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Improving vision of patients with angle-closure glaucoma

12 December 2014

Research on the epidemiology and mechanisms of angle-closure glaucoma has influenced understanding, guidelines and clinical management of the condition around the world.

Glaucoma is one of the leading causes of blindness across the world. There were an estimated 16 million people with angle-closure glaucoma in the world in 2010, and this number is predicted to increase to 21 million by 2020.

There are a number of different types of glaucoma. The most prevalent in the UK and the West in general is known as open-angle glaucoma and this has been extensively studied. Angle-closure glaucoma is less common - 10% of glaucoma cases in European people - and has not received the same attention. Prior to 1995 there was little research to guide clinical decision-making.

The first step in finding a solution to a clinical problem is often to define it. Professor Paul Foster (UCL Institute of Ophthalmology) undertook a series of epidemiological studies in Mongolia, Singapore and China, which led to the first high-quality reports of glaucoma prevalence and risk factors. These studies revealed that there are high numbers of angle-close glaucoma sufferers glaucoma in Asian populations, and also gave a deeper understanding of the natural history and mechanisms of the disease - something that is essential for the management of the condition. Further work defined a classification system, which has now become the international standard for natural history staging of angle-closure glaucoma. In 2006 it was adopted by the World Glaucoma Association as a recommended standard international classification system.

Professor Foster's research has made a major contribution to widespread recognition of the scale and significance of angle-closure glaucoma as a global problem, particularly in Asia but also in Europe, where an estimated 1.6 million are currently affected. In 2004, he was a member of the working party that produced the first-ever Asia Pacific Glaucoma Guidelines, and he also advised on production of the 3rd edition of the European Glaucoma Society's Terminology and guidelines for glaucoma, published in 2008.

The contribution of the research and its influence on guidelines has led to an increased global understanding of angle-closure glaucoma. This has improved the clinical management of patients through a more proactive approach to the management of angle-closure glaucoma in the UK, especially as a result of increased awareness of its early stages. Trends in laser surgery for angle-closure glaucoma reflect this impact. Laser iridotomy rates in the UK rose almost three-fold between 2003 and 2010, a direct reflection of the findings and recommendations in Foster's research; correspondingly, there was a 45% fall in the rate of acute attacks of angle-closure glaucoma in the UK.

Funders included NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, Fight for Sight, Richard Desmond Charitable Trust, International Glaucoma Association, British Council for Prevention of Blindness, Special Trustees of Moorfields Eye Hospital, the MRC, Wellcome Trust, National Medical Research Council of Singapore, Johns Hopkins University, the Ministries of Education and Science & Technology, China, and the Zhongshan Ophthalmic Centre, China.