@article {1608588,
	title = {The Singapore Asymptomatic Narrow Angles Laser Iridotomy Study: Five-Year Results of a Randomized Controlled Trial},
	journal = {Ophthalmology},
	volume = {129},
	number = {2},
	year = {2022},
	month = {2022 02},
	pages = {147-158},
	abstract = {PURPOSE: To examine the efficacy of laser peripheral iridotomy (LPI) in patients who received a diagnosis of primary angle-closure suspect (PACS). DESIGN: Prospective, randomized controlled trial. PARTICIPANTS: This multicenter, randomized controlled trial (ClinicalTrials.gov identifier, NCT00347178) enrolled 480 patients older than 50 years from glaucoma clinics in Singapore with bilateral asymptomatic PACS (defined as having >=2 quadrants of appositional angle closure on gonioscopy). METHODS: Each participant underwent prophylactic LPI in 1 randomly selected eye, whereas the fellow eye served as a control. Patients were followed up yearly for 5 years. MAIN OUTCOME MEASURES: The primary outcome measure was development of primary angle closure (PAC; defined as presence of peripheral anterior synechiae, intraocular pressure [IOP] of \&gt;21 mmHg, or both or acute angle closure [AAC]) or primary angle-closure glaucoma (PACG) over 5 years. RESULTS: Of the 480 randomized participants, most were Chinese (92.7\%) and were women (75.8\%) with mean age of 62.8 {\textpm} 6.9 years. Eyes treated with LPI reached the end point less frequently after 5 years (n\&nbsp;= 24 [5.0\%]; incidence rate [IR], 11.65 per 1000 eye-years) compared with control eyes (n\&nbsp;= 45 [9.4\%]; IR, 21.84 per 1000 eye-years; P\&nbsp;= 0.001). The adjusted hazard ratio (HR) for progression to PAC was 0.55 (95\% confidence interval [CI], 0.37-0.83; P\&nbsp;= 0.004) in LPI-treated eyes compared with control eyes. Older participants (per year; HR, 1.06; 95\% CI, 1.03-1.10; P \&lt; 0.001) and eyes with higher baseline IOP (per millimeter of mercury; HR, 1.35; 95\% CI, 1.22-1.50; P \&lt; 0.0001) were more likely to reach an end point. The number needed to treat to prevent an end point was 22 (95\% CI, 12.8-57.5). CONCLUSIONS: In patients with bilateral asymptomatic PACS, eyes that underwent prophylactic LPI reached significantly fewer end points compared with control eyes over 5 years. However, the overall incidence of PAC or PACG was low.},
	keywords = {Aged, Female, Follow-Up Studies, Glaucoma, Angle-Closure, Gonioscopy, Humans, Intraocular Pressure, Iridectomy, Iris, Lasers, Solid-State, Male, Middle Aged, Prospective Studies, Singapore, Tonometry, Ocular, Treatment Outcome, Visual Acuity},
	issn = {1549-4713},
	doi = {10.1016/j.ophtha.2021.08.017},
	author = {Baskaran, Mani and Kumar, Rajesh S and Friedman, David S and Lu, Qing-Shu and Wong, Hon-Tym and Chew, Paul Tk and Lavanya, Raghavan and Narayanaswamy, Arun and Perera, Shamira A and Foster, Paul J and Aung, Tin}
}
