Anterior Chamber Depth and Chamber Angle and Their

Associations with Ocular and General Parameters: The
Beijing Eye Study

LIANG XU, WEI FANG CAO, YA XING WANG, CHANG XI CHEN, AND JOST B. JONAS

S
● PURPOSE: To investigate the normative data of anterior INCE THE CLINICAL INTRODUCTION OF THE SLIT-
chamber depth (ACD) and angle width and their associ- lamp into ophthalmology by Vogt, the dimensions of
ations in Chinese adults. the anterior segment of the eye have usually been
● DESIGN: Population-based study. estimated by slit-lamp-supported biomicroscopy of the eye.
● METHODS: The Beijing Eye Study 2006 included The development of optical coherence tomography (OCT)
3,251 subjects (73.3%) (aged 45ⴙ years) out of 4,439 and its application in clinical ophthalmology allowed a direct
subjects who participated in the 2001 survey and who measurement of the intraocular structures. It was first applied
returned for reexamination. The subjects underwent an to determine the structures of the posterior segment of the
ophthalmologic examination including measurement of eye, to evaluate the thickness of the macula, and to monitor
the anterior chamber dimensions by slit-lamp-based op- a therapeutic success of intravitreally applied medications.1
tical coherence tomography (OCT). Recently, OCT has become available to also measure the
● RESULTS: Out of the 3,251 subjects, OCT measure- structures of the anterior segment of the eye, such as the
ments were available for 2,985 subjects (91.8%). Mean depth of the anterior chamber and the width of the anterior
ACD measured 2.42 ⴞ 0.34 mm and the mean anterior chamber angle (ACA).2–5
chamber angle (ACA) was 38.3 ⴞ 16.3 degrees. In Since the associations between anterior segment mea-
multivariate analysis, a shallow chamber depth was sig- surements and ocular and general parameters, including
nificantly associated with age (P < .001), hyperopic major medical diseases, have not yet been systemically
refractive error (P < .001), female gender (P < .001), assessed, and because the anterior segment measurements
short body stature (P ⴝ .003), nuclear cataract (P ⴝ are risk factors of primary angle-closure glaucoma, which is
.03), central corneal thickness [CCT] (P < .001), large common particularly in Asia, it was the purpose of the
optic disk (P < .001), and presence of chronic angle- present study to measure depth and angle of the anterior
closure glaucoma (P < .001). Correspondingly, a narrow chamber and to assess their associations with other param-
ACA was associated with age (P < .001), female gender eters in a population-based study in mainland China.
(P < .001), hyperopia (P < .001), nuclear cataract (P <
.001), short body stature (P ⴝ .001), large optic disk
(P < .001), and angle-closure glaucoma (P < .001).
Chamber depth and angle width were not associated with METHODS
presence of age-related maculopathy and diabetic retinop-
THE BEIJING EYE STUDY IS A POPULATION-BASED CROSS-
athy.
● CONCLUSIONS: A shallow anterior chamber and a nar-
sectional study in Northern China. It was carried out in
four communities in the urban district of Haidian in the
row chamber angle in Chinese adults are associated with
North of Central Beijing and in three communities in the
age, female gender, hyperopia, nuclear cataract, small optic
village area of Yufa of the Daxing District South of Beijing.
disk, short body stature, CCT, and chronic angle-closure
The study has been described in detail recently.6,7 At the
glaucoma. These data may be helpful to explain anatomic
time of the first survey in the year 2001, the seven
relationships of the anterior segment of the eye, and to
communities had a total population of 5,324 individuals
elucidate risk factors of angle-closure glaucoma. (Am J
aged 40 years or older. In total, 4,439 individuals (2,505
Ophthalmol 2008;145:929 –936. © 2008 by Elsevier Inc.
women) participated in the eye examination, correspond-
All rights reserved.)
ing to an overall response rate of 83.4%. The study was
Accepted for publication Jan 5, 2008. divided into a rural part (3,946 eyes; 1,973 subjects; 1,143
From the Beijing Institute of Ophthalmology, Beijing Tongren Hospi- women) and an urban part (4,932 eyes; 2,466 subjects;
tal, Capital Medical University, Beijing, China (L.X., W.F.C., Y.X.W.,
C.X.C., J.B.J.); and the Department of Ophthalmology, Faculty of 1,362 women). Mean age was 56.20 ⫾ 10.59 years (me-
Clinical Medicine Mannheim, University of Heidelberg, Mannheim, dian, 56 years; range, 40 to 101 years).
Germany (J.B.J.). In the year 2006, the study was repeated by reinviting all
Inquiries to Jost B. Jonas, Beijing Institute of Ophthalmology, 17
Hougou Street, Chong Wen Men, 100005 Beijing, China; e-mail: participants from the survey from 2001 to be reexamined,
Jost.Jonas@augen.ma.uni-heidelberg.de with 3,251 subjects participating (response rate: 73.3%).

