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Letter to the Editor: Self-Identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy

Letter to the Editor: Self-Identified Black Race as a Risk Factor for Intraocular Pressure... LETTERS TO THE EDITOR synechial closure was present if (OR: 2.7, P = 0.007). They were less Letter to the dynamic gonioscopy with compression likely to receive Selective Laser Trabe- was not always performed. If partic- culoplasty (OR: 0.37, P = 0.009), which Editor: Self-Identified ipants had synechiae indicating that the is consistent with the fact that advanced Black Race as a trabecular meshwork (TM) function synechial closure could preclude suc- was already compromised at the time cessful Selective Laser Trabeculoplasty. Risk Factor for of LPI, the intraocular pressure would African Americans also had shorter be more likely to spike when burdened times to glaucoma surgery in time to Intraocular Pressure with this sudden increase in the load of event analysis (Hazard Ratio: 2.57, iris pigment. An eye prone to synechial P = 0.004). Elevation and angle closure would also possibly be Thus, we suggest that the phe- more prone to iritis after a laser pro- nomena of post-LPI IOP elevation Iritis Following cedure on the iris. Finally, the sugges- and iritis in African Americans may Prophylactic tion that iris pigmentation in dark be because of late presentation after irides of Black patients explains the the TM has been compromised. This Laser Peripheral difference in findings seems less plau- may be because of missed diagnoses sible given that Asian patients had a on Van Herrick, which can under- Iridotomy similar rate of post-LPI IOP elevation estimate the presence of occludable as White patients (P = 0.19) despite narrow angles, placing these patients having dark irides. at risk of developing synechial closure over time. We have shown that eyes Another reason to suspect that with PAC and PACG are more likely some patients were at the PAC stage at than thosewithPACStobemis- the time of LPI is that the baseline IOP diagnosed as deep using the Van was reported as 17.1 ± 5.8 in those Herrick technique and that Black race treated with Nd:YAG and 17.2 ± 5.6 in We read with great interest the article is an independent risk factor for a those treated with Argon-Nd:YAG by Adetunji et al Self-identified Black deep grading with Van Herrick techni- LPI. Two standard deviations above Race as a Risk Factor for Intraocular que in eyes with narrow angles on the mean would indicate an IOP of 28.7 Pressure Elevation and Iritis Following gonioscopy. Improved screening meth- or 28.4 mm Hg, respectively. More- Prophylactic Laser Peripheral Iridot- ods are needed to target African Ameri- omy. In this retrospective review of over, in the discussion, the authors note cans with occludable narrow angles so 1485 primary angle closure suspects that 2 of the 5 surgeons with the that preventive interventions such as LPI (PACS) eyes that underwent Nd:YAG greatest number of cases reported that can be performed earlier in the course of or sequential argon and Nd:YAG laser they had already initiated a glaucoma the disease to decrease the risk of medication in patients with a baseline peripheral iridotomy (LPI), self-identi- progression. IOP > 22 mm Hg undergoing LPI, fied Black race was documented as a which would suggest that those patients risk factor for both postprocedure IOP had at least PAC. According to the elevation [odds ratio (OR): 1.19, American Academy of Ophthalmology, P < 0.001] and iritis (OR: 5.07, Atalie C. Thompson, MD, MPH*† the definition of PAC includes those P < 0.001). The authors report that this Sanjay Asrani, MD† with synechiae or intraocular pressure finding was independent of laser type *Wake Forest Baptist Health, Department of > 21 mm Hg consistent with TM com- and energy, and conclude that greater Surgical Ophthalmology, Winston-Salem, NC promise, which may be due to inter- iris pigmentation in Black patients may †Department of Ophthalmology, Duke mittent angle closure. explain the higher incidence of post- University Medical Center, Durham, NC procedure ocular hypertension and We suggest that the more plausible iritis. reason for the presence of post-LPI IOP elevation in Black participants may be The authors describe that eyes REFERENCES due to late presentation and the pres- with a prior diagnosis of primary angle 1. Adetunji MO,Meer E,Whitehead G, et al. ence of PAC or possibly even PACG at closure (PAC), primary angle closure Self-identified black race as a risk factor the time of LPI. We have previously glaucoma (PACG), or chronic angle for intraocular pressure elevation and documented that African Americans closure glaucoma were excluded based iritis following prophylactic laser peri- are significantly more likely than on International Classification of Dis- pheral iridotomy. JGlaucoma. 2022;31: Whites to have PAC/PACG than eases codes. However, the methodology 218–223. PACS (OR: 2.12, P < 0.001) and to 2. Thompson AC, Vu DM, Cowan LA, does not describe the gonioscopy tech- et al. Factors associated with inter- already be taking glaucoma medi- nique that was used to determine ventions after laser peripheral iridotomy cations (OR: 2.25, P < 0.001) at the whether patients were indeed at the for primary angle-closure spectrum diag- stage of PACS. It is possible that time of LPI. In multivariable logistic noses. Ophthalmol Glaucoma. 2019;2: regression analysis, African Americans 192–200. A.C.T. receives support from the American were also more likely to be prescribed 3. Thompson AC, Vu DM, Cowan LA, Glaucoma Society and NIH/NEI additional glaucoma medications after et al. Risk factors associated with missed K23EY030897. LPI (OR: 1.73, P = 0.025), which is diagnoses of narrow angles by the Van Disclosure: The authors declare no conflict of consistent with IOP elevation, and were Herick technique. Ophthalmol Glaucoma. interest. more likely to receive glaucoma surgery 2018;1:108–114. DOI: 10.1097/IJG.0000000000002073 J Glaucoma Volume 31, Number 9, September 2022 www.glaucomajournal.com e87 Copyright r 2022 Wolters Kluwer Health, Inc. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Glaucoma Wolters Kluwer Health

