Differences in Screening Indicator Performance for Primary Angle Closure and Primary Angle Closure Diseases: The Handan Eye Study.

Objective: Primary angle closure disease (PACD) has long been the focus of screening, yet most cases are nonprogressive. In contrast, primary angle closure with or without glaucoma (PAC/G) poses greater risk and may deserve more attention. We aimed to compare screening indicator profiles for PACD and PAC/G, highlighting potential differences that may inform a shift in screening priorities. Design: A population-based cross-sectional study. Participants: Adults aged ≥35 years who completed standardized eye examinations. Only right eyes were analyzed; eyes with prior laser peripheral iridotomy were excluded. Methods: Participants underwent gonioscopy, anterior-segment OCT (AS-OCT), and A-scan ultrasound biometry. Univariable logistic regression and multivariable elastic-net models assessed the association and discriminative performance of AS-OCT parameters for detecting PACD and PAC/G. Main Outcome Measures: Odds ratios (ORs) and area under the receiver operator characteristic curve (AUROC) values of AS-OCT parameters for detecting PACD and PAC/G. Results: Of the 4546 eyes analyzed, 3831 had open angles and 715 had PACD, of which 53 had PAC/G. In the univariable logistic regression analysis, the angle opening distance (AOD) at 250 μm (AOD250) and the trabecular-iris space area (TISA) at 500 μm (TISA500) were more strongly associated with PAC/G than with PACD ( Conclusions: Angle parameters closer to the scleral spur were underestimated, and curved irises were overestimated when screening for PAC/G versus PACD. Anterior-segment OCT-derived models for PAC/G screening have shown promising feasibility in population-based settings. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.