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D. S. Friedman, Y. Jiang, P. J. Foster, D. S. Chang, S. Huang, T. Aung, M. He; Dark Room Prone Provocative Testing is Uninformative in Primary Angle Closure Suspects. Invest. Ophthalmol. Vis. Sci. 2010;51(13):196.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the results of dark room prone provocative testing (DRPPT) in primary angle closure suspects [PACS] and to compare the findings to controls with open angles
All eligible subjects in the ZAP Trial (a study to compare prophylactic laser iridotomy to no treatment in PACS) were placed in a dark room face down for 15 minutes. Eye pressure was measured immediately before and within one minute of sitting up. DRPPT was also performed on subjects with open angles participating in the Liwan Eye Study follow up study.
808 primary angle closure suspects and 89 persons with open angles underwent DRPPT. All subjects were Chinese residents of Guangzhou. PACS participants were slightly younger than open angle controls (59.5 versus 60.5) were more often female (81.6 versus 58.4%), and had lower IOP (14.1 versus 15.0, p < 0.05 for all). The average IOP increase after DRPPT was 4.2 mmHg (SD = 2.9) in PACS and 5.2 (SD = 2.8) in those with open angles (p < 0.05). In univariate analysis, IOP rose more in persons with open angles, males, lower baseline IOP, and greater axial length. Open angle status, baseline IOP and axial length remained significant predictors of a greater IOP rise in a multivariate model. 23.6% with open angles and 13.5% with PACS had an IOP increase of > 8 mmHg (p < 0.05).
DRPPT fails to separate persons with angle closure from those with open angles. In fact, in this large study, IOP increase in response to DRPPT was greater in those with open angles. The DRPPT test was 15 minutes, shorter than in some previous reports. However, the findings indicate that DRPPT is uninformative in determining risk of angle closure.
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