Letter to the Editor: Self-Identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy

Thompson, Atalie C.; Asrani, Sanjay
Journal of Glaucoma , Volume 31 (9) – Sep 6, 2022
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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1057-0829
eISSN
1536-481X
DOI
10.1097/ijg.0000000000002073
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Abstract

LETTERS TO THE EDITOR synechial closure was present if (OR: 2.7, P = 0.007). They were less Letter to the dynamic gonioscopy with compression likely to receive Selective Laser Trabe- was not always performed. If partic- culoplasty (OR: 0.37, P = 0.009), which Editor: Self-Identified ipants had synechiae indicating that the is consistent with the fact that advanced Black Race as a trabecular meshwork (TM) function synechial closure could preclude suc- was already compromised at the time cessful Selective Laser Trabeculoplasty. Risk Factor for of LPI, the intraocular pressure would African Americans also had shorter be more likely to spike when burdened times to glaucoma surgery in time to Intraocular Pressure with this sudden increase in the load of event analysis (Hazard Ratio: 2.57, iris pigment. An eye prone to synechial P = 0.004). Elevation and angle closure would also possibly be Thus, we suggest that the phe- more prone to iritis after a laser pro- nomena of post-LPI IOP elevation Iritis Following cedure on the iris. Finally, the sugges- and iritis in African Americans may Prophylactic tion that iris pigmentation in dark be because of late presentation after irides of Black patients explains the the TM has been compromised. This Laser Peripheral difference in findings seems less plau- may be because of missed diagnoses sible given that Asian patients had a on Van Herrick, which can under- Iridotomy similar rate of post-LPI IOP elevation estimate the presence of occludable as White patients (P = 0.19) despite narrow angles, placing these patients having dark irides. at risk of developing synechial closure over time. We have shown that eyes Another reason to suspect that with PAC and PACG are more likely some patients were at the PAC stage at than thosewithPACStobemis- the time of LPI is that the baseline IOP diagnosed as deep using the Van was reported as 17.1 ± 5.8 in those Herrick technique and that Black race treated with Nd:YAG and 17.2 ± 5.6 in We read with great interest the article is an independent risk factor for a those treated with Argon-Nd:YAG by Adetunji et al Self-identified Black deep grading with Van Herrick techni- LPI. Two standard deviations above Race as a Risk Factor for Intraocular que in eyes with narrow angles on the mean would indicate an IOP of 28.7 Pressure Elevation and Iritis Following gonioscopy. Improved screening meth- or 28.4 mm Hg, respectively. More- Prophylactic Laser Peripheral Iridot- ods are needed to target African Ameri- omy. In this retrospective review of over, in the discussion, the authors note cans with occludable narrow angles so 1485 primary angle closure suspects that 2 of the 5 surgeons with the that preventive interventions such as LPI (PACS) eyes that underwent Nd:YAG greatest number of cases reported that can be performed earlier in the