Can ultrasonic biometric indices with optimal cut-offs be a potential screening tool for primary angle closure disease? A case-control study

Background/Objectives Despite a significant disease burden and potential to cause blindness, primary angle closure disease (PACD) does not have a population-based screening programme. Biometric indices using ultrasound A-scan is a potential tool for glaucoma case-detection. Given that genetic and environmental factors influence these parameters and paucity of data on their discrimination thresholds in Indian populace, we conducted a matched case-control study to determine the biometric indices and their discrimination thresholds associated with PACD. Methods We studied 172 eyes of 86 participants (43 cases; 43 controls). We compared the following biometric parameters of cases (PACD, occludable angle >= 180 degrees +/- raised intraocular pressure) with age and gender-matched controls (1:1): Anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens position (LP), relative lens position (RLP), lens axial factor (LAF), simple crowding value (Cs), ACD/AXL). We performed conditional logistic regression (to identify factors associated with PACD) and Receiver operating characteristic (ROC) analysis (to determine discrimination thresholds). Results Reduced ACD (Adj OR 0.01; 95% CI: 0.0003-0.15, p < 0.001) and increased LT (Adj OR 10.3; 95% CI:2.42-43.93, p < 0.001) were associated with PACD. On ROC analysis, ACD, Cs, and ACD/AXL had optimum sensitivity/specificity at <= 3.015, >= 0.056 and <= 0.1303, respectively. ACD (88.4%) and Cs (94.2%) had highest sensitivity and specificity, respectively. Conclusion Ultrasonic biometric parameters differed significantly between PACD and controls. ACD and Cs (at discrimination thresholds of <= 3.015 mm and >= 0.056, respectively) using ultrasound A-scan could be a potential tool for PACD case-detection that requires evaluation of its diagnostic yield and cost-effectiveness.