0002-9394/08/$34.00 © 2008 BY ELSEVIER INC. ALL RIGHTS RESERVED. 929
doi:10.1016/j.ajo.2008.01.004

7 The pupil was dilated using tropicamide once or twice.26 Glaucoma type No glaucoma 2893 96. We measured the either in schoolhouses or in community houses.66 Age group (years) 45⬃ 1180 39. iris whorling.75 65⬃ 752 25.68 Gender Male 1291 43. anterior chamber depth (ACD) and the ACA in the rected visual acuity was measured (Snellen charts) in a temporal region and the nasal region using a software distance of 5 m.72 15. max. and changes in the anterior segment repeated. SD ⫽ standard deviation.33 36. Japan) by an experienced technician. an ab- ments was taken for further statistical analysis.42 0.31 42. Gonioscopy was generally performed tonometer (CT-60 computerized tonometer.94 2.8 Intraocular specialist for all study participants with glaucoma and all pressure (IOP) was measured using a noncontact pneumo.53 16.00 D. glaucoma suspects.9 Gonioscopy doubling perimetry using the screening program C-20-1 was routinely performed by an experienced glaucoma (Zeiss-Humphrey.34 34. The ACD was performed.78 2.03 12.47 2.34 38.85 .37 48.36 0. Digital axial optical resolution capacity ⬍ 25 ␮m. Three mea.32 39. and glaukomflecken of the lens.20 1. an surements were taken. Refractive error (expressed as spherical equivalents.12 15.19 16. the central tometer AR-610.34 41. Automatic refractometry (Auto Refrac. those subjects with an IOP higher than 21 mm Hg. USA). until the pupil diameter was at least 6 mm.45 No refractive data available 44 1. diode laser. 20 to 100 ␮m. Anterior Chamber Depth and Anterior Chamber Angle as Measured by Optical Coherence Tomography in Adult Chinese of the Beijing Eye Study.69 14. Japan) was corneal thickness (CCT) was determined. synechiae.0.00 D. SER): hyperopia as mean SER ⬎ 1. such as peripheral anterior ophthalmologist.25 ACA ⫽ anterior chamber angle.33 32.41 0.25 2.31 37. Nidek Co.40 32.19 2. program supplied with the device. mm. 2006 ACD (mm) ACA (degree) N (Subjects) Percent (%) Mean SD Mean SD Area Rural 1428 47. lateral optical resolution capacity.25 0.07 Primary open-angle glaucoma 58 1.00 D and ⱖ ⫺1.56 2. ACD ⫽ anterior chamber depth.34 36.27 18.57 Primary angle-closure glaucoma 33 1.00 diopter (D). All examinations were carried out in the communities. ACD is evaluated from corneal endothelial surface to anterior lens surface.40 39.58 Female 1694 56.53 2. abnormal result in frequency doubling perimetry.75 2.03 2. if uncorrected visual acuity was lower than 1.52 0.84 2. subjectively assessed using the van Herick method. respectively. 15 mm. em- Visual field examinations were performed by frequency ploying a slit-lamp-assisted biomicroscopy. In addition.45 0. A slit-lamp examination was performed by an of the eye suggesting glaucoma.34 2.25 0.31 16.34 15.16 2. Ltd.39 0.38 15. inclusive. Topcon Ltd.36 37. photographs of the cornea and retro-illuminated photo- 1310 nm) of the anterior segment of the globe was carried graphs of the lens were taken using the Neitz CT-R camera 930 AMERICAN JOURNAL OF OPHTHALMOLOGY MAY 2008 .55 16.30 30.93 2.37 18.43 0. and emmetropia as mean SER ⱕ 1.43 . 48. Dublin.43 0. If the normal finding in slit-lamp biomicroscopy such as a shal- measurements were higher than 25 mm Hg.51 Refractive error Myopia 513 17. Total 2985 100. scan size. An OCT (Heidelberg Engineering.25 55⬃ 846 28.74 14. out for the right eyes of the subjects.50 0.90 12.00 2. Germany. senheim.33 0.22 Secondary glaucoma 1 0. prior to the pupil dilation. scan depth.24 0. Glaucoma suspects were all Tokyo.59 Hyperopia 471 15. ACA is the angle with the scleral spur as apex and two boundaries at a distance of 500 ␮m at the inner corneoscleral surface and at the iris surface. myopia as mean SER ⬍ ⫺1.19 2.60 0.42 0.97 16. Dos. Uncor.74 Urban 1557 52.60 19.92 2. TABLE 1. and the mean of the three measure. California.89 0.43 75⬃ 207 6. tonometry was low anterior chamber.33 38.56 Emmetropia 1957 65. Tokyo.17 15.

