PACS+ Guidance on GOS18 module
When referring a patient with suspect glaucoma and a van Herick angle of grade 2 or less in either eye, clinicians will now be given the option to view the PACS plus referral guidance before making referral.
The guidance is as follows:
PACS-plus referral guidance
Primary Angle Closure Suspect (PACS) definition: limbal anterior chamber depth is <25% (van Herick grade 0 or 1), IOP is normal, no evidence of optic nerve damage or visual field loss.
When to refer PACS patients: Routine referral is only required if patient meets above definition PLUS at least one of the following criteria:
- People with only one ‘good’ eye
- Vulnerable adults who may not report ocular or visual symptoms
- Family history of significant angle closure disease
- High hypermetropia (> +6.00 dioptres)
- Diabetes or another condition necessitating regular pupil dilation
- Those using antidepressants or medication with a definite anticholinergic action
- People living in remote locations where rapid access to emergency ophthalmic care is not possible
PACS-minus:
If an individual has the angle-characteristics specified above but none of the above additional criteria and does not meet NICE glaucoma referral guidelines (based on IOP ≥24mm Hg or presence of signs of glaucoma) they should be advised to seek an annual examination.
References and further information:
https://www.rcophth.ac.uk/wp-content/uploads/2022/06/Management-of-Open-Angle-Closure-Glaucoma.pdf