Angle Closure Glaucoma
Robert Ritch, Jeffrey M Liebermann

Accurate assessment of narrow or closed angles requires precise 4-mirror dynamic gonioscopy.1 Use of the Goldmann lens is much less accurate. Pressure on the cornea forces aqueous humour into the angle, widening it. The presence and extent of synechial closure and the depth of the angle can be determined. The angle should be assessed with respect to iris convexity, width, depth, and the dimensions of peripheral anterior synechiae (PAS) or the presence of other pathology. when assessing a narrow angle for occludability, gonioscopy in a completely darkened room using the smallest square of slit-beam light to avoid stimulating the pupillary light reflex is of the utmost importance. The quadrant of angle to be assessed is examined with the 4-mirror lens without pressure on the cornea and with the patient looking sufficiently far in the direction of the mirror so that the examiner can see deeply into the angle. The angle is observed while the pupil dilates in the dark. The narrowest quadrant is usually the superior angle (inferior mirror). PAS may be deep in the angle and difficult to see when the angle is very narrow and the iris very con- vex. Appositional closure and PAS most commonly form initially in the superior angle. When angle closure is limited to the superior angle, maximum pigmenta-tion of the trabecular meshwork may occur there.3 This pigment is characteris-tically blotchy and scattered over the trabecular meshwork. The Anatomic Basis of Angle Closure Glaucoma ttt Angle closure glaucoma (ACG) is an anatomic disorder comprising a final common pathway of iris apposition to the trabecular meshwork resulting from various abnormal relationships of anter-ior segment structures. These in turn result from 1 or more abnormalities in the relative or absolute sizes or positions of anterior segment structures or poster-ior segment forces that alter anterior segment anatomy.4 ACG can be caused

SightFirst China Action
An Interview with Dr Tam Wing Kun

According to the World Health Organization, more than 9 million people in China are blind, with 4 million due to cataracts. Although 200,000 cataract surgeries are conducted annually in China, 400,000 new cataract cases arise each year as a result of age-ing and population growth. "SightFirst China Action" is part of a worldwide programme called "SightFirst" that was established to help people with curable sight problems. The programme was started by the Lions Club Inter-national (LCI) in 1990. It is estimated that there are about 40 million blind people worldwide and that 80% have conditions that are reversible, curable or preventable. So far, US$146 million has been raised by Lions Club members to support this initiative. A pilot programme was run in China in 1993, using more than US$620,000 given by LCI. A total of 25,612 cataract surgeries were performed. Because of the success of this trial and keen interest by the Chinese government, a further sum of US$15.4 million was set aside by LCI in 1997. This was matched with US$150 million from the Chinese government and so the first year of a 5-year agenda called "SightFirst China Action" began. In 1997 and 1998, approximately 710,000 cataract surgeries had been performed, with 59 medical teams having visited 30 provinces.

The plan is for 2 medical teams to visit a province twice a year and to treat at least 800 patients at each visit. 38 ophthalmologists from Hong Kong have volunteered their services. Rural poverty-stricken areas are being focused on because people in these places do not have work-related health insurance as do many city-dwellers in China and have to pay for any treatment they might need under the state system. These people are often farmers and cannot afford to pay hospital fees and so remain untreated. In addition, people living in high altitude areas often have cataracts because of their high daily UV exposure. The programme has some wide-ranging objectives but the primary one is to help make China self-reliant in terms of performing an adequate number of quality cataract surgeries. Sophisti- cated equipment taken to China for use in operations will be left behind and local ophthalmologists will be trained in the necessary surgical skills and expertise. The aims of SightFirst China Action include: · restoring sight to 1.75 million people with cataract blindness in China between 1997 and 2002 · establishing or improving eye clinics in 100 county hospitals · training 4000 ophthalmologists and 7000 clinical support staff · introducing advanced production lines for the increased production of quality artificial intraocular lenses. SightFirst China Action is also develop-ing an eye disease prevention database to help research into eye disease clusters and causes, and recruiting 'eye screen-ing teams' for training and dispatch to designated areas to perform eye disease research, management and treatment. Educating the public about the need for eye care and ways to prevent blindness and gain treatment is another priority.