In 2022, a review article titled ‘A deep dive into the latest European and Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines’ provided recommendations for the diagnosis of primary angle-closure glaucoma (PAC). However, a slight update was done in 2023 to the figure. After the modifications, the definition of primary angle- closure glaucoma was in sync with the APGS guidelines depicted in the below figure.¹

Figure 1. Diagnostic algorithm for PAC glaucoma by the APGS1

Adapted from Murthy GJ, et al. Indian Journal of Ophthalmology. 2023

APGS: Asia-Pacific Glaucoma Society; IOP: intraocular pressure; PAC: Primary angle closure.

Inclusion of acetazolamide/mannitol depends on the level of intraocular pressure (IOP) and its safety. The mechanism of action of anti-glaucoma drugs works with elevated IOP as they act at the receptor level. The lack of an effect of pilocarpine on the sphincter pupillae is due to the elevated IOP resulting from a pupillary block, leading to sphincter ischemia.¹

The EGS and APGS guidelines recommend:¹

• The ideal intraocular pressure (IOP) should be tailored to each individual.
• Continuously reassessed based on the current stage of disease.