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Subtypes of primary angle closure disease based on age-independent anterior segment optical coherence tomography parameters

Eye volume 39, pages 1384–1389 (2025)Cite this article

Subjects

Abstract

Objective

To identify subgroups of angle closure disease by considering age-independent anterior segment parameters.

Methods

Anterior-segment optical coherence tomography (ASOCT) was performed in primary angle closure suspect (PACS) and primary angle closure glaucoma (PACG) patients. Clustering analysis using age-independent parameters, anterior chamber width (ACW), anterior vault (AV), posterior corneal arc length (PCAL), and iris area was performed. The optimum number of subgroups was determined using Bayesian Information Criterion and subjects were classified into subgroups by Gaussian Mixture Model methods.

Results

A total of 650 PACS and 411 PACG were analysed. The optimal number of subgroups of the combined PACS and PACG dataset was 3. Subgroup 1 (n = 186, 29.3%) has the largest anterior chamber dimension with large AV and total anterior chamber area, subgroup 2 (n = 16, 2.5%) has the widest ACW and shallowest anterior chamber depth (ACD), and subgroup 3 (n = 432; 68.1%) has large iris area with the smallest anterior chamber dimensions, characterised by a small ACW, AV, and PCAL. Subgroup 3 comprised a significantly greater proportion of PACG compared to PACS (74.2% vs 64.6%, p = 0.04) while subgroup 1 had the greatest proportion of PACS ≥ 70 years old, yet to have progressed to PACG.

Conclusion

We identified 3 subgroups of angle closure eyes, each characterised by distinct structural components based on ASOCT. A greater proportion of older PACS yet to have progressed to PACG belonging to the subgroup with the largest anterior chamber dimensions suggests that a more spacious anterior chamber may be associated with PACS that remains stable.

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Fig. 1: The parameters measured by anterior segment optical coherence tomography as determined by the Zhongshan Angle Assessment Programme.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Author information

Author notes

  1. These authors contributed equally: Ruthra Umapathi, Marco Yu.

Authors and Affiliations

  1. Duke-NUS Medical School, Singapore, Singapore

    Ruthra Umapathi, Marco Yu, Ching-Yu Cheng, Raymond P. Najjar, Tina T. Wong, Shamira Perera, Eranga N. Vithana, Tin Aung & Monisha E. Nongpiur

  2. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

    Marco Yu, Ching-Yu Cheng, Raymond P. Najjar, Rahat Husain, Ching Lin Ho, Tina T. Wong, Pui Yi Boey, Shamira Perera, Tin Aung & Monisha E. Nongpiur

  3. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Ching-Yu Cheng, Raymond P. Najjar & Tin Aung

Authors
  1. Ruthra Umapathi
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  2. Marco Yu
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  3. Ching-Yu Cheng
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  12. Monisha E. Nongpiur
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Contributions

This project was conceptualised by MY and MEN. RU and MY were responsible for extracting and analysing the data and writing the manuscript together with MEN. CYC, RPN, RH, CLH, TTW, PYB, SP, ENV and TA provided feedback on the manuscript.

Corresponding author

Correspondence to Monisha E. Nongpiur.

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The authors declare no competing interests.

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Umapathi, R., Yu, M., Cheng, CY. et al. Subtypes of primary angle closure disease based on age-independent anterior segment optical coherence tomography parameters. Eye 39, 1384–1389 (2025). https://doi.org/10.1038/s41433-025-03597-5

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