s. ⫺5. ⫺0. Tokyo.68 (n.) ⫺0.001 0.03 0. 0.24 (n.22 Age (years) ⬍.66 concentration (mmol/l) Fasting blood high-density . 95% CIs of the difference between the two groups tested or of the steepness of the regression line.s.08 0. The “grade 6.85 (n.02 .75 Cortical cataract (%) ⬍.03. the Wisconsin ARM Grading System was lens photographs using the classifying scheme for cataract used as described recently.s. Canon Inc.71.88.s. ⫺0. 145.45. presence of Instruments Co).” Grade 1 was no nuclear opacity in the lens and optic disk slides were projected and we examined the grade 6 was very dense nuclear lens opacity.005 0.64 0.01. ⫺0. ⫺0.02 . ities appeared as darkly shaded areas on the white back.08 (n.11 ⫺0.51 ⫺0. Associations Between Anterior Chamber Depth and Anterior Chamber Angle as Measured by Optical Coherence Tomography in the Beijing Eye Study 2006. arteries in the peripapillary region.04 0.68 Fasting blood glucose (mmol/l) .001 ⫺0. Japan).76 lipoprotein (mmol/l) Fasting blood low-density .5 18.6. 0.s.085.99 damage Chronic angle-closure ⬍.15 .001 ⫺0.04.017.) ⫺0.011. 0.066 0. ⫺2. 0.03 0.72.001 ⫺3.) ⫺1.46 (n. decreased diffuse visibility of the RNFL and occurrence of ground through the computer screen.06.13 0.29 Body mass index .032 ⫺0.002.s.01. ⫺0.70.036.32 .22.23 .11 Diabetes mellitus .001 5.) ⫺0. 5 ANTERIOR CHAMBER DEPTH IN CHINESE 931 .32 lipoprotein (mmol/l) Glaucomatous optic nerve .75 (n.43 ⫺4. For the assessment of age-related macu- nuclear cataract was graded in 6 grades according to the lopathy (ARM). ⫺0.01 ⫺0.026.74.07 0.01 ⫺0.9 9.001 0.001 ⫺2. 0.06 ⬍. 0.001 ⫺0. and Ocular and General Parameters (Univariate Analysis) Anterior Chamber Depth (mm) Anterior Chamber Angle (degrees) Slope of the Slope of the Regression Line or 95% CI of the Slope Regression Line or 95% CI of the Slope P value Mean Difference or Mean Difference P value Mean Difference or Mean Difference Gender ⬍.01 ⫺0.49 Body weight (cm) ⬍.69.s. The degree of qualitative parameters “shape of the neuroretinal rim” with cortical lens opacification and posterior subcapsular lens special respect to the inferior-superior-nasal-temporal opacification was graded using two photographs taken by (ISNT) rule including presence of neuroretinal rim retro-illumination with the Neitz CT-R camera (Neitz notches.001 0.51.24 0.008 ⬍.68. ⫺0.8 glaucoma Chronic open-angle glaucoma .s.00 ⫺0. 0. 3. ⫺0.78 ⫺6.03.061 ⬍.10 Monoscopic pho. 0.65 (n.) ⫺0.17 ⫺1.12 CI ⫽ confidence intervals.01 ⫺0.19. that is.01. 0. 0.004 ⫺1.025 .15 0.81 ⬍.000 ⫺0.1.26.012 ⬍.21 Rural/urban region .006 1.001 ⫺0.001.s.33 Optic disk area (mm2) . 0.s. The degree of Tokyo.95 Age-related maculopathy . 4.005 .14 ⫺0. 0.001 0. The percentage area marked diffuse thinning or focal thinning of the retinal of opacity was measured using a grid. 0.46 ⫺2. ⫺0.001 0.000 .23 Fasting blood cholesterol .10 . for the presence of glaucomatous optic nerve damage.39 (n. ⫺0.s. ⫽ nonsignificant.42 0.16 Diabetic retinopathy .001 0.) 0. (Neitz Instruments Co.66 0.4 Central corneal thickness (␮m) .10 (n.03 4.002 .) 0.005 31.47 0. D ⫽ diopter. 3.01 . NO.004 .04.001 0.) 0.048 0.01 .36 (n. ⫺0.s.11 of the Age-Related Eye Disease Study.004 ⫺2. 0.73 ⫺0.91 ⫺1. n.) ⫺0.10 We combined In addition.12 The optic disk pho- tographs (on film) of the macula and optic disk were taken tographs were additionally digitized and the optic disk using a fundus camera (Type CR6-45NM.02.94 . 2.47.027 ⬍.) 1.s.) ⫺2.01. ⫺0.13 0.05 3. ⫺0.002 ⫺0.107 . 54. ⫺2. Japan).074.73 0.48.32 concentration (mmol/l) Fasting triglycerides .34 Refractive error (D) ⬍.40 ⫺0. ⫺0.049 ⫺0. TABLE 2.02 ⫺0. 30.22.88 Arterial hypertension ⬍.50.17 0.15.48 (n.001 ⫺0.39 . 0.006 ⫺0.005.001 24.001 0.35.76 (n.09. 0. 0.009. structures were measured by outlining the borders of the VOL.15 (n.01 Body height (cm) ⬍.003 ⫺0.19.004 0.20 ⫺0.80 Nuclear cataract (degree 0 to 6) ⬍.51.017.02 ⫺0.88 ⫺6.88. 6.s.02 0.11.05 ⫺0.34 ⫺0.010 0. ⫺4. 0. occurrence of optic disk hemorrhages. the optic disk photographs were examined standard photographs 6 and 7 into one grade.004 ⫺13. 0. 9. 0.) 0.04 ⫺0.02 . Cortical and posterior subcapsular opac.5 ⫺22. 0.009 ⫺0.) ⫺0.03 ⫺1.10.001 ⫺0.001 0.4 Subcapsular cataract (%) .001 ⫺0. localized defects in the retinal nerve fiber layer (RNFL).16 ⬍.31 ⫺3.46.03 ⫺0. 0.

