Search

El Testamento Vital (TV) recoge las preferencias de tratamiento de una persona para cuando sea incapaz de tomar decisiones por sí misma. Nuestro país está dando los primeros pasos para su implantación. Para que el TV sea accesible y útil para las personas mayores, conviene conocer cómo se ha desarrollado en otros países. En EE.UU., el TV ha pasado de una concepción formal y burocrática a otra integral, denominada de Planificación Anticipada de Decisiones Sanitarias. La población mayor española tiene una opinión favorable sobre el TV si se incluye en una estrategia de comunicación con la familia y los profesionales. Tener en cuenta los hallazgos de la literatura facilitará el desarrollo de un modelo organizativo efectivo que normalice en España el uso del testamento vital por parte de los mayores.The Living Will (LW) gathers the treatment preferences of a person. Spain is starting the LW' implantation. In order to the TV will be accessible and useful for the older people, we have to know how it has been developed in other countries. In United States, TV has happened through different stages: from a formal and bureaucratic conception to an integral concept, denominated Advance Care Planning. Spanish old adults have a favourable opinion about TV, but it is necessary to include it in a strategy of communication and dialogue with its family and its professionals caregivers. Review literature findings will facilitate the development of an effective organizational model that standardizes in Spain the use of the TV by the old adults.

Se llevo a cabo un estudio exploratorio-bibliométrico de principales proyectos editoriales para la divulgación del conocimiento arquitectónico y de urbanismo sobre América Latina. Se analizó el enfoque de especialización temática, particularmente respecto al conocimiento de los procesos de urbanización. Se presentan algunas directrices de consolidación de la investigación y la divulgación de este tipo de conocimiento a partir de los resultados.

Afortunadamente, nuestra sociedad, avanza en cuanto a libertades individuales. Esto se hace evidente desde la aparición de la Ley 41/ 2002 básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica, entrando en vigor el 16 de mayo de 2003 donde quedan reflejados los mínimos éticos por debajo de los cuales nadie debe situarse. Está Ley además de otorgar protagonismo al respeto de la autonomía de nuestros pacientes hace referencia al documento de Instrucciones Previas (IP), entendiendo por este como una declaración anticipada de elección de cuidados para que esta se cumpla en el momento en que llegue a situaciones en cuyas circunstancias no sea capaz de expresarlos personalmente cuando se acerque al fallecimiento. La literatura muestra que las IP son un fenómeno donde están involucrados no solo los pacientes y profesionales sanitarios, sino la sociedad en su conjunto. Este artículo pretende revisar cuál es la participación de los profesionales sanitarios en este proceso, e intenta reflexionar sobre el profesional que liderará y motivará este fenómeno, para no identificar el proceso de cuidado con la simple revisión de la firma de un documento, sino mas bien con la planificación de las decisiones sanitarias al final de la vida desde una concepción integral de los cuidados. Abstract: Our society keeps on achieving goals regarding individual liberties. This fact has been reinforced since the law 41/2002 (basic law on patient rights, duties and autonomy regarding health information and documentation) was approved on May 16th 2003. This law establishes the ethic boundaries not to be crossed regarding health attention. Additionally to the patient autonomy, this law includes the reference to the living wills, defined as an anticipated declaration about the desired care in case of loosing the capability to give an opinion about it when the end of life is coming. Literature makes clear that living wills are a phenomena in which not only the patients and the health professionals are involved, but the whole society. This article aims to revise the participation of the health and medical professionals in this process, as well as to think about the role of the health carer leading this process. The objective is not to reduce the caring process to a simple document signing, but to plan health decisions when the end of life is coming from a global conception of the caring process. Centro de Trabajo: Hospital General Universitario Morales Meseguer (Murcia), (*) Hospital Infantil La Paz (Madrid), Instituto Servicios Sociales de la Región de Murcia (**). Red Temática de Investigación en cuidados a personas mayores (RIMARED) Fecha del Trabajo: 01/09/2005 Palabra Clave: Autonomía, Instrucciones Previas, Voluntades Anticipadas, Voluntades Vitales Anticipadas, Testamento Vital, Planificación Anticipada de las Decisiones, Enfermería. Key Words: Autonomy, Living Wills, Advance directives, advance care planning, Advance Decision care planning’s, Nursing

Our society keeps on achieving goals regarding individual liberties. This fact has been reinforced since the law 41/2002 (basic law on patient rights, duties and autonomy regarding health information and documentation) was approved on May 16th 2003. This law establishes the ethic boundaries not to be crossed regarding health attention. Additionally to the patient autonomy, this law includes the reference to the living wills, defined as an anticipated declaration about the desired care in case of loosing the capability to give an opinion about it when the end of life is coming.Literature makes clear that living wills are a phenomena in which not only the patients and the health professionals are involved, but the whole society.This article aims to revise the participation of the health and medical professionals in this process, as well as to think about the role of the health carer leading this process. The objective is not to reduce the caring process to a simple document signing, but to plan health decisions when the end of life is coming from a global conception of the caring process.

