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E. Ong, J. Baasanhu, W. Nolan, P. S. Lee, P. H. Alsbirk, G. J. Johnson, S. Low, P. J. Foster; The Utility of Symptoms in the Identification of Angle-Closure: A Valid Approach?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3598.
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Clinical classification of angle-closure disease currently emphasizes the presence or absence of symptoms. We sought to evaluate the validity of this approach by examining the frequency of symptoms associated with primary angle-closure in a high-risk East Asian population.
One thousand subjects aged 40 years and older chosen from rural and urban provinces of Mongolia were examined in a population-based survey. An eight point questionnaire was used to determine a history of symptoms associated with angle-closure such as ocular pain and visual disturbance. Participants all underwent a slit-lamp examination including gonioscopy by the same observer. The frequency of symptoms was compared between normal subjects and those with 1) gonioscopically-confirmed occludable angles 2) peripheral anterior synechiae (PAS); and 3) anterior chamber depth (ACD) < 2.5mm. Proportions were compared using the chi-square test and a multiple logistic regression model.
Out of the 942 patients that attended the study, 64 were angle-closure suspects, 46 had PAS and 154 with an ACD <2.5mm. Symptoms traditionally linked with angle-closure were reported by both normal and potentially affected people. Intermittent blurring of vision at night was the only symptom of angle-closure that was reported significantly more often in affected people in all three groups (p=0.017, p=0.114 and p=0.010 respectively).
Direct questioning about presence of symptoms associated with angle-closure identified high rates of positive responses in both affected and unaffected groups. Our results show that nocturnal blurring of vision and haloes around lights were more frequent in people with angle-closure, but none of these symptoms alone were specific enough to be considered useful as a diagnostic criterion.
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