The primary angle-closure spectrum occurs most commonly, but not exclusively, in patients with hyperopia, regardless of race. Nonetheless, angle closure does occur in patients with significant myopia, underscoring the importance of gonioscopy in all patients. Angle closure in a patient with high myopia is a prompt for the clinician to search for secondary mechanisms such as microspherophakia, plateau iris, or phacomorphic angle closure related to nuclear sclerotic cataract. However, the primary angle-closure spectrum may occur in individuals even with simple myopia, particularly those of Asian descent. Axial myopia is primarily the result of elongation of the posterior segment of the eye, while the anterior segment sometimes retains properties that predispose to angle closure. Thus, even though myopia and axial elongation are associated with lower risk for angle closure, there may be some risk in myopic eyes.
Yong KL, Gong T, Nongpiur ME, et al. Myopia in Asian subjects with primary angle closure: implications for glaucoma trends in East Asia. Ophthalmology. 2014;121(8):1566–1571.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.