Objetivo principal Estudiar si la cumplimentación de una Voluntad Vital Anticipada (VVA) o el añadido de una intervención educativa mejoran la concordancia entre las preferencias de cuidado y tratamiento expresadas por una persona mayor y las que en su lugar estimaría su representante. Objetivos secundarios 1. Valorar la confianza de la persona mayor en la capacidad del representante de predecir sus preferencias sobre cuidado y tratamiento. 2. Recoger la opinión de los mayores sobre la probabilidad de que su sustituto respete sus preferencias de cuidado y tratamiento. 3. Explorar la opinión de los mayores y representantes sobre la realización de un documento de VVA. 4. Vivencias del representante cuando tiene que decidir por una persona mayor que ha perdido la capacidad. Participantes y metodologia: Ensayo clínico en el que usuarios de 65 y más años serán muestreados sistemáticamente de los Centros de Salud del Distrito de Granada y aleatorizados con enmascaramiento simple en tres grupos experimentales: En el grupo control el representante predice las preferencias de cuidado y tratamiento del mayor sin la cumplimentación del documento de VVA. En el Grupo de Intervención 1 el mayor cumplimenta un documento de VVA y se le entrega al representante para que lo conozca. En el Grupo de Intervención 2, mayor y representante asisten a una sesión educativa y un proceso comunicativo sobre la toma de decisiones por representación, y luego el mayor rellena, en presencia del representante, un documento de VVA. La concordacia será medida con el LSPQ (Life Support Preferences Questionnaire), ya traducido y validado para poblacion hispanoparlante, y la opinión mediante una encuesta de items cerrados diseñada para tal fin. Abstract General Objective To study if just completing an Advanced Directive document (ADd) or adding an educational intervention improve the accuracy between care and treatment preferences expressed by an elderly person and the predicted by the surrogate. Specific Objectives 1. To evaluate the confidence of elderly people in the aptitude of the surrogate to predict their preferences on care and treatment. 2. To collect the opinion of elders about the probability that the surrogate will respect their care and treatment preferences. 3.To explore the elderly people opinion and their surrogates´ about the Advance Directive document. 4. To explore the surrogate´s experience when he must decide for a elderly that he has lost the capacity. Participants and Methodology Clinical trial where elderly persons above 65 will be systematically sampled from the patients attended at the Primary Health Care Centers of Granada District. The sample will be single blind randomized in three groups: in the control group the surrogate predicts the elderly person care and treatment preferences, without completing an ADd. In the Intervention Group 1 the elder will complete an Advance Directive document, and the surrogate will predict the elder preferences using the Add. In the Intervention Group 2, the elder and his/her surrogate will attend an educational session and a communicative proccess on surrogate decision making, before the elder complete the ADd. Accuracy will be mesured with the LSPQ (Life Support Preferences Questionnaire), translated and validated for Spanish Speakers, and the opinion will be meausered by a cuestionnaire. Centro de Trabajo: (1) Fund. Hosp. Virgen de las Nieves, (2) Asoc. Àmbits-Esport, (3) Dist. AP de Granada, (4) Hosp. Morales Meseguer, (5) Hosp. Santa Creu i Sant Pau, (6) Asesoría y Desarrollo de Proyectos de Salud, (7) EASP, (8) Hosp. Txagorrixtu, (9) Hosp. Juan Canalejo Fecha del Trabajo: 15/07/2004 Palabra Clave: Decisiones de representación, voluntades anticipadas, testamento vital, planificación anticipada de las decisiones sanitarias, preferencias de cuidado Key Words: Substituted decision making, Living will, advance care planning, care preferences

Purpose: To develop and test a deep learning (DL) algorithm for detecting referable glaucoma in the Los Angeles County (LAC) Department of Health Services (DHS) teleretinal screening program., Methods: Fundus photographs and patient-level labels of referable glaucoma (defined as cup-to-disc ratio [CDR] ≥ 0.6) provided by 21 trained optometrist graders were obtained from the LAC DHS teleretinal screening program. A DL algorithm based on the VGG-19 architecture was trained using patient-level labels generalized to images from both eyes. Area under the receiver operating curve (AUC), sensitivity, and specificity were calculated to assess algorithm performance using an independent test set that was also graded by 13 clinicians with one to 15 years of experience. Algorithm performance was tested using reference labels provided by either LAC DHS optometrists or an expert panel of 3 glaucoma specialists., Results: 12,098 images from 5,616 patients (2,086 referable glaucoma, 3,530 non-glaucoma) were used to train the DL algorithm. In this dataset, mean age was 56.8 ± 10.5 years with 54.8% females and 68.2% Latinos, 8.9% Blacks, 2.7% Caucasians, and 6.0% Asians. 1,000 images from 500 patients (250 referable glaucoma, 250 non-glaucoma) with similar demographics (p ≥ 0.57) were used to test the DL algorithm. Algorithm performance matched or exceeded that of all independent clinician graders in detecting patient-level referable glaucoma based on LAC DHS optometrist (AUC = 0.92) or expert panel (AUC = 0.93) reference labels. Clinician grader sensitivity (range: 0.33-0.99) and specificity (range: 0.68-0.98) ranged widely and did not correlate with years of experience (p ≥ 0.49). Algorithm performance (AUC = 0.93) also matched or exceeded the sensitivity (range: 0.78-1.00) and specificity (range: 0.32-0.87) of 6 LAC DHS optometrists in the subsets of the test dataset they graded based on expert panel reference labels., Conclusions: A DL algorithm for detecting referable glaucoma developed using patient-level data provided by trained LAC DHS optometrists approximates or exceeds performance by ophthalmologists and optometrists, who exhibit variable sensitivity and specificity unrelated to experience level. Implementation of this algorithm in screening workflows could help reallocate eye care resources and provide more reproducible and timely glaucoma care.

