Narrow angle of the anterior chamber & narrow angle glaucoma

Considerations

The angle formed between the cornea and the iris gradually decreases with age as the crystalline lens thickens. This trend is more marked in people with brown eyes. The condition will generally be identified in a presbyopic applicant undergoing routine optometrist examination for the purpose of near vision prescription.

The existence of a narrow angle puts the applicant at risk of chronic glaucoma or acute angle closure, an incapacitating condition. Prophylactic office surgery by laser iridotomy or iridoplasty is generally effective. Cataract extraction is curative because the thin lens implant no longer puts pressure on the anterior chamber angle.

Information to be provided

Applicants who first present with a history of narrow angle or narrow angle glaucoma or whom the ME suspects may have a narrow angle, should provide:

• A special eye report;
• An ophthalmologist report;
• If glaucoma is present or suspected, the result of visual fields testing.

Applicants who subsequently present with a history of history of narrow angle of the anterior chamber or narrow angle glaucoma should provide:

• Follow up reports and any other reports at intervals as advised by their treating ophthalmologist. The ME or Director may seek further reports.

Disposition in case of narrow angle of the anterior chamber or narrow angle glaucoma

• An applicant with untreated narrow angle, or who has glaucoma should be assessed as having a condition that is of aeromedical significance.

An applicant with narrow angle may be considered as not having a condition that is of aeromedical significance only if:

• The applicant has undergone prophylactic treatment; and
• The ophthalmologist indicates a low residual risk of acute narrow angle closure; and
• Glaucoma is not present; and
• The applicant undertakes regular surveillance as advised by the treating specialist.

An applicant with narrow angle glaucoma that is treated, stable and has only a small unilateral visual field deficit, not overlapping the contralateral blind spot, may be considered as having a condition that is not of aeromedical significance if:

• The ophthalmologist indicates a low residual risk of acute narrow angle closure;
• If beta-blocker eye drops are used, there are no respiratory, cardiac, or others side effects; and
• If other medications are used, there are no side effects of aeromedical significance; and
• Regular surveillance, including repeat visual fields determination as appropriate, takes place as recommended by the treating ophthalmologist but at least annually.

In case of doubt the ME should seek advice from the CAA.