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John F. Salmon, FRCS; Andre Mermoud, MD; Andrew Ivey, MB ChB; Sonya A. Swanevelder; Margaret Hoffman, MB ChB

Arch Ophthalmol. 1993;111(9):1263-1269.

Abstract
Objective
To determine the prevalence of primary angle closure glaucoma in the so-called Cape people of mixed ethnic background.

Design
A population-based prevalence study.

Setting
Mamre, a village near Cape Town, South Africa.

Participants
Individuals aged 40 years or older. Historically, their ancestors were Southeast Asians and indigenous Africans and, to a lesser extent, Europeans. Of a total of 1194 people, 987 (82.7%) were examined.

Main Outcome Measure
Primary angle closure glaucoma was diagnosed in individuals with previous acute or intermittent symptoms of angle closure and in individuals with an "occludable" angle and an intraocular pressure of greater than 21 mm Hg or a glaucomatous visual field.

Main Results
An age-related trend toward hypermetropia was found, which was greatest in women older than age 50 years. Gonioscopy identified Shaffer grade 1 angles in 89 (9%) of 987 subjects. The prevalence of primary angle closure glaucoma was 2.3% (23 subjects) and increased with age in both sexes. Women were affected more than four times as often as men and the sex difference persisted across all age groups. In comparison, the prevalence of primary open angle glaucoma was 1.5% (15 subjects). Primary glaucoma (angle closure plus open angle) was the leading cause of bilateral blindness in the community, with a prevalence rate of 0.5% (five subjects).

Conclusions
This study identified primary angle closure glaucoma as a significant public health problem in the Western Cape Province. Because of the ethnic background of the people studied, these findings may also apply to the populations of Southeast Asia.

Author Affiliations
From the Departments of Ophthalmology (Drs Salmon, Mermoud, and Ivey) and Community Health (Dr Hoffman), Groote Schuur Hospital and University of Cape Town (South Africa) and the Department of Biostatistics, Medical Research Council of South Africa, Cape Town (Ms Swanevelder).

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