Purpose: To assess patterns in gonioscopy during initial glaucoma evaluations in the United States., Design: Retrospective, case-control study., Methods: Patients undergoing initial glaucoma evaluation between 2009-2020 were identified in the Optum Clinformatics DataMart. Initial evaluation was defined as follows: (1) glaucoma suspect, anatomical narrow angle (ANA), or primary/secondary glaucoma diagnosed by an ophthalmologist; (2) continuously observable during a 36-month lookback period; (3) no history of glaucoma medications, laser, or surgical procedures; and (4) optical coherence tomography (OCT) or visual field performed within 6 months of initial diagnosis. Logistic regression models were developed to identify factors associated with no record of gonioscopy based on Current Procedural Terminology (CPT) codes., Results: Among 198,995 patients, 20.4% and 29.5% had recorded gonioscopy on the day of diagnosis or within 6 months, respectively. On multivariable analysis, odds of recorded gonioscopy within 6 months of initial evaluation was lower (P < .001) among non-Hispanic Whites (OR=0.84) but similar for Blacks (OR=1.02) and Hispanics (OR=0.96) compared with Asians. Age ≥60 years (OR<0.82), pseudophakia/aphakia (OR=0.58), or residence outside of the Northeast region (OR=0.66-0.84) conferred lower odds of recorded gonioscopy (P < .001). Angle closure glaucoma (OR=0.85), secondary glaucoma (OR=0.31), or open angle glaucoma/suspect (OR=0.12/0.24, respectively) patients were less likely to have recorded gonioscopy compared to ANA patients (P < .01)., Conclusions: More than 70% patients undergoing initial glaucoma evaluation in the United States do not have a record of gonioscopy, especially elderly, non-Hispanic White, and pseudophakic patients in non-Northeast regions. This pattern does not conform to current practice guidelines and could contribute to misdiagnosed disease and suboptimal outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To assess treatment and visit patterns among patients with newly diagnosed anatomical narrow angle (ANA) and identify sociodemographic factors associated with disparities in care., Design: Retrospective practice pattern evaluation study., Methods: A total of 263,422 patients diagnosed with ANA between 2007 and 2019 were identified in the Optum Clinformatics Data Mart. Inclusion was limited to newly diagnosed ANA, defined as (1) continuous enrollment during a 2-year lookback period and 1-year study period from first diagnosis; (2) diagnosis by an ophthalmologist or optometrist; and (3) no history of pseudophakia, ANA treatments, or prior primary angle closure glaucoma diagnosis. Outcome measures were treatment with laser peripheral iridotomy (LPI), cataract surgery, or intraocular pressure-lowering medications and number of eye care visits. Logistic and Poisson regression were performed to assess factors associated with treatment and eye care visits, respectively., Results: Among 52,405 eligible cases, 27.7% received LPI, 13.9% received drops, and 15.1% received cataract surgery. Odds of LPI were higher in Asians and Hispanics (odds ratio [OR] ≥ 1.16, P < .001). Non-Whites had higher odds of drops (OR ≥ 1.19, P < .001), but Hispanics had lower odds of cataract