Inaugural EGS Angle-Closure Special Interest Group Meeting
5th October 2007, Moorfields Eye Hospital, London

Programme Highlights and Summary
The formation of a Special Interest Group on Angle-closure Glaucoma was the brain-child of Professor Roger Hitchings and Dr Gus Gazzard. The inaugural group meeting, held on the 5th October 2007, was organised by Dr Paul Foster and Dr Gazzard, together with the Joint Angle-closure Glaucoma Research Group at Moorfields Eye Hospital and the UCL Institute of Ophthalmology. A wide range of topics related to angle-closure were discussed at this one day meeting covering diagnostic standards, epidemiology and mechanisms of disease, genetics, surgical, laser and medical management, as well as screening and prophylaxis.

Session 1: Identifying the disease
This session was chaired by Dr Paul Foster (in place of Carlo Traverso, who was unable to attend) and Dr Winnie Nolan (Birmingham, UK). The session commenced with an introduction to a video-based gonioscopy instructional package developed at Moorfields, and presented by Dr Gus Gazzard (London, UK). The high quality video footage was highly commended, and it was felt that this may form the basis for development of teaching material that the EGS may wish to use in future courses. Distinguished overseas speakers Associate Professor Tin Aung and Professor Mingguang He both presented updates on anterior segment optical coherence tomography imaging. Professor Aung described possible methods of screening for angle-closure in Singapore with IOLMaster, ASOCT and SPAC (Scanning Peripheral Anterior Chamber device). He also discussed problems with scleral spur identification and the clinical relevance of ASOCT findings in comparison to gonioscopy. Prof He’s presentation on biometric software developed in his unit in Guangzhou, China demonstrated the ability of non-contact imaging techniques to rapidly assess quantitative risk indicators such as relative lens position, iris thickness and configuration to further our understanding of angle-closure mechanisms. Professor Giorgio Marchini from Italy concluded the session with a thorough discussion of the role of UBM imaging in diagnosis and management of angle-closure, in particular addressing the essential role of UBM in assessing ciliary body position.

Session 2: Classification, Mechanism, Epidemiology and Genetics
The second session was chaired by Prof Franz Grehn (Wurzburg, Germany) and Assoc Prof Tin Aung. Associate Professor David Friedman from Johns Hopkins Hospital in Baltimore updated the group on the AIGS Consensus Project in the classification of angle closure which no longer focuses on symptoms of angle-closure but the stage in natural history of the disease. Dr Gazzard and Dr Foster presented projections of the number of people with angle-closure glaucoma in Europe. This is estimated at a prevalence around 1% of the population aged 40 years and older, accounting for 10% - 12% of all cases of glaucoma subtypes. Preliminary data from the European Prospective Investigation of Cancer (EPIC) eye study in Norfolk found 1 person in 20 to be in the at risk category of ocular biometry. Dr Sancy Low introduced the topic of angle-closure genetics with the challenges posed by drug and environmental stimuli that often co-exist with a family history of angle closure. Family based linkage studies presented by Prof Tin Aung suggested a locus in Chromosome 10q but this has not been replicated to date. Active gene-hunting for angle-closure susceptibility loci are continuing in Singapore, with various candidate genes including MFRP, CHX10 and single nucleotide polymorphisms in MMP-9 excluded to date. Prof Mingguang He’s final presentation on the Guangzhou Twin Study included an impressive array of data from a very large cohort of twins, which has been used to examine the heritability of multiple biometric factors across the population of child and adult twins. Interestingly, may of the heritability estimates from China are very similar to those reported by Dr Poul Alsbirk almost 30 years ago.

Session 3: Surgical and Medical Management
This lively session chaired by Prof John Thygesen (Copenhagen, Denmark) and Dr Gus Gazzard saw an exchange of clinical experience and surgical pearls. Prof Tin Aung started this session with a summary of the EXACT study concerning the efficacy of prostaglandin analogue (Xalatan) treatment in angle-closure glaucoma after laser iridotomy. This was followed by a summary of current work in primary lensectomy for angle-closure by Prof Thygesen. Dr Paul Foster presented an audit of phacoemulsification in angle-closure and both speakers demonstrated a benefit in lens removal for IOP control and widening of the anterior chamber angle, particularly in presbyopic cases where accommodative change is less of an issue. Prof Franz Grehn discussed laser versus surgical peripheral iridotomy for various clinical subgroups and mechanisms of disease. Dr Jennifer Burr from Aberdeen, Scotland updated the group on the proposed multi-centre collaborative EAGLE trial which is being planned by several EGS members and collaborators to evaluate the safety of lens extraction for angle-closure glaucoma.

Session 4: Laser Treatment and Prophylaxis
The last session of the day was chaired by current EGS president Prof Roger Hitchings and Prof David Friedman. Angle-closure glaucoma is an important cause of world-blindness, Dr Paul Foster updated the group on current laser treatment guidelines at MEH. Results of a randomised controlled trial of Nd:YAG laser vs sequential argon laser iridotomy in dark irides is awaited. Dr Winnie Nolan updated the group on the follow-up screening trial in Mongolia in cataract progression following iridotomy and the incidence of glaucoma. Tin Aung introduced the Singapore ANALIS screening study of asymptomatic angle closure with laser iridotomy which is on-going and will provide much awaited results to guide us with treatment protocols. Finally, a large scale randomised controlled trial in laser peripheral iridotomy in China run by Dr Paul Foster, Prof David Friedman and Prof Mingguang He was outlined, scheduled to start in 2008, and aims to answer important questions on who and how to treat this blinding condition in East Asia.

Delegates who attended: Franz Grehn (Wurzburg), Thomas Klink (Wurzburg), John Thygesen (Copenhagen), Poul Alsbirk (Copenhagen), Giorgio Marchini Verona), Hans Lemji (Rotterdam), Jan Erik Jakobsen (Oslo), Jennifer Burr (Aberdeen), Winnie Nolan (Brimingham), Rupert Bourne (Huntingdon), James Kirwan (Portsmouth), Paul Foster (London), Gus Gazzard (London), Roger Hitchings (London), Clive Migdal (London), Peng Khaw (London), Dilani Siriwardena (London), Maria Papadopoulos (London), Sancy Low (London), Pak Sang Lee (London), Tom Ressiniotis (London), Peter Fedor (USA), Mingguang He (Guangzhou, China), Tin Aung (Singapore), David Friedman (Baltimore), Thomas Will (Carl Zeiss, Europe), John Hood (Carl Zeiss, UK), Martin Long (Heidelberg Engineering), Toby Cooper (Allergan UK), Jeremy Carr (Allergan UK), Wai Yin Cheung (Haag-Streti UK), Dina Christopoulou (Pfizer Europe), Anne-Marie Swift (Pfizer Europe).

We thank our sponsors Carl- Zeiss Meditech (platinum), Pfizer (Platinum), Allergan (Gold), Heidelberg Engineering (Gold), Alcon (Bronze)for their generous support that helped make this meeting such a success

Summary by S.Low 9th October 2007