title: Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease.
abstract: OBJECTIVE
  To evaluate the angle closure scoring system (ACSS) for stratifying primary angle course disease.
  
  
  METHODS
  This observational cross sectional institutional study included patients with primary open angle glaucoma suspects (n = 21) and primary angle closure disease (primary angle closure, PAC, n = 63 and primary angle course glaucoma, PACG, n = 58 (defined by International society of Geographical and Epidemiological Ophthalmology, ISGEO). Two independent examiners blinded to clinical details, graded good quality pre-laser goniophotographs of the patients incorporating quadrants of peripheral anterior synechieae (PAS), non-visibility of posterior trabecular meshwork (PTM) and blotchy pigments (ranging from 1-4 quadrants), iris configuration, angle recess (sum of above depicting ACSSg) and lens thickness/axial length ratio (LT/AL), cup disc ratio and baseline intraocular pressure (IOP) to give total score (ACSSt).
  
  
  RESULTS
  There were significant differences in ACSSg scores within the same ISGEO stage of PAC and PACG between eyes that required nil or >1medicines after laser iridotomy, p<0.001. The ACSSg was associated with need for >1 medicines in both PAC and PACG eyes, p<0.001. An ACSSg score>12 and 14 in PAC (odds ratio = 2.7(95% CI-1.7-5.9) and PACG (Odds ratio = 1.6(95%CI-1.19-2.2) predicted need for single medicines while ACSSg scores >14 and 19 predicted need for ≥2 medicines in PAC and PACG eyes, respectively. The LT/Al ratio, IOP score or cup disc score did not influence the need for medical treatment independently.
  
  
  CONCLUSIONS
  The ACSS can be a useful clinical adjunct to the ISGEO system to predict need for medicines and prognosticate each stage more accurately.
authors: Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India.
authors: Aparna
authors: A
authors: Rao
authors: Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India.
authors: Debananda
authors: D
authors: Padhy
authors: Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India.
authors: Sarada
authors: S
authors: Sarangi
authors: Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India.
authors: Gopinath
authors: G
authors: Das
mesh_terms: D001699:Biometry; D003430:Cross-Sectional Studies; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged