Determinants of angle closure in older Singaporeans

Objectives: To investigate systemic and ocular risk factors for angle closure (AC) in older Singaporeans and to determine if these risk factors are different in men vs women and in Chinese vs non-Chinese persons. Methods: A cross-sectional study of 2042 subjects with phakia 50 years or older recruited from a primary care clinic in Singapore. Subjects completed a detailed questionnaire and underwent refraction, biometry, and gonioscopy. Univariate and multivariate analyses were performed to determine risk factors for AC. Results: The prevalence of AC among this study population was 19.3% (n=395); 89.4% (n=1826) of the study population were Chinese. In univariate analysis, patients with AC were older, female, and of Chinese descent and had shorter axial length, lower body mass index, higher intraocular pressure, and shallower anterior chamber depth. In multivariate analysis, female sex ( odds ratio [ OR], 1.43; 95% confidence interval [CI], 1.06-1.92; P=.02), Chinese race/ethnicity ( OR, 3.58; 95% CI, 2.03-6.29; P <.001), axial length ( OR per millimeter increase, 0.69; 95% CI, 0.58-0.81; P <.001), and central anterior chamber depth of less than 2.80mm vs at least 3.00 mm ( OR, 42.5; 95% CI, 27.4-66.2; P <.001) were independently associated with AC. Conclusions: In this community-based study of older Singaporeans, statistically significant independent predictors of AC were female sex, shorter axial length, shallower central anterior chamber depth, and Chinese race/ethnicity. Sex and racial/ethnic differences in the risk of AC were not fully explained by sex and racial/ethnic variations in axial length or anterior chamber depth.