Table 2 “PACS PLUS” - Criteria for referral of people with suspected occluded angles to Hospital Eye Service or secondary care provider.

Angle criteria

Either—an anterior segment OCT showing irido-trabecular contact (ITC)

Or—a limbal chamber depth grade <25%

PLUS: one of the following criteria

• People with only one “good eye” in which deterioration of vision may threaten independent living or livelihood.

• Vulnerable adults who may not report ocular or vision symptoms

• Family history of significant angle-closure disease

• High hypermetropia (>+6.00 dioptres)

• Diabetes or another condition necessitating regular pupil dilation

• Those using antidepressants or medication with an anticholinergic action

• People either living in remote locations (such as foreign aid workers, armed forces stationed overseas or oil rig workers etc.) where rapid access to emergency ophthalmic care is not possible

The finding of “PACS PLUS” should trigger referral to the Hospital Eye Service

“PACS MINUS”

If an individual has the angle-characteristics specified above but none of the “plus” criteria, and does not meet NICE glaucoma referral guidelines, they should be advised to seek an annual NHS sight test.