surgery (OR = 0.79, P < .001). The mean number of eye care visits was 2.6±2.1 including the day of diagnosis. Older age and treatment were associated with higher rates of eye care visits (rate ratio > 1.15, P < .001)., Conclusion: More than a quarter of patients with newly diagnosed ANA receive treatment with LPI. Racial minorities are more likely to receive ANA-specific treatments but less likely to receive cataract surgery. These differences may reflect racial differences in disease severity and the need for clearer practice guidelines in ANA care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States., Design: Retrospective cross-sectional study., Methods: Eligible patients from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); and 3) no history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤20/200) at first diagnosis of PACG., Results: Among 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (odds ratios [ORs] 1.42 and 1.21, respectively; P < .001) and bilateral (ORs 2.04 and 1.53, respectively; P < .001) blindness compared with non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred a higher risk of blindness (OR > 1.28; P ≤ .01)., Conclusions: Blindness affects 1 of 9 patients with newly diagnosed PACG in the IRIS Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among patients with PACG and the need for improved disease awareness and detection methods., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Assess how the roles of refractive error (RE) and ocular biometrics as risk factors for primary open-angle glaucoma (POAG) differ by race and ethnicity., Methods: Data from the Los Angeles Latino Eye Study (LALES) and the Chinese American Eye Study (CHES), two population-based epidemiological studies, were retrospectively analyzed. Multivariable logistic regression and interaction term analyses were performed to assess relationships between POAG and its risk factors, including RE and axial length (AL), and to assess effect modification by race/ethnicity., Results: Analysis included 7601 phakic participants of LALES (47.3%) and CHES (52.7%) with age ≥ 50 years. Mean age was 60.6 ± 8.3 years; 60.9% were female. The prevalence and unadjusted risk of POAG were higher in LALES than CHES (6.0% and 4.0%, respectively; odds ratio [OR] = 1.55; P < 0.001). In the multivariable analysis, significant risk factors for POAG included Latino ethnicity (OR = 2.25; P < 0.001), refractive myopia (OR = 1.54 for mild, OR = 2.47 for moderate, OR = 3.94 for high compared to non-myopes; P ≤ 0.003), and longer AL (OR = 1.37 per mm; P < 0.001). AL (standardized regression coefficient [SRC] = 0.3) was 2.7-fold more strongly associated with POAG than high myopia status (SRC = 0.11). There was no modifying effect by race/ethnicity on the association between RE (per diopter) or AL (per millimeter) and POAG (P = 0.49)., Conclusions: Although the POAG risk conferred by myopic RE and longer AL is similar between Latino and Chinese Americans, the difference in POAG prevalence between the two groups is narrowed by higher myopia prevalence among Chinese Americans. Racial/ethnic populations with higher myopia incidence may become disproportionately affected by POAG in the context of the global myopia epidemic.

