Prone Provocative Testing for Narrow Angle Glaucoma

New comparative clinical and biometric findings between acute primary angle-closure and glaucomatous eyes with narrow angle

“…Several provocative tests have been employed to try to identify patients at risk of developing acute angleclosure glaucoma, but most of them are either not very sensitive (29)(30) or time-consuming, and thus not suitable as screening procedures in general practice. Some authors suggested that an increase of a single parameter (LT/AL) is correlated with a decrease in duration in time to the need for LPI (30) .…”

Dark Room Provocative Test and Extent of Angle Closure

“…[10][11][12][13][14][15] It has been used extensively in the past to identify subjects with narrow angles at risk to develop angle closure. However, a followup study performed by Wilensky et al 16 indicated that the provocative test showed both a low sensitivity and a low positive predictive value in detecting the eyes that later developed angle closure.…”

Dark-room Prone-position Test for Intermittent Angle Closure

“…When the prone-position test was combined with the dark-room test, the incidence of positive results reached approximately 90% in narrow angle patients. 7 However, in a follow-up study of patients presumed to have angle-closure glaucoma with shallow anterior chambers or narrow anterior chamber angles, DRPT did not showed high sensitivity. 8 In that study, out of the 129 presumed glaucoma patients who performed DRPT, only 25 eyes in 17 patients (19.4%) showed positive results.…”

“…A positive response to the provocation test may be caused by a relative pupillary block, either because of the forward movement of the lens or the compression of the anterior chamber angle caused by a forward shift of the lens-iris diaphragm. 6,7,9 Recently, Kondo et al used ultrasound biomicroscopy (UBM) and observed that the anterior chamber angle of each eye remained open, despite the high level of IOP in eyes that showed a positive response to the prone provocation test, whereas the profile of the iris showed a markedly convex shape with a large space behind the posterior iris. 10 They suggested that the initial increase in IOP during the prone provocation test was associated with high pressure in the posterior chamber because of the relative pupillary block.…”