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Relationship between ocular biometry and severity of primary angle-closure glaucoma: relevance for predictive, preventive, and personalized medicine



Several ocular factors have been identified for primary angle-closure glaucoma (PACG), such as a small cornea, elevated intraocular pressure (IOP), shallow anterior chamber, and short axial length (AL). However, the relationship between the severity of PACG and various ocular parameters [IOP, anterior chamber depth, AL, central corneal thickness] is not fully understood.


A 7-year cross-sectional study. A total of 2254 eyes of 1312 PACG patients (females = 856 [1479 eyes] and males = 456 [775 eyes]) were included. A detailed eye examination was performed. The participants were categorized into gender subgroups followed by subdivision into three different severity groups according to their mean deviation (MD) of the visual fields results as follows: mild (MD ≤ 6 dB), moderate (MD 6–12 dB), and severe (MD > 12 dB) PACG. The associations of ocular biometry with severity of PACG were analyzed using paired Student’s t test, multivariate linear regression, and logistic regression analysis.


There was a significant positive correlation between the MD and AL in the female subgroup (B = 0.663, p = 0.001, 95%CI = 1.070 to 1.255) but not in the male subgroup. Increased AL levels (mild [OR = 1], moderate [OR = 1.047, p = 0.062, 95%CI = 0.947 to 2.462], and severe [OR = 1.274, p < 0.001, 95%CI = 1.114 to 1.457]) were only associated with the severity of PACG in females. Paired Student’s t tests showed that the long AL female eyes have a higher MD value than in the short AL female eyes (mean difference = 3.09, t = 6.846, p < 0.001) in the same subjects, but not in the male subgroup (p = 0.648).


The AL was positively and significantly related to the severity of PACG in female but not male subjects. This finding refers to the PACG pathogenesis and suggests the use of AL assessment in glaucoma monitoring, diagnosis, and progression. This may contribute to further development of personalized strategies in preventive medicine.

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  1. Tham Y-C, Li X, Wong TY, Quigley HA, Aung T, Cheng C-Y. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081–90.

    Article  Google Scholar 

  2. Sun X, Dai Y, Chen Y, Yu D-Y, Cringle SJ, Chen J, et al. Primary angle closure glaucoma: what we know and what we don’t know. Prog Retin Eye Res. 2017;57:26–45.

    Article  PubMed  Google Scholar 

  3. Karvonen E, Stoor K, Luodonpää M, Hägg P, Kuoppala J, Lintonen T, et al. Prevalence of glaucoma in the northern Finland birth cohort eye study. Acta Ophthalmol. 2019;97:200–7.

    Article  PubMed  Google Scholar 

  4. Jonas JB, Aung T, Bourne RR, Bron AM, Ritch R, Panda-Jonas S. Glaucoma. Lancet Lond Engl. 2017;390:2183–93.

    Article  Google Scholar 

  5. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Binggeli T, Schoetzau A, Konieczka K. In glaucoma patients, low blood pressure is accompanied by vascular dysregulation. EPMA J. 2018;9:387–91.

    Article  PubMed  PubMed Central  Google Scholar 

  7. George R, Paul PG, Baskaran M, Ramesh SV, Raju P, Arvind H, et al. Ocular biometry in occludable angles and angle closure glaucoma: a population based survey. Br J Ophthalmol. 2003;87:399–402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lan Y-W, Hsieh J-W, Hung P-T. Ocular biometry in acute and chronic angle-closure glaucoma. Ophthalmologica. 2007;221:388–94.

    Article  PubMed  Google Scholar 

  9. Marchini G, Pagliarusco A, Toscano A, Tosi R, Brunelli C, Bonomi L. Ultrasound biomicroscopic and conventional ultrasonographic study of ocular dimensions in primary angle-closure glaucoma. Ophthalmology. 1998;105:2091–8.

    Article  CAS  PubMed  Google Scholar 

  10. Sihota R, Dada T, Gupta R, Lakshminarayan P, Pandey RM. Ultrasound biomicroscopy in the subtypes of primary angle closure glaucoma. J Glaucoma. 2005;14:387–91.