course of or sequential argon and Nd:YAG laser they had already initiated a glaucoma the disease to decrease the risk of medication in patients with a baseline peripheral iridotomy (LPI), self-identi- progression. IOP > 22 mm Hg undergoing LPI, fied Black race was documented as a which would suggest that those patients risk factor for both postprocedure IOP had at least PAC. According to the elevation [odds ratio (OR): 1.19, American Academy of Ophthalmology, P < 0.001] and iritis (OR: 5.07, Atalie C. Thompson, MD, MPH*† the definition of PAC includes those P < 0.001). The authors report that this Sanjay Asrani, MD† with synechiae or intraocular pressure finding was independent of laser type *Wake Forest Baptist Health, Department of > 21 mm Hg consistent with TM com- and energy, and conclude that greater Surgical Ophthalmology, Winston-Salem, NC promise, which may be due to inter- iris pigmentation in Black patients may †Department of Ophthalmology, Duke mittent angle closure. explain the higher incidence of post- University Medical Center, Durham, NC procedure ocular hypertension and We suggest that the more plausible iritis. reason for the presence of post-LPI IOP elevation in Black participants may be The authors describe that eyes REFERENCES due to late presentation and the pres- with a prior diagnosis of primary angle 1. Adetunji MO,Meer E,Whitehead G, et al. ence of PAC or possibly even PACG at closure (PAC), primary angle closure Self-identified black race as a risk factor the time of LPI. We have previously glaucoma (PACG), or chronic angle for intraocular pressure elevation and documented that African Americans closure glaucoma were excluded based iritis following prophylactic laser peri- are significantly more likely than on International Classification of Dis- pheral iridotomy. JGlaucoma. 2022;31: Whites to have PAC/PACG than eases codes. However, the methodology 218–223. PACS (OR: 2.12, P < 0.001) and to 2. Thompson AC, Vu DM, Cowan LA, does not describe the gonioscopy tech- et al. Factors associated with inter- already be taking glaucoma medi- nique that was used to determine ventions after laser peripheral iridotomy cations (OR: 2.25, P < 0.001) at the whether patients were indeed at the for primary angle-closure spectrum diag- stage of PACS. It is possible that time of LPI. In multivariable logistic noses. Ophthalmol Glaucoma. 2019;2: regression analysis, African Americans 192–200. A.C.T. receives support from the American were also more likely to be prescribed 3. Thompson AC, Vu DM, Cowan LA, Glaucoma Society and NIH/NEI additional glaucoma medications after et al. Risk factors associated with missed K23EY030897. LPI (OR: 1.73, P = 0.025), which is diagnoses of narrow angles by the Van Disclosure: The authors declare no conflict of consistent with IOP elevation, and were Herick technique. Ophthalmol Glaucoma. interest. more likely to receive glaucoma surgery 2018;1:108–114. DOI: 10.1097/IJG.0000000000002073 J Glaucoma Volume 31, Number 9, September 2022 www.glaucomajournal.com e87 Copyright r 2022 Wolters Kluwer Health, Inc. All rights reserved.

Journal

Journal of Glaucoma – Wolters Kluwer Health

Published: Sep 6, 2022

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