Myopia in asian subjects with primary angle closure: implications for glaucoma trends in East Asia.

PURPOSE: To evaluate the occurrence of myopia in Asian subjects with angle closure and to assess the ocular biometric parameters in these subjects. DESIGN: Cross-sectional study. PARTICIPANTS: We prospectively recruited 427 angle-closure subjects (143 primary angle-closure suspects, 75 patients with primary angle closure, 165 patients with primary angle-closure glaucoma, and 44 patients with acute primary angle closure) from a Singapore hospital. METHODS: Refractive status was derived from the spherical equivalent of autorefraction. A-scan biometry (Nidek Echoscan Ultrasound US-800; Nidek Co., Tokyo, Japan) was performed to obtain anterior chamber depth (ACD), axial length (AL), lens thickness, and vitreous cavity length (VL). Anterior segment optical coherence tomography was performed to measure lens vault. MAIN OUTCOME MEASURES: Refractive status was categorized as myopia (≤-0.50 diopter [D]), emmetropia (-0.50 to +0.50 D), and hyperopia (≥+0.50 D). RESULTS: The mean age ± standard deviation of study subjects was 65.6 ± 7.6 years, with most being Chinese (n = 394; 92.3%) and women (n = 275; 64.4%). Overall, myopia was present in 94 subjects (22%), hyperopia was present in 222 subjects (52%), and emmetropia was present in 111 subjects (26%). Of the 94 myopic angle-closure patients, 28 (29.8%) were categorized as having moderate myopia (≤-2.0 to -5.0 D) and 11 (11.7%) were categorized as having high myopia (≤-5.00 D). Although myopic angle-closure subjects had longer ALs (P<0.001) and VLs (P = 0.001) than their emmetropic and hyperopic counterparts, there were no significant differences in ACD (P = 0.77), lens thickness (P = 0.44), or lens vault (P = 0.053). CONCLUSIONS: Almost one quarter of angle-closure patients were myopic. Myopic angle-closure subjects had longer VLs and ALs, but there was no difference in ACD. With the increasing rate of myopia in many East Asian populations, there may be many subjects with axial myopia but shallow ACD and angle closure. The implication is that ophthalmologists should not assume that glaucoma patients who are myopic have open angles.

Subgrouping of primary angle-closure suspects based on anterior segment optical coherence tomography parameters.

PURPOSE: To identify subgroups of primary angle-closure suspects (PACS) based on anterior segment optical coherence tomography (AS-OCT) and biometric parameters. DESIGN: Cross-sectional study. PARTICIPANTS: We evaluated 243 PACS subjects in the primary group and 165 subjects in the validation group. METHODS: Participants underwent gonioscopy and AS-OCT (Carl Zeiss Meditec, Dublin, CA). Customized software (Zhongshan Angle Assessment Program, Guangzhou, China) was used to measure AS-OCT parameters. An agglomerative hierarchical clustering method was first used to determine the optimum number of parameters to be included in the determination of subgroups. The best number of subgroups was then determined using Akaike Information Criterion (AIC) and Gaussian Mixture Model (GMM) methods. MAIN OUTCOME MEASURES: Subgroups of PACS. RESULTS: The mean age of the subjects was 64.8 years, and 65.02% were female. After hierarchical clustering, 1 or 2 parameters from each cluster were chosen to ensure representativeness of the parameters and yet keep a minimum of redundancy. The parameters included were iris area, anterior chamber depth (ACD), anterior chamber width (ACW), and lens vault (LV). With the use of GMM, the optimal number of subgroups as given by AIC was 3. Subgroup 1 was characterized by a large iris area, subgroup 2 was characterized by a large LV and a shallow ACD, and subgroup 3 was characterized by elements of both subgroups 1 and 2. The results were replicated in a second independent group of 165 PACS subjects. CONCLUSIONS: Clustering analysis identified 3 distinct subgroups of PACS subjects based on AS-OCT and biometric parameters. These findings may be relevant for understanding angle-closure pathogenesis and management.

Unsupervised medical image classification by combining case-based classifiers.

We introduce an automated pathology classification system for medical volumetric brain image slices. Existing work often relies on handcrafted features extracted from automatic image segmentation. This is not only a challenging and time-consuming process, but it may also limit the adaptability and robustness of the system. We propose a novel approach to combine sparse Gabor-feature based classifiers in an ensemble classification framework. The unsupervised nature of this non-parametric technique can significantly reduce the time and effort for system calibration. In particular, classification of medical images in this framework does not rely on segmentation, nor semantic-based or annotation-based feature selection. Our experiments show very promising results in classifying computer tomography image slices into pathological classes for traumatic brain injury patients.

Anterior segment optical coherence tomography parameters in subtypes of primary angle closure.

PURPOSE: To compare anterior segment parameters, assessed by anterior segment optical coherence tomography (ASOCT), in subjects categorized as primary angle closure suspect (PACS), primary angle closure (PAC), primary angle closure glaucoma (PACG), and previous acute PAC (APAC); and to identify factors associated with APAC. METHODS: This was a prospective ASOCT study of 425 subjects with angle closure (176 PACS, 66 PAC, 125 PACG, and 58 APAC). Customized software was used to measure ASOCT parameters, including angle opening distance (AOD750), trabecular-iris space area (TISA750), anterior chamber depth, width, area and volume (ACD, ACW, ACA, ACV), iris thickness (IT750), iris area (IAREA), and lens vault (LV). Mean differences in anterior segment parameters were evaluated by analysis of covariance (ANCOVA) adjusted for age, sex, and pupil diameter (PD). RESULTS: Comparison among the different subgroups showed that ACD, ACA, and ACV were smallest, and IT750 thickest in the APAC group compared with the other subgroups (P < 0.001). LV was greatest in the APAC group (1218 ± 34 µm) followed by PAC (860 ± 31 µm), PACG (845 ± 23 µm), and PACS (804 ± 19 µm), respectively (P = <0.001). While the APAC group had the narrowest angles, the PACS group had the widest (P < 0.001 for both AOD750 and TISA750). Logistic regression showed that greater LV (P = <0.001), narrower TISA750 (P = <0.001), and thicker IT750 (P = 0.007) were the major determinants of APAC. CONCLUSIONS: Eyes with APAC had the narrowest angles, smallest anterior segment dimensions, thickest iris, and largest LV compared with PACS, PAC, and PACG. LV, TISA750, and IT750 were the major determinants of APAC.