56 75 to 79 Male 83 2.33.29 0. peripapillary scleral ring. IOP was no criterion for the diagnosis. ment of high blood pressure at the time of the interview.29 38. as Female 17 2.” the optic disk appeared glaucomatous and the visual field showed defects that could be explained by no other disease than glaucomatous optic neuropathy.30 44.87 15. A visual field defect was defined as any abnormal test point in the frequency doubling perimetry if the rate of false- positive results was equal to or lower than 0.20 0.68 15. Chicago.22 chronic open-angle glaucoma vs chronic angle-closure glaucoma 70 to 74 Male 156 2.06 14. Statistical analysis was performed using a commercially oretinal atrophy was divided into a peripheral alpha zone available statistical software package.34 0.72 15. and alpha self-reported history of physician diagnosis of diabetes zone and beta zone of peripapillary atrophy border on the mellitus or by a history of drug treatment for diabetes computer screen.35 15.31 41. optic cup.42 0.0 mmol/l or by a optic disk.28 14.32 47.59 in the Beijing Eye Study. and/or self-reported current treatment for arterial hypertension with antihyper- FIGURE 1. The optic disk was defined as all the area (insulin or oral hypoglycemic agents).28 28. The statistical analysis was performed on the basis 932 AMERICAN JOURNAL OF OPHTHALMOLOGY MAY 2008 .33 32. low- density lipoproteins.36 0.33 37. and the arterial blood pressure was determined by the Riva-Rocci method. Box plots showing the distribution of the anterior tensive medication.34 33.41 27.33 0. and if the rate of fixation loss was equal to or lower than 0. 2006.23 0.0 (SPSS.07 Total 2.09 15.83 15. cholesterol. we diagnosed diabetes mellitus as any fasting plasma glucose concentration ⱖ 7.84 FIGURE 2.34 37.46 0.52 0.30 60 to 64 Male 177 2.27 Female 68 2.69 55 to 59 Male 153 2. For study purposes. Chi-square tests optic disk border with visible large choroidal vessels and were used to compare proportions. presented.23 0.34 38. The fasting concentrations of glucose. SPSS for Windows.60 Female 235 2. In the definition of “perimetric glau- coma. Treatment of arterial hypertension chamber depth in normal subjects and subjects with chronic open-angle glaucoma vs chronic angle-closure glaucoma in the was defined as use of a prescribed medication for manage- Beijing Eye Study. and high-density lipoproteins were determined in blood samples.25 described in detail previously.85 16.88 14.30 13.93 Female 375 2. for the diagnosis.33 34.73 16. TABLE 3. 2006 Anterior Chamber Anterior Chamber Depth (mm) Angle (degrees) Age Group (Years) Gender N (Subjects) Mean SD Mean SD 45 to 49 Male 249 2. Female 175 2.44 0.51 pearance of the optic disk as the only criterion. Illinois.43 0.15 0.72 15.” IOP was not a criterion *Mean ⫾ standard deviation.64 80⫹ Male 39 2.18 13.36 0.63 0. with irregular pigmentation and a central beta zone at the version 15.33 anterior chamber angle in normal subjects and subjects with Female 209 2.13 Glaucoma was defined by the glaucomatous ap.35 31.33 37.31 16. arterial hypertension was defined as a systolic blood pressure ⱖ 140 mm Hg and/or a diastolic blood pressure ⱖ 90 mm Hg. Box plots showing the distribution of the mean 65 to 69 Male 212 2. USA). diagnosis of “optic disk glaucoma. Anterior Chamber Depth* and Anterior Chamber Angle* in the Beijing Eye Study.32 37. Confidence intervals were sclera.52 14.985 2.65 Female 281 2.66 50 to 54 Male 222 2.60 0.83 16.79 Female 334 2. 2006.32 32.29 43. Peripapillary chori. inside of the peripapillary scleral ring. Using criteria of the World Health Organization (WHO).49 0. Body weight and height were measured.6 The height of IOP and presence of visual field defects were not criteria for the SD ⫽ standard deviation.33.