    Article  PubMed  Google Scholar 

  11. Chen Y-Y, Chen Y-Y, Sheu S-J, Chou P. The biometric study in different stages of primary angle-closure glaucoma. Eye. 2013;27:1070–6.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Nolan WP, Baasanhu J, Undraa A, Uranchimeg D, Ganzorig S, Johnson GJ. Screening for primary angle closure in Mongolia: a randomised controlled trial to determine whether screening and prophylactic treatment will reduce the incidence of primary angle closure glaucoma in an east Asian population. Br J Ophthalmol. 2003;87:271–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Thapa SS, Paudyal I, Khanal S, Paudel N, van Rens GHMB. Comparison of axial lengths in occludable angle and angle-closure glaucoma--the Bhaktapur Glaucoma study. Optom Vis. 2011;88:150–4.

    Article  Google Scholar 

  14. Jiang X, Varma R, Wu S, Torres M, Azen SP, Francis BA, et al. Los Angeles Latino eye study group baseline risk factors that predict the development of open-angle glaucoma in a population: the Los Angeles Latino eye study. Ophthalmology. 2012;119:2245–53.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Suzuki Y, Iwase A, Araie M, Yamamoto T, Abe H, Shirato S, et al. Risk factors for open-angle glaucoma in a Japanese population: the Tajimi study. Ophthalmology. 2006;113:1613–7.

    Article  PubMed  Google Scholar 

  16. Qiu M, Wang SY, Singh K, Lin SC. Association between myopia and glaucoma in the United States population. Invest Ophthalmol Vis Sci. 2013;54:830–5.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Xu L, Wang Y, Wang S, Wang Y, Jonas JB. High myopia and glaucoma susceptibility the Beijing eye study. Ophthalmology. 2007;114:216–20.

    Article  PubMed  Google Scholar 

  18. Czudowska MA, Ramdas WD, Wolfs RCW, Hofman A, De Jong PTVM, Vingerling JR, et al. Incidence of glaucomatous visual field loss: a ten-year follow-up from the Rotterdam study. Ophthalmology. 2010;117:1705–12.

    Article  PubMed  Google Scholar 

  19. Hagan S, Martin E, Enríquez-de-Salamanca A. Tear fluid biomarkers in ocular and systemic disease: potential use for predictive, preventive and personalised medicine. EPMA J. 2016;7:15.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sabel BA, Wang J, Cárdenas-Morales L, Faiq M, Heim C. Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalized medicine. EPMA J. 2018;9:133–60.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Li S, Chen Y, Shao M, Tang L, Sun X, Cao W. Association of plasma complement C3 levels with primary angle-closure glaucoma in older women. Invest Ophthalmol Vis Sci. 2017;58:682–9.

    Article  PubMed  Google Scholar 

  22. Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia. The Blue Mountains eye study. Ophthalmology. 1996;103:1661–9.

    Article  CAS  PubMed  Google Scholar 

  23. Casson RJ, Baker M, Edussuriya K, Senaratne T, Selva D, Sennanayake S. Prevalence and determinants of angle closure in Central Sri Lanka: the Kandy eye study. Ophthalmology. 2009;116:1444–9.

    Article  PubMed  Google Scholar 

  24. Li S, Shao M, Tang B, Zhang A, Cao W, Sun X. The association between serum uric acid and glaucoma severity in primary angle closure glaucoma: a retrospective case-control study. Oncotarget. 2017;8:2816–24.

    CAS  PubMed  Google Scholar 

  25. Atalay E, Nongpiur ME, Yap SC, Wong TT, Goh D, Husain R, et al. Pattern of visual field loss in primary angle-closure glaucoma across different severity levels. Ophthalmology. 2016;123:1957–64.

    Article  PubMed  Google Scholar 

  26. Yarmohammadi A, Zangwill LM, Diniz-Filho A, Suh MH, Yousefi S, Saunders LJ, et al. Relationship between optical coherence tomography angiography vessel density and severity of visual field loss in glaucoma. Ophthalmology. 2016;123:2498–508.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim NR, Kim CY, Oh JH, Lee ES. Corneal thickness and anterior chamber depth by Orbscan in normal and primary open-angle glaucoma patients in Korea. J Glaucoma. 2008;17:465–9.

