The edition · Ophthalmology
Angle closure that is really VKH: the cost of not looking behind the lens
An Indian series shows Vogt-Koyanagi-Harada disease masquerading as angle closure with diagnostic delays of up to seven years, genetics flag a retinal signal for CETP inhibitors, and home tonometry catches pressure burden the clinic misses.
The edition in brief
Among 768 patients with Vogt-Koyanagi-Harada disease at an Indian tertiary centre, 18 (36 eyes) first presented as angle closure; fundus examination was often deferred, diagnosis was delayed by up to seven years, and poorer presenting vision predicted worse outcome. Drug-target Mendelian randomisation in UK Biobank and a Singapore cohort linked genetically proxied CETP inhibition with higher risk of AMD, including roughly threefold odds of exudative AMD and polypoidal choroidal vasculopathy in East Asians - a safety signal to watch as these lipid drugs advance. In 150 treated glaucomatous eyes, home tonometry metrics capturing how far and how often pressure exceeded the patient's target were associated with faster visual field loss, while clinic readings were not. A Korean natural history study of 126 patients with EYS retinal degeneration found linear ellipsoid zone loss of about 4.6% a year. The pearl covers bilateral acute angle closure.
Genetic CETP inhibition was linked to higher AMD risk
Genetic evidence links CETP inhibition with AMD; if these drugs reach practice, retinal surveillance in high-risk patients deserves consideration.
Home tonometry caught pressure excess that clinic readings missed
When glaucoma progresses despite good clinic pressures, consider home tonometry - time spent above target tracked field loss better than clinic readings.
EYS retinal degeneration progresses linearly, about 4.6% a year
Expect steady structural decline of about 4-5% a year in EYS retinal degeneration, and track it with serial OCT.
Bilateral acute angle closure: ask what pushed the lens forward
Bilateral acute angle closure calls for a drug history and posterior segment imaging before treating it as pupil block.
Vogt-Koyanagi-Harada disease presenting as angle closure was diagnosed late
In angle closure with a poor fundus view, especially bilateral or inflamed, image the posterior segment early - VKH can masquerade and delay costs vision.
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