49 ⫺2. P values are statistical significance of the association. and arterial hypertension. range. and presence of primary angle-closure measurements (n ⫽ 1.06. presence of 4. In a second step. and fasting blood concentrations of cholesterol 1.17 diopters (D). and low-density and high- measurements (n ⫽ 2.24.17 ⫺4.002.000.007 ⫺0. 0. cholesterol. optic disk size.08 ⫺0.51 ⫾ chronic angle-closure glaucoma. The mean ACD measured 2.02 0.001 ⫺0. ated with the dependent variables in univariate analysis.001 ⫺2. with ACD as dependent param- available for 2. arterial hypertension. rural region. body height and weight.001 ⫺0.62. ⫺0. 0. fasting blood concentra- (n ⫽ 4.251 SUBJECTS OF THE BEIJING EYE STUDY 2006. In addition. D ⫽ diopter.89.05.42 ⫾ 0.001 ⫺17.72. P ⫽ . In OCT measurements of the ACD and chamber angle were that multivariate analysis.69 Central corneal thickness (␮m) . ⫺0.98 years. hyper- concentrations of glucose.002 0. 60 years. ⫺0. 2 and 3). ⫺2. large optic disk. 60. low-density and high-density lipoproteins. 95% CI: 0. cortical cataract and thy. hypertension.001 0. fasting blood concentrations of choles- Table 2).66.30 ⬍.16 Nuclear cataract (degree 0 to 6) . nuclear cataract. 95% CI for the coefficient and model R-square was 0. prevalence of diabetes mellitus. It was excluded from the multivariate analysis.3 ⫾ 16.05. ⫺0. and presence of chronic open-angle glaucoma or ARM. The same results were obtained if stepwise the indepen- In univariate analysis. odds ratio [OR]: 1.001) larger in men than in women (Tables 2 and 3). as independent parameters. significantly associated with age.05 ⫺0.03.001.1 ⫾ 9. *As measured by optical coherence tomography as dependent parameter and ocular and general variables as independent parameters.9.5 ⫺26.02 ⫺0.001) larger in men than in women (Tables 2 and 3).16 0. 2. the ACD was significantly (P ⬍ dent parameters described above were included in or . 95% confidence interval (CI): 2.985) with the subjects without OCT density lipoproteins.06 ⬍. ⫺0.2 ⫾ 10.005 ⬍.1. body mass index.04 Chronic angle-closure glaucoma ⬍.06 ⫺1.45 D vs ⫺0. Including all participants of the Beijing Eye Study 2001 prevalence of diabetes mellitus. presence of diabetic retinopa.27 Body weight (kg) .04.10 0.34.02 ⫺0. fasting blood concentration of triglycerides. P ⬍ .05. body mean refractive error was – 0. arterial hypertension.001 ⫺0. and high-density and low-density lipoproteins (Table 4).02 D). 2 ⫽ female) ⬍. cortical cataract and subcapsular cataract. The mean ACA measured 38.001 ⫺0.40 ⫺2.91.002 0.06 ⬍.13 ⫺2. and VOL.3 degrees (Tables nuclear cataract.16 Refractive error (D) ⬍.004 0. years.18). NO.03. a multivariate analysis was performed RESULTS that included all parameters that were significantly associ- OUT OF THE 3. ⫺8. the mean ACD was not less than .001 ⫺2. Mean age was eter and age. ⫺0.30.83 Arterial hypertension . body height and weight. 5 ANTERIOR CHAMBER DEPTH IN CHINESE 933 .04. 0. cataract.15 Gender (1 ⫽ male. CCT.09 ⫺0. In univariate analysis. subcapsular cataract. TABLE 4. ⫺0. cholesterol. 2006* Anterior Chamber Depth (mm) Anterior Chamber Angle (degrees) P value Coefficient 95% CI P value Coefficient 95% CI Age (years) ⬍. of subjects and not of eyes. presence of and primary angle-closure glaucoma (Figures 1 and 2.008. low body height.1 CI ⫽ confidence interval.25 ⫺0. nuclear cataract. gender. 0.8 ⫾ 11. height. cortical and subcapsular in gender (P ⫽ . hyper- was significantly older (58. All P values were two-sided and correlated with the ACA (P ⬍ .18 D. ⫺0.50 ⫺0.001 ⫺0. arterial (P ⬍ . fasting blood It was significantly associated with age.76).004 ⬍.8%) (Table 1).0 years (median. refractive error. significantly associated with rural vs urban region.001 ⫺0. CCT.001 0. cortical cataract and subcapsular cataract.32 ⫾ 2. ⫺0. 95% CI: ⫺0.30.40 years) and was significantly more myopic (⫺0. the ACA was significantly CCT.007 .33 It was no longer associated with the presence of diabetes diopters.62 Body height (cm) ⬍. ⫺0.001 ⫺3. Results of the Multivariate Analysis of the Associations Between Anterior Chamber Depth and Anterior Chamber Angle in the Beijing Eye Study.33 ⫾ 2.985 subjects (91. In univariate analysis. 45 to 89 years).69. optic disk size.004 ⫺0.001.12.001 ⫺0. 0. female gender. 0. opic refractive error. ⫺1.001 ⫺1. nuclear cataract. a shallow anterior OCT measurements and not included in the present study chamber was still significantly associated with age.003 . correlation coefficient were considered statistically significant when the values were r ⫽ 0.454) showed that the group without glaucoma.9 opic refractive error.01 ⫺0.86 ⫺3. the ACD was highly significantly terol and low-density and high-density lipoproteins.001. Both groups did not differ significantly mellitus or diabetic retinopathy.34 mm (Table 1).11.000 — — — Optic disk size (mm2) ⬍.01 .6 years vs 55. body weight. 145. hyperopic refractive error.439) and comparing the subjects with OCT tions of glucose. ⫺0.03 ⫺0.04 ⬍.

hyperopic refractive error. and presence of chronic angle-closure glaucoma had a significantly shorter body height than glaucoma (Table 4). found in the present study. chamber angles. Although the rate of coma (personal data). In univariate with a shallow anterior chamber. female gender.14 –16 They explain why age and hyperopia are the chamber. Taking all the findings together. with a risk different glaucoma types may be considered separately. the ACA The finding of the association between shallow anterior became narrower with increasing age. one has to consider thin cornea has been reported to be a risk factor for that the global attrition rate as based on the originally progression. females. presence of arterial hypertension. body as found in the Rotterdam Study and the Beijing Eye height and weight.21 It fasting blood concentrations of cholesterol and low-density seems to contradict the association of a large optic disk and and high-density lipoproteins. It has remained unclear why on various ethnic populations and hospital-based investi. Considering that the optic disk size is correlated with THE PRESENT POPULATION-BASED STUDY ON MAINLAND the number of rods. large optic disk. central cornea (Table 4).324 subjects invited to participate in the Beijing Eye risk factors or associated factors of glaucoma. the larger the optic disk. a thick cornea takes away some space from the anterior As for any population-based study. it also explains why the disk size was not ract.24 future studies may address whether refractive error.23. nuclear association between body height and size of the optic disk cataract. Study: the taller the person. refractive error. cones. chamber depth and chamber angle are correlated with each other. recent study in which subjects with chronic angle-closure nuclear cataract. body corneal curvatures. and retinal ganglion cell axons as well as with the shallow ACD is associated with higher age. chronic open-angle angle-closure glaucoma group than in the remaining eyes glaucoma. how much the results of the present study performed in the Correspondingly. subjects with chronic open-angle glaucoma:25 it may sug- The results on the association between shallow anterior gest that a short body height may be one of the potential chamber. although high-density and low-density lipoproteins (Table 4). In addition. therefore. shorter body height. the mean ACA was not significantly associated with degree of nuclear cataract was significantly higher in the CCT. and triglycerides (Table 2). nuclear cataract. short body stature. This association is similar to the dent parameter and age. eyes with greater Beijing area can be generalized to the population of primary angle-closure glaucoma had significantly thicker the whole country. 2001 was close to 2. a thick cornea may be a relative risk factor. and thicker correlate with ACD and body height. Interestingly. was associated significantly older (P ⬍ . 2006 was in contrast to chronic open-angle glaucoma. the question arises chamber so that the chamber depth becomes shallower. the analysis. the two Study. cortical cataract and subcapsular cataract. arterial hypertension. One of the reasons could be that females had a predominant risk factors for an acute primary angle-closure shorter body stature and that the statistical multivariate attack. with a short body stature.339 of 5. and relatively flat cornea22 and. Correspondingly. with ACA as depen. small the count of the retina cells and optic nerve fibers also optic disk. nonparticipation. prevalence of diabetes mellitus. It may suggest that for angle-closure subjects with OCT measurements compared with the glaucoma. compared with males. longer associated with the presence of diabetes mellitus Since eyes with flat corneas do not necessarily have narrow and arterial hypertension.985 of 3. cortical and subcapsular cata. nuclear cataract. retinal pigment epithelium Chinese living in the greater Beijing area suggest that a cells. small optic disk. and fasting blood concentration of glucose of the Beijing Eye Study (personal data).251 (91.chronic angle-closure glaucoma (Table 2). and presence of chronic a relatively shallow anterior chamber as simultaneously angle-closure glaucoma as independent parameters re. which is usually measurements and not included in the present study was associated with a thickening of the