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

EPMA Journal volume 10, pages 261–271 (2019)Cite this article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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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Funding

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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Authors and Affiliations

  1. Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China

    Shengjie Li, Mingxi Shao, Yani Wan, Binghua Tang & Wenjun Cao

  2. Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, No.83 Fenyang Road, Shanghai, 200031, China

    Shengjie Li, Mingxi Shao, Yani Wan, Binghua Tang, Xinghuai Sun & Wenjun Cao

  3. NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China

    Shengjie Li & Xinghuai Sun

  4. State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China

    Xinghuai Sun

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  1. Shengjie Li
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Correspondence to Shengjie Li or Wenjun Cao.

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All individuals were informed about the purposes of the study and have signed their consent for publishing the data.

Ethical approval

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). https://doi.org/10.1007/s13167-019-00174-1

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  • DOI: https://doi.org/10.1007/s13167-019-00174-1

Keywords

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