who attended the follow-up examination, 5298 at risk for primary angle-closure glaucoma (PACG) and 5060 at risk for PACD were included for analyses.
Standardized examinations including slit-lamp biomicroscopy, indentation gonioscopy, intraocular pressure (IOP) measurement, and static automated perimetry were performed. In this study, PACD includes primary angle-closure suspect (PACS), primary angle-closure (PAC), and PACG.
The 6-year PACD incidence was evaluated among an at-risk population excluding adults with baseline glaucoma, PACS, PAC, pseudophakia at baseline or follow-up, or laser peripheral iridotomy or iridectomy at baseline visit. Logistic regression analysis adjusting for age, gender, and ethnicity was performed to evaluate associations between PACD development and demographic or ocular characteristics. Forward selection based on the Quasi-likelihood Information Criterion was used in multivariable analysis to reduce potential multicollinearity.
The 6-year age-adjusted PACD incidence was 3.50% (95% confidence interval [CI], 2.94-4.16). In multivariable analysis, increasing age per decade (odds ratio [OR], 1.35; 95% CI, 1.15-1.59), higher IOP (OR, 1.04; 95% CI, 1.00-1.08), and shallower anterior chamber depth (OR, 1.11; 95% CI, 1.08-1.14) at baseline were associated with higher odds of PACD, whereas late posterior subcapsular cataract (PSC) (OR, 0.60; 95% CI, 0.48-0.76) was associated with lower odds of PACD. The 6-year age-adjusted incidences of PACG, PAC, and PACS were 0.29% (95% CI, 0.14-0.55), 0.46% (95% CI, 0.29-0.75), and 2.54% (95% CI, 2.07-3.12), respectively.
Our study showed that the 6-year incidence of PACD was 3.50%. Increasing age, higher IOP, and shallower anterior chamber were associated with a higher risk of incident PACD, whereas late PSC was associated with a lower odds of PACD. These findings can aid in future projections and formulation of health care policies for screening of at-risk individuals for timely intervention.
在一个多民族亚洲人群中，确定原发性闭角型青光眼（PACD）在 6 年内的发病情况和危险因素。
基于人群的纵向研究。
新加坡眼病流行病学研究是一项在 40 岁或以上成年人中进行的基于人群的队列研究。基线检查于 2004 年至 2010 年进行，6 年随访于 2011 年至 2017 年进行。在参加随访检查的 6762 名参与者中，有 5298 名有原发性闭角型青光眼（PACG）风险，5060 名有 PACD 风险纳入分析。
进行了标准化检查，包括裂隙灯生物显微镜检查、压陷式房角镜检查、眼压（IOP）测量和静态自动视野检查。在本研究中，PACD 包括原发性房角关闭可疑（PACS）、原发性房角关闭（PAC）和 PACG。
在排除基线青光眼、PACS、PAC、基线或随访时白内障、基线激光周边虹膜切开术或虹膜切除术的高危人群中，评估 6 年 PACD 的发病情况。调整年龄、性别和种族的 logistic 回归分析用于评估 PACD 发病与人口统计学或眼部特征之间的关系。基于拟似然信息准则的向前选择用于多变量分析以减少潜在的共线性。
6 年年龄校正的 PACD 发病率为 3.50%（95%置信区间[CI]，2.94-4.16）。多变量分析显示，每十年年龄增长（优势比[OR]，1.35；95%CI，1.15-1.59）、IOP 升高（OR，1.04；95%CI，1.00-1.08）和前房深度变浅（OR，1.11；95%CI，1.08-1.14）与 PACD 的发病风险增加相关，而晚期后囊下白内障（PSC）（OR，0.60；95%CI，0.48-0.76）与 PACD 的发病风险降低相关。6 年年龄校正的 PACG、PAC 和 PACS 的发病率分别为 0.29%（95%CI，0.14-0.55）、0.46%（95%CI，0.29-0.75）和 2.54%（95%CI，2.07-3.12）。
我们的研究表明，6 年 PACD 的发病率为 3.50%。年龄增长、IOP 升高和前房变浅与 PACD 的发病风险增加相关，而晚期 PSC 与 PACD 的发病风险降低相关。这些发现有助于未来预测和制定卫生保健政策，以筛查高危人群，进行及时干预。
