Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.
Center for Eye Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Ophthalmol. 2022 Jun 1;140(6):598-603. doi: 10.1001/jamaophthalmol.2022.1231.
If an anatomic narrow angle is not appropriately diagnosed and treated, it can result in acute angle-closure crisis (AACC) and lead to substantial vision loss.
To identify patients who presented with AACC and assess for factors that may have been associated with risk of developing it.
DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study conducted from January 1, 2001, to December 31, 2015, included a 20% nationwide sample of 1179 Medicare beneficiaries. Patients aged 40 years or older with AACC were identified with billing codes. A 2-year lookback period from the date of initial presentation of AACC was used to identify patients who had at least 1 eye care visit, received a diagnosis of open-angle glaucoma (OAG) or suspected OAG, or received at least 1 medication associated with risk of AACC. Of the patients who had at least 1 eye care visit, those who underwent gonioscopy, received a diagnosis of an anatomic narrow angle before developing AACC, or both were identified.
Proportions of patients who had at least 1 eye care visit, had OAG or suspected OAG, received at least 1 medication associated with risk of AACC, underwent gonioscopy, or received a diagnosis of an anatomic narrow angle before development of AACC.
A total of 1179 patients had a confirmed diagnosis of AACC. The mean (SD) age of patients with AACC was 66.7 (11.8) years (range, 40-96 years), 766 were women (65.0%), 57 were Asian (4.8%), 109 were Black (9.2%), 126 were Latino (10.7%), 791 were White (67.1%), and 96 were other race and ethnicity (8.1%). Of these patients, only 796 (67.5%) consulted an optometrist or ophthalmologist at least once during the 2-year lookback period. A total of 464 individuals (39.4%) had OAG or suspected OAG, and 414 (35.1%) had received at least 1 medication associated with increased risk of AACC before developing it. Of the 796 patients who consulted an optometrist or ophthalmologist in the lookback period, less than one-third underwent gonioscopy in the 2 years before developing AACC (n = 264 [33.2%]), and less than one-half of all patients undergoing gonioscopy received a diagnosis of an anatomic narrow angle (n = 113 [42.8%]). Most patients underwent gonioscopy in the 1 to 4 weeks preceding the AACC.
In this group of Medicare patients, there appear to have been multiple opportunities for interventions that may have averted AACC. Interventions aimed at addressing risk factors associated with AACC and improving performance of gonioscopy might be associated with reduced risk for ocular morbidity.
如果未能适当诊断和治疗解剖性窄房角，可能导致急性房角关闭危机，并导致视力严重丧失。
识别出现急性房角关闭危机的患者，并评估可能与发病风险相关的因素。
设计、设置和参与者：本基于人群的回顾性队列研究于 2001 年 1 月 1 日至 2015 年 12 月 31 日进行，纳入了全国范围内 1179 名 Medicare 受益人的 20%的代表性样本。通过计费代码识别出患有急性房角关闭危机的年龄在 40 岁或以上的患者。使用从急性房角关闭危机初次就诊日期开始的 2 年回溯期，以确定至少有 1 次眼科就诊、接受开角型青光眼（OAG）或疑似 OAG 诊断或接受至少 1 种与急性房角关闭危机风险相关药物治疗的患者。在至少有 1 次眼科就诊的患者中，确定了接受过房角镜检查、在发生急性房角关闭危机之前被诊断为解剖性窄房角或同时接受过这两种治疗的患者。
至少有 1 次眼科就诊、接受 OAG 或疑似 OAG 治疗、接受至少 1 种与急性房角关闭危机风险相关药物治疗、接受房角镜检查或在发生急性房角关闭危机之前被诊断为解剖性窄房角的患者比例。
共纳入 1179 例确诊为急性房角关闭危机的患者。急性房角关闭危机患者的平均（SD）年龄为 66.7（11.8）岁（范围，40-96 岁），其中 766 例为女性（65.0%），57 例为亚洲人（4.8%），109 例为黑人（9.2%），126 例为拉丁裔（10.7%），791 例为白人（67.1%），96 例为其他种族和民族（8.1%）。在这些患者中，只有 796 例（67.5%）在 2 年回溯期内至少咨询过 1 次验光师或眼科医生。共有 464 例（39.4%）患者患有 OAG 或疑似 OAG，414 例（35.1%）患者在发生急性房角关闭危机之前接受过至少 1 种与增加急性房角关闭危机风险相关的药物治疗。在回溯期内咨询验光师或眼科医生的 796 例患者中，不到三分之一（n=264，33.2%）在发生急性房角关闭危机前的 2 年内接受过房角镜检查，所有接受过房角镜检查的患者中不到一半（n=113，42.8%）被诊断为解剖性窄房角。大多数患者在急性房角关闭危机前 1 至 4 周内接受房角镜检查。
在这群 Medicare 患者中，似乎有多次可以采取干预措施的机会，这些措施可能可以避免急性房角关闭危机。旨在解决与急性房角关闭危机相关的风险因素并改善房角镜检查性能的干预措施可能与降低眼部发病率有关。
