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    Why primary angle-closure glaucoma is declining in Scotland


    The mandatory, comprehensive ocular examinations introduced through this initiative included an assessment of the fundus following pupil dilation. Optometrists assessed anterior chamber depth and angle width using a slit lamp. National training included workshops on anterior segment assessment and gonioscopy.

    As an effect of this, optometrists may be referring more patients to hospital eye services with suspected narrow angles, the researchers speculated.

    The number of glaucoma specialist consultants in Scotland doubled from 2006 to 2012, and patients were streamlined into specialist glaucoma clinics. This, too, could have contributed to greater awareness of narrow angle disease and a higher rate of prophylactic iridotomy.

    These findings in Scotland mostly parallel trends reported in England over the same time period, the researchers wrote. In the English study, overall PACG rates increased while acute angle-closure episodes decreased.


    The authors speculated that the discrepancy might be attributable to the coding system in Scotland, which does not capture asymptomatic or chronic PACG that is managed in an outpatient clinic. They also said that not including these patients would not entirely account for the trends they documented.

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