Post Hoc Evaluation of Low-Cost Glaucoma Risk Calculator in Screening for Angle-Closure Risk in High- Risk Groups
Jasmine Okafor MD, Kara Grimes MD and Daniel Laroche MD*
ABSTRACT
In this post hoc analysis, we evaluated the Laroche Glaucoma Risk Calculator as a screening tool to identify patients requiring gonioscopy to detect primary angle-closure glaucoma (PACG) within a high-risk, community-based cohort. The calculator, which incorporates age, intraocular pressure, and central corneal thickness, was originally designed as an affordable screening tool for use in under-resourced settings and is now implemented in routine clinical screening to stratify glaucoma risk and guide further evaluation. Iridotrabecular contact can lead to IOP elevation and glaucoma preceding glaucomatous optic neuropathy. We did a retrospective analysis of 149 patients identified as high risk, of which 9 (6.04%, p-value) were diagnosed with primary angle closure glaucoma PACG and 2 (1.34%, p-value) were classified as angle-closure suspects (PACS); these individuals were more often older with a mean age of 72.2 and female (54.5%), showing narrow angles on slit-lamp examination or optic nerve cupping on fundus evaluation. The prevalence of angle-closure disease in this high risk screened cohort exceeded global estimates, particularly among Black and Hispanic patients, who represented most of the study population (95%). These findings suggest that the Laroche glaucoma risk calculator can help triage patients who may benefit from gonioscopy, potentially facilitating earlier detection of PACG in underserved populations where gonioscopy remains underutilized.