Prcis: The risk of primary angle closure disease (PACD) rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Refractive error (RE) is useful for angle closure risk stratification in the absence of biometric data., Purpose: To assess the role of RE and anterior chamber depth (ACD) as risk factors in PACD., Methods: Chinese American Eye Study participants received complete eye examinations including refraction, gonioscopy, amplitude-scan biometry, and anterior segment ocular coherence tomography imaging. PACD included primary angle closure suspect (≥3 quadrants of angle closure on gonioscopy) and primary angle closure/primary angle closure glaucoma (peripheral anterior synechiae or intraocular pressure >21 mm Hg). Logistic regression models were developed to assess associations between PACD and RE and/or ACD adjusted for sex and age. Locally weighted scatterplot smoothing curves were plotted to assess continuous relationships between variables., Results: Three thousand nine hundred seventy eyes (3403 open angle and 567 PACD) were included. The risk of PACD increased with greater hyperopia [odds ratio (OR) = 1.41 per diopter (D); P < 0.001] and shallower ACD (OR = 1.75 per 0.1 mm; P < 0.001). Hyperopia (≥ + 0.5 D; OR = 5.03) and emmetropia (-0.5 D to +0.5 D; OR = 2.78) conferred a significantly higher risk of PACD compared with myopia (≤0.5 D). ACD (standardized regression coefficient = -0.54) was a 2.5-fold stronger predictor of PACD risk compared with RE (standardized regression coefficient = 0.22) when both variables were included in one multivariable model. The sensitivity and specificity of a 2.6 mm ACD cutoff for PACD were 77.5% and 83.2% and of a +2.0 D RE cutoff were 22.3% and 89.1%., Conclusion: The risk of PACD rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Although RE is a weaker predictor of PACD than ACD, it remains a useful metric to identify patients who would benefit from gonioscopy in the absence of biometric data., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To assess rates of diagnostic conversion from anatomical narrow angle (ANA) to primary angle-closure glaucoma (PACG) in the United States and identify factors associated with diagnostic conversion., Design: Retrospective case-control study., Participants: Patients diagnosed with ANA between the years 2007 and 2019 were identified based on International Classification of Diseases (ICD) codes in the Optum Clinformatics Data Mart Database. Inclusion was limited to newly diagnosed ANA, defined as the following: (1) continuous enrollment during a 2-year look back period and 6-year study period from index (first) date of ANA diagnosis; (2) diagnosis by an ophthalmologist or optometrist and record of gonioscopy; and (3) no history of intraocular pressure (IOP)-lowering drops, laser peripheral iridotomy (LPI), or intraocular surgery., Methods: Cox proportional hazards models were developed to assess factors associated with diagnostic conversion, defined as a change in ICD code from ANA to PACG., Main Outcome Measures: New diagnosis of PACG within the 6-year study period recorded after an index diagnosis of ANA., Results: Among 3985 patients meeting inclusion criteria, 459 (11.52%) had detected diagnostic conversion to PACG within the study period. The conversion rate was stable at 3.54% per year after the first 6 months of ANA diagnosis. In the Cox proportional hazards model, age > 70 years and early (within 6 months of ANA diagnosis) need for LPI or IOP-lowering drops were positively associated with diagnostic conversion (hazard ratio [HR] > 1.59; P < 0.02). Cataract surgery at any time and late (after 6 months of ANA diagnosis) need for IOP-lowering drops appeared protective against diagnostic conversion (HR < 0.46; P < 0.004)., Conclusions: Annual risk of diagnostic conversion from ANA to PACG is relatively low overall; elderly patients are at higher risk whereas patients receiving cataract surgery are at lower risk. The utility of long-term