Angle Closure in the Young Patient

Key considerations include the patient’s disease stage, age, and presbyopic status.

Daniel Zhu, MD, and Manjool Shah, MD

Glaucoma Today

Key Takeaways Angle closure is best conceptualized not as a single diagnosis but as a spectrum. The staging of angle closure matters clinically because it reframes management away from laser peripheral iridotomy versus lensectomy as a binary decision and toward a more nuanced calculus Key considerations include the patient’s disease stage, age, and presbyopic status. Angle closure is best conceptualized not as a single diagnosis but as a spectrum. The term primary angle-closure suspect (PACS) describes appositional anatomy alone. PAC presents with either elevated IOP or peripheral anterior synechiae (PAS) without evidence of optic nerve damage. The term primary angle-closure glaucoma (PACG) refers to the stage at which optic neuropathy has occurred. This staging matters clinically because it reframes management away from laser peripheral iridotomy (LPI) versus lensectomy as a binary decision and toward a more nuanced calculus (Figure). The questions become the following: Where does this eye sit on the spectrum, and what does the patient’s age, and more specifically, their presbyopic status, demand of the conversation? THE PACS PATIENT Regardless of their age, for patients with appositional angles alone and no PAS, IOP elevation, or evidence of nerve damage, management is a discussion rather than an algorithm. Risk factors, fellow-eye and family history, the logistic burden of frequent dilated exams, access to care, and symptoms suggestive of intermittent angle closure all factor into whether a patient would be better served by observation, LPI, or early lens extraction.

Research Briefs

Modern Optometry

Unlocking Clinical Trial Enrollment with AI Screening

It’s not a patient population problem. It’s a signal-extraction problem.

Sunil Gupta, MD, and Joshua Koo, MS, BS

Retina Today

KEY TAKEAWAYS Current clinical trial screening methods rely on physician memory or a manual pre-screener, often leading to missed eligible patients, high screen failure rates, and lagging trial enrollment. An investigational AI model can automatically flag eligible candidates, allowing the physician to initiate the trial conversation and potential formal screening on the same day. Using the AI system allowed the Retina Specialty Institute to bring a protocol live in about 4 weeks. Every practice that runs clinical trials knows a particular kind of frustration. You open a new protocol for geographic atrophy, wet AMD, or diabetic macular edema, confident that patient volume will fill it. And then you watch enrollment crawl. The reflex is to assume the shortfall is a supply problem: not enough patients. However, in a busy retina clinic, the eligible patients are there—the problem isn’t patient scarcity, it’s patient identification. On any given clinic day, dozens of patients have the conditions our open protocols were written to study, and the information needed to identify them as trial candidates is already in the record: acuity measurements, medical and treatment histories, laterality notes, and OCT scans. However, we still need a dependable way to identify that information quickly for each patient.