Risk Factors for Angle-Closure Glaucoma
The most important risk factors for primary angle-closure glaucoma are Asian ethnicity, older age (especially >50 years), female sex, hyperopia, short axial length, shallow anterior chamber depth, and thick/anteriorly positioned crystalline lens. 1
Demographic Risk Factors
Ethnicity
- Highest risk populations: Inuit, Chinese, and other Asian populations have dramatically elevated rates compared to other ethnic groups 1, 2
- Asian descent confers substantially higher risk even when controlling for other anatomical factors 3
- Lower rates in African-derived and European-derived populations 1
- In some Asian populations, angle-closure glaucoma accounts for nearly as many cases as open-angle glaucoma 1
Age
- Risk increases significantly with age, particularly after 50 years 1, 2
- Patients aged 60-69 have 3.5-fold increased odds compared to those 50-59 years 3
- Patients aged 70-79 have 4.7-fold increased odds 3
- Most affected individuals are adults over 50 years 1
Sex
- Female sex is a consistent independent risk factor 1, 4
- Women have higher prevalence across multiple population studies 4
Ocular Anatomical Risk Factors
Anterior Segment Characteristics
- Shallow peripheral anterior chamber depth - one of the strongest predictors 1, 2
- Shallow central anterior chamber depth 1, 2
- Short axial length - each millimeter shorter increases risk 1.67-fold 1, 2, 5, 3
- Hyperopia (farsightedness) - particularly high hyperopia 1, 2, 4
Lens-Related Factors
- Thick crystalline lens 1, 2
- Anteriorly positioned lens 1
- Lens thickening with age increases risk by crowding the anterior chamber angle 1
Other Ocular Features
- Steep corneal curvature 1, 2
- Anterior position of ciliary body (plateau iris configuration) 1
- Thinner central corneal thickness 3
Systemic and Clinical Risk Factors
Medical Conditions
- Presence of cataract - 3.77-fold increased odds 6
- Hyperlipidemia - 1.10-fold increased odds 6
- Elevated triglyceride levels 6
- Lower body weight 6
Intraocular Pressure
Family History
- Positive family history of glaucoma - 3.21-fold increased odds 5
- Genetically related family members should be counseled about their risk 1
Medication-Related Risk Factors
Drugs That May Precipitate Angle Closure
- Anticholinergic medications (over-the-counter cold/flu medications, allergy medications, sleeping aids) 1, 2
- Adrenergic agents (decongestants) 2
- Topiramate and sulfonamides (can cause ciliary body edema) 1, 2
- Short-term antidepressant exposure - 1.36-fold increased odds of acute angle closure 6
- Psychoactive and motion-sickness medications with anticholinergic properties 1
Clinical Implications
Important caveat: The untreated fellow eye in patients with unilateral acute angle-closure crisis is at extremely high risk for developing acute angle closure 1, 2. This represents a critical opportunity for prevention through prophylactic intervention.
The combination of multiple risk factors compounds the overall risk. For example, an elderly Asian woman with hyperopia and family history of glaucoma represents the highest-risk profile and warrants careful gonioscopic screening 1.
Prevalence context: Worldwide, 0.7% of people over 40 have angle-closure glaucoma, representing 20.2 million people, with 15.5 million in Asia 1, 2. The prevalence is projected to increase 50% by 2040 1.