Novel association of smaller anterior chamber width with angle closure in Singaporeans

Ophthalmology. 2010 Oct;117(10):1967-73. doi: 10.1016/j.ophtha.2010.02.007. Epub 2010 Jun 11.


Purpose: To describe variations in anterior chamber width (ACW) and investigate its association with the presence of narrow angles.

Design: Cross-sectional study.

Participants: We recruited 2047 subjects aged 50 years or more from a community polyclinic and 111 subjects with primary angle closure (PAC) or primary angle closure glaucoma (PACG) from an eye hospital in Singapore.

Methods: All participants underwent gonioscopy, anterior chamber depth (ACD) and axial length (AL) measurement (IOLMaster; Carl Zeiss, Jena, Germany), and anterior-segment optical coherence tomography (AS-OCT, Visante, Carl Zeiss Meditec, Dublin, CA). Customized software was used to measure the ACW, defined as the distance between the scleral spurs in the horizontal (nasal-temporal) axis of AS-OCT scans. An eye was deemed to have narrow angles if the posterior trabecular meshwork was not visible for at least 180 degrees on non-indentation gonioscopy with the eye in the primary position.

Main outcome measures: Anterior chamber width and narrow angles.

Results: Data on 1465 community-based subjects were available for analysis. Anterior chamber width was significantly smaller in women compared with men (11.70 mm vs. 11.81 mm, respectively, P<0.001) and decreased significantly with age (P for trend <0.001). Significant predictors of smaller ACW were lower educational level, lower body mass index, shorter AL, shallower ACD, and Chinese race. Of the 1465 subjects, 315 (21.5%) had narrow angles on gonioscopy. Mean ACW was smaller in eyes with narrow angles compared with those without narrow angles (11.60 mm vs. 11.80 mm, P<0.001). The age- and gender-adjusted odds ratio for the highest quartile compared with the lower 3 quartiles of ACW with the presence of narrow angles was 3.4 (95% confidence interval, 2.3-5.0; P for trend <0.001). Hospital-based subjects with PAC/PACG had even smaller ACW than community subjects with narrow angles (11.33 mm vs. 11.60 mm, P<0.001).

Conclusions: In this cross-sectional study, ACW was smaller in women, Chinese persons, and older persons, and was associated with narrow angles in 2 different study populations. These data suggest that a smaller ACW may represent a novel risk indicator for angle closure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anterior Chamber / pathology*
  • Asians / ethnology
  • Cross-Sectional Studies
  • Eye / pathology
  • False Positive Reactions
  • Female
  • Glaucoma, Angle-Closure / diagnosis*
  • Glaucoma, Angle-Closure / ethnology
  • Gonioscopy
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Odds Ratio
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sex Factors
  • Singapore / epidemiology
  • Tomography, Optical Coherence