    Article  PubMed  Google Scholar 

  28. Moghimi S, Vahedian Z, Fakhraie G, Ghaffari R, Eslami Y, Jabarvand M, et al. Ocular biometry in the subtypes of angle closure: an anterior segment optical coherence tomography study. Am J Ophthalmol. 2013;155:664–673, 673.e1.

    Article  PubMed  Google Scholar 

  29. Adewara BA, Adegbehingbe BO, Onakpoya OH, Ihemedu CG. Relationship between intraocular pressure, anterior chamber depth and lens thickness in primary open-angle glaucoma patients. Int Ophthalmol. 2018;38:541-7.

  30. Marcus MW, de Vries MM, Junoy Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. Ophthalmology. 2011;118:1989–1994.e2.

    Article  PubMed  Google Scholar 

  31. Yanagisawa M, Yamashita T, Matsuura M, Fujino Y, Murata H, Asaoka R. Changes in axial length and progression of visual field damage in glaucoma. Invest Ophthalmol Vis Sci. 2018;59:407–17.

    Article  PubMed  Google Scholar 

  32. Jonas JB, Xu L, Wei WB, Pan Z, Yang H, Holbach L, et al. Retinal thickness and axial length. Invest Ophthalmol Vis Sci. 2016;57:1791–7.

    Article  PubMed  Google Scholar 

  33. Bai HX, Mao Y, Shen L, Xu XL, Gao F, Zhang ZB, et al. Bruch’s membrane thickness in relationship to axial length. PLoS One. 2017;12:e0182080.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Jonas JB, Kutscher JN, Panda-Jonas S, Hayreh SS. Lamina cribrosa thickness correlated with posterior scleral thickness and axial length in monkeys. Acta Ophthalmol. 2016;94:e693–6.

    Article  PubMed  Google Scholar 

  35. Primary Open-Angle Glaucoma PPP (2015) Available online: Accessed 11 Nov 2018.

  36. Golubnitschaja O, Costigliola V, EPMA. General report & recommendations in predictive, preventive and personalised medicine 2012: white paper of the European Association for Predictive, Preventive and Personalised Medicine. EPMA J. 2012;3:14.

  37. Golubnitschaja O, Baban B, Boniolo G, Wang W, Bubnov R, Kapalla M, et al. Medicine in the early twenty-first century: paradigm and anticipation - EPMA position paper 2016. EPMA J. 2016;7:23.

    Article  PubMed  PubMed Central  Google Scholar 

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This work was supported by Shanghai Sailing Program (18YF1403500), Shanghai Municipal Commission of Health and Family Planning (20174Y0169), Shanghai Municipal Commission of Health and Family Planning (201840050), The State Key Program of National Natural Science Foundation of China (81430007), The subject of major projects of National Natural Science Foundation of China (81790641), The Shanghai Committee of Science and Technology, China (17410712500), and The top priority of clinical medicine center of Shanghai (2017ZZ01020). Shanghai Science and Technology Committee Foundation grant (19411964600). The sponsor or funding organization had no role in the design or conduct of this research.

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Correspondence to Shengjie Li or Wenjun Cao.

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All the patient investigations conformed to the principles outlined in the Declaration of Helsinki and have been performed with the permission EENT2015011 released by the responsible Ethic’s Committee of Eye & ENT Hospital of Fudan University. All the patients were informed about the purposes of the study and have signed their “consent of the patient.” This article does not contain any studies with animals performed by any of the authors.

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Li, S., Shao, M., Wan, Y. et al. Relationship between ocular biometry and severity of primary angle-closure glaucoma: relevance for predictive, preventive, and personalized medicine. EPMA Journal 10, 261–271 (2019).

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  • Glaucoma
  • Primary angle-closure glaucoma
  • Ocular parameters
  • Axial length
  • Female
  • Patient stratification
  • Clinical medicine
  • Recommendations
  • Individualized patient profile
  • Predictive preventive personalized medicine