Original article
Determinants of Lens Vault and Association With Narrow Angles in Patients From Singapore

https://doi.org/10.1016/j.ajo.2012.01.015Get rights and content

Purpose

To describe the distribution and determinants of lens vault and to investigate the association of lens vault with narrow angles.

Design

Prospective cross-sectional study.

Methods

Phakic subjects 50 years and older were evaluated at a primary healthcare clinic with gonioscopy, partial laser interferometry, and anterior segment optical coherence tomography (AS-OCT). Narrow angles were defined as posterior trabecular meshwork not visible for ≥2 quadrants on non-indentation gonioscopy. Lens vault was defined as the perpendicular distance between the anterior pole of the crystalline lens and the horizontal line joining the 2 scleral spurs on horizontal AS-OCT scans. Analysis of covariance, multivariate logistic regression, and area under the receiver operating characteristic curves (AUC) were performed.

Results

Of the 2047 subjects recruited, 582 were excluded because of poor image quality or inability to locate scleral spurs, leaving 1465 subjects for analysis. Eyes with narrow angles had greater lens vault compared to eyes with open angles (775.6 µm vs 386.5 µm, P < .0001). Women had significantly greater lens vault than men (497.28 µm vs 438.56 µm, P < .001), and lens vault increased significantly with age (P for trend <.001). Adjusted for age and sex, significant associations with greater lens vault were shorter axial length, shallower anterior chamber depth(ACD), higher intraocular pressure, and more hyperopic spherical equivalent (all P < .001). On multivariate analysis, subjects with lens vault >667.6 µm were more likely to have narrow angles (OR 2.201, 95% CI: 1.070-4.526) compared to those with lens vault ≤462.7 µm. The AUC for lens vault (0.816) and ACD (0.822) for detecting narrow angles were similar (P = .582).

Conclusions

Lens vault was independently associated with narrow angles and may be useful in screening to detect eyes with narrow angles.

Section snippets

Study Population

This was a cross-sectional study of persons aged 50 years and older who were recruited between December 7, 2005 and July 12, 2006 from a government-run polyclinic in Singapore that provides primary healthcare services for residents living in the area around the clinic. Details of the study have been described previously.12, 13 In brief, subjects were identified by systematic sampling (every fifth patient registered at the polyclinic) and asked to participate in the study after obtaining written

Results

A total of 2047 participants were recruited into the study. Among them, 582 subjects were excluded for the following reasons: 11 subjects could not undergo gonioscopy; 62 subjects did not complete AS-OCT examination or had poor quality AS-OCT images; 42 subjects showed software delineation errors; and the scleral spur was not clearly visible on AS-OCT images in 467 subjects. There were no significant differences between included and excluded subjects regarding race, spherical equivalent

Discussion

We found that lens vault is strongly associated with narrow angles in this Singapore Chinese population. Lens vault measures the extent of anterior projection of the lens over the level of the scleral spurs but AS-OCT is unable to assess the posterior portion of the lens (or the zonules or ciliary body). Since lens vault will be affected by both lens thickness and lens position, it serves as a measure that encompasses the effect of both parameters. This is important as individually each

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      They concluded that once LV goes above a given threshold for that particular ethnicity, angle narrowing tends to occur. Tan et al.11 found that there were no association between LV and race, and concluded that LV was independently associated with the presence of narrow angles and showed good diagnostic performance in detecting eyes with narrow angles. In contrast, Lee et al.18 reported that ethnic variation in anterior segment biometric parameters exists.

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