Objective:

To evaluate the management strategies for patients with primary angle-closure suspect (PACS) in the context of preventing progression to angle-closure glaucoma (PACG) and assessing the effectiveness of various interventions.

Key Findings:

• Prophylactic LPI significantly reduces the risk of conversion from PACS to PAC or PACG, highlighting its role in preventive care.
• Routine gonioscopy is often inaccurately performed, leading to misclassification of angle-closure patients, which can impact treatment decisions.
• AS-OCT metrics may aid in diagnosing and monitoring PACS but have limitations in predictive power, necessitating further validation.

Interpretation:

The management of PACS requires a nuanced approach, weighing the benefits of prophylactic LPI against the risks and considering individual patient factors, emphasizing the need for patient-centered care.

Limitations:

• Variability in gonioscopy accuracy due to clinic conditions and clinician experience, which may introduce biases in patient classification.
• Lack of longitudinal studies on the predictive power of AS-OCT, limiting its application in routine clinical practice.

Conclusion:

While LPI is favored in many cases, careful monitoring and individualized treatment plans are essential for managing PACS effectively, and ongoing research is crucial to refine these strategies.