General
Domains: Clinical Practice, Communication
No CPD Points
Welcome to Sound Optometry, a podcast from Docet hosted by Michelle Hanratty, an IP optometrist with over 20 years’ experience in both high street and hospital settings. Each month, through case studies and in-depth conversations, we explore the topics that matter most to you as an optometrist and are relevant to everyday practice.
Episode 48 - PACS: Management of primary angle closure suspects
Primary angle closure disease is more prevalent in the UK than previously thought, making it essential for optometrists to understand its progression—from primary angle closure suspect (PACS), to primary angle closure (PAC), and ultimately, primary angle closure glaucoma (PACG). PACG, which involves irreversible optic nerve damage and vision loss due to an occluded drainage angle, is significantly more visually destructive than primary open angle glaucoma. However, early detection allows for effective preventative treatments, such as laser peripheral iridotomy or clear lens extraction.
The disease stems from iridotrabecular contact leading to narrowing of the anterior chamber angle, and it accounts for a larger share of glaucoma cases than often assumed. Because its symptoms can be subtle and the impact severe, recognising signs during routine eye exams is crucial.
In this podcast episode, following the PAC, PACS, and PACS+ in Focus webinar, consultant ophthalmic surgeon Nishani Amerasinghe joins Michelle to recap the critical insights optometrists need to know. Through a case discussion, they highlight key risk factors guiding patient management, answer listener questions, and explore long-term treatment strategies in community practice.
An additional reading element consolidates the learning on this topic.
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First published: April 2025
Last reviewed: December 2025