lens. eyes with a large disk tend to have a height and weight. Correspondingly. and age and hyperopic screening parameters to detect subjects prone to develop refractive error confirm previous population-based studies angle-closure glaucoma. for which a relatively high 2. a relatively shallow central anterior chamber. The reason for the discrepancy vealed that narrow ACA was still significantly associated may be the correlation between disk size and low anterior with age. hyperopic retinal surface area. had a shallower anterior gations. The relationship between a shallow anterior cham. the group without OCT Similar to the CCT.324 (44%). in the Beijing Eye Study. narrow chamber angles. because of the relatively flat presence of chronic angle-closure glaucoma. study is. gender.001) and was significantly more 934 AMERICAN JOURNAL OF OPHTHALMOLOGY MAY 2008 .17–20 It also shows that for the assessment of 5. It was no cornea. A major concern in any prevalence central corneas than eyes with chronic open-angle glau. and fasting blood concentrations of cholesterol and associated with the ACA in the present study.8%). analysis did not completely compensate the interdepen- ber and a thick cornea may be explained by the fact that dency of female gender and shorter body height. female gender. of a selection bias. a shallow anterior chamber was associated Performing a multivariate analysis. optic disk size. one may infer that subjects with a short body stature may have smaller DISCUSSION eyes with a shallower anterior chamber and a smaller optic disk. female gender. ARM. It is whole population of the Beijing Eye Study. hyperopic refractive chamber and short body stature is in agreement with a error.

The Age.J. Wang S.120:714 –720. de Jong Ophthalmol 2001.131:734 – mol 2002. Since. Foster PJ. Xu L. Determinants of optic disk characteristics in a VOL.X. small optic disks.119:1179 –1185. the present population-based study on data. Muliyil JP. optical coherence tomography of the anterior segment at and Black populations. the onset of primary open-angle glaucoma. depth measurement as a screening tool for primary angle- thalmol 2005. Involved in design of study (L. et al.C.).). tomography. however.).. 145. Role of Hypertension Treatment Study: baseline factors that predict frequency doubling perimetry in detecting neuro-ophthal. Y. See JL.B. 16. Panda-Jonas S. et al. Arch Oph- 5. The Wisconsin Age-Related Maculopathy Grading System.C. 19. Ophthalmology 1991. 1.W.. 4.X. Ophthalmoscopic nerve fiber layer and optic nerve head in glaucoma with evaluation of the optic nerve head.X. Jonas JB. Leung CK. Hofmann A.. Noncontact 15. Beiser JA. Klein R. collection and management of the data (L.46:891– 13.F. 14. Am J Ophthalmol 1969. PTVM. width of angle of anterior chamber.F. closure glaucoma in an East Asian population.F. angle-closure glaucoma.W.B. Arch Oph. abnormalities in ocular hypertensive eyes. Weinreb RN. and to elucidate risk factors of tical significances of the correlations.W. Jonas JB. Y. Optische Kohärenztomographie der Kornea Part I. 2.18:375–381. Biometry and 3. however. Chan WM. female gender. Central corneal 9..X.F.J. Xu L.C. Congdon NG. et al. Am J 21. 5 ANTERIOR CHAMBER DEPTH IN CHINESE 935 . 741. 1495.03). Nguyen NX. Since age and refractive error were dare to say that the associations found between the found to be associated with ACD and ACA. Ramrattan RS. Characteristics of corneal thickness in the Ocular Hypertension Treatment highly myopic eyes. Ophthalmology 2001. and approval of the manuscript (L. Optical coherence thalmol 2000. Invest Ophthalmol Vis Sci und des vorderen Augenabschnitts. Dr Jonas received an unrestricted grant and is a speaker for Heidelberg Engineering and holds an advisory position with Zeiss-Meditec Inc.). Wang Y. Y. angle-closure using anterior segment optical coherence 6. et al. Thomas D.X.. Gusek GC.). W. Wang Y. Ophthalmol.131:167–175. The Medical Ethics Committee of the Beijing Tongren Hospital approved the study protocol and all participants gave informed consent.. Jonas JB. Peripap- 899. Estimation of thickness as a risk factor for advanced glaucoma damage. anterior segment of the eye. 481– 486. Ophthalmology 1997.C. Brandt JD.X. et al. Wang Y.B. Karandish M.X.108:1779 –1788. 18. High myopia and tomography in Asian eyes. tomography imaging of the anterior chamber angle. et al.94: 1989. objective of the study was to provide population normative In summary. Roth JE. 39. W. Gordon MO.. Shaffer RN. hyperopia. Jonas JB. Haberle H. The Ocular 8. Hui YL... C. Baasanhu J. preparation and review of the manuscript (L. nuclear choose not to adjust the data but to present the data as cataract. Beiser JA.. Jonas JB. measurements and frequency doubling technology perimetry 10. It has.C... The Beijing Eye Study. Oph. Radhakrishnan S. Kass MA. Arch Ophthalmol 2001. Medeiros FA. J. Y. White.30:908 –918. Birngruber R. Morphometric data. Naumann GOH.X.118:257–263. C. Herndon LW.X. using optical coherence 43:293–320. Huang D. Incidence and signif. Ophthalmology Related Eye Disease Study (AREDS) system for classifying 2003. Nolan WP.114:121–126. Flache S. Invest Ophthalmol Vis Sci 2005. a higher measured. a short body stature. different reference plane offsets. CHINA. The Beijing Eye Study.110:1903–1908. Smith S.X. Anterior chamber goniometry with optical coherence tomography.).114:216 –220. Detection of primary thalmol Clin N Am 2005. Arch Ophthal- mic visual field defects. THIS STUDY WAS SUPPORTED BY THE BEIJING KEY LAB FUNDING.J. Devereux JG.98:1128 –1134. Youlin Q. one may anterior chamber measurements and the other ocular and argue that some adjustment would be required since the general parameters may be valid.X. C. 2007.C.W. J. Am J Ophthalmol 2001. W. Stinnett SS. Rollins AM. Arch Ophthalmol 2004. one may. Davis MD. Chew PT.. Surv Ophthalmol 1999.W. Radhakrishnan S.myopic (P ⫽ . remained unclear how far the CCT.. 17.122:17–21. REFERENCES 11.B. Y. et al. Gordon MO. Lankenau E. J. et al.104:1489 – 1310 nm.X. W. Central 7. Real-time primary angle-closure glaucoma among Chinese. Age-Related Eye Disease Study Research Group. Thomas R.68: 20. 4. Van Herick W. age and myopic refractive error have Chinese adults living in the greater Beijing area suggests an opposite effect on the anterior chamber measurements that a shallow anterior chamber and a narrow ACA are and may thus partially compensate for each other. George R. J. These data results of the present study can be generalized for the whole may be helpful to explain anatomic relationships of the Chinese population.. Corneal thickness 626 – 629. therefore. Brandt JD. ogy 2007. illary chorio-retinal atrophy in normal and glaucoma eyes. Koop N.. Weizer JS. Ophthalmology Study (OHTS).C. Magli YL. we associated with higher age. W.J. Schwartz A.X. Analysis of retinal 12.123:179 –185. conduct of study (L. cataracts from photographs: AREDS Report No.C.114:33– glaucoma susceptibility. Sample PA. Ophthalmology 2007. according to the Declaration of Helsinki. BEIJING. Wirbelauer C. Engelhardt R. THE AUTHORS INDICATE NO FINANCIAL conflict of interest. Wang S. Quigley H. analysis and interpretation of the data (L. icance of the narrow angle. Wolfs RCW.. Li Y. Ophthalmologe 1997. and chronic angle-closure glaucoma.F. Brinkmann R. NO. Budde WM. In view of the relatively high statis.X.

25. Macrodiscs in eyes with flat and and optic disc size. Li J.101:519 –523. optic disc size in normal human eyes. Ophthalmology The Beijing Eye Study. Ger J Ophthalmol 1994. Schmidt AM. Human optic nerve fiber count 22. Jonas JB. Xu L. Invest Ophthalmol Vis Sci 1992. Müller-Bergh JA.106:1588 –1596.33: large corneas. Wang Y. Ophthalmology 24. general population. Schneider U. Königsreuther KA. Jonas JB. Naumann GO. Jonas JB.85:914 – 1994. and ences between angle-closure versus open-angle glaucoma. 23. Jakobczyk M. 915. hardt UM. 2012–2018. Schlötzer-Schre- 1999. Acta Ophthalmol 2007. Anthropomorphic differ- Retinal photoreceptor count. retinal surface area.3:179 –181. The Rotterdam Study. Panda-Jonas S. Jonas JB. 936 AMERICAN JOURNAL OF OPHTHALMOLOGY MAY 2008 .

145. and Editor-In-Chief of Ophthalmology in China. VOL.e1 . 5 ANTERIOR CHAMBER DEPTH IN CHINESE 936. Biosketch Professor Liang Xu is a Director at the Beijing Institute of Ophthalmology (WHO Collaborating Center for Prevention of Blindness). Dr Xu’s main research interests are glaucoma and epidemiology (Principal Investigator. Beijing Eye Study). the Vice President of the Beijing Tongren Hospital. NO. a member of the standing committee of the Chinese Ophthalmological Society. Dr Xu received the Golden Key Medal of the Sino-American Ophthalmologic Society and the Outstanding Service in Prevention of Blindness Award by APAO congress.