monitoring seems low for most patients with ANA, highlighting the need for improved clinical methods to identify patients at higher risk for PACG., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to develop and test a programmable closed-loop system for tracking, modulating, and assessing dynamic iris behavior, including in the mid-dilated position., Methods: A programmable closed-loop iris control system was developed by customizing an ANTERION OCT device (Heidelberg Engineering, Heidelberg, Germany). Custom software was developed to store camera and optical coherence tomography (OCT) images, track pupillary diameter (PD), control a light-emitting diode (LED), and modulate ambient lighting to maintain the iris in a dilated, constricted, or mid-dilated position in real-time. Study participants underwent 3 consecutive 65-second scan sessions. Dynamic iris behavior in the form of peak constriction velocity (PCV) and mid-dilated iris activity (MDIA) were calculated and analyzed offline., Results: Among 58 participants, 56 (96.6%) were eligible for analysis based on achieving and maintaining mean PD within ±10% of the calculated mid-dilated PD. Mean participant age was 49.8 ± 18.9 years. Mean PCV was 3.92 ± 0.83 mm/s, and mean MDIA was 0.37 ± 0.15 mm. The mean difference between the calculated and achieved mid-dilated PD was 0.166 ± 0.192 mm. There were significant negative correlations between PCV and age (slope = -0.022, P < 0.001) and MDIA and age (slope = -0.004, P < 0.001). Success rates were lower (69.0%) but relationships between dynamic iris behavior and age were similar based on achieving and maintaining mean PD within ±5% of the calculated mid-dilated PD., Conclusions: A programmable closed-loop iris control system can modulate dynamic iris behavior and maintain the iris in a mid-dilated position. Pupillary constriction velocity and iris activity in the mid-dilated position decrease with age., Translational Relevance: This system can be applied to study dynamic disease processes involving the iris and establish novel biometric measures that could serve as risk factors for acute and chronic primary angle closure glaucoma (PACG).

Purpose: To assess the proportion of newly diagnosed cases of primary angle-closure glaucoma (PACG) with and without prior diagnosis of anatomical narrow angle (ANA) and to identify sociodemographic risk factors for late detection (PACG without prior ANA diagnosis)., Design: Retrospective cohort study., Methods: One hundred two thousand six hundred seventeen patients with PACG were identified from the Optum Clinformatics Data Mart Database (2007-2019). Patients with newly diagnosed PACG met the following criteria: (1) diagnosis made by an ophthalmologist, (2) disease observable for at least 12 months before diagnosis, and (3) no history of treatment before diagnosis unless preceded by a diagnosis of ANA. Multivariate logistic regression modeling was performed to identify sociodemographic risk factors for late detection., Main Outcome Measures: Proportion of patients with newly diagnosed PACG without prior ANA diagnosis and sociodemographic factors associated with late detection., Results: Thirty-one thousand forty-four patients were eligible. More than 70% of PACG cases were detected without prior ANA diagnosis, regardless of patient age, sex, or race. The odds of late detection were significantly higher (P < 0.001) among men (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.25-1.40), Black patients (OR, 1.25; 95% CI, 1.15-1.37), and patients 80 years of age or older (OR, 1.28; 95% CI, 1.11-1.47) or living in Southern (OR, 1.30; 95% CI, 1.22-1.40) or Pacific (OR, 1.27; 95% CI, 1.16-1.36) regions. Findings were similar for patients with PACG with a record of gonioscopy and treatment or with a 24-month lookback period., Conclusions: Most patients who receive a new diagnosis of PACG in the United States do not have a prior diagnosis of ANA. The elderly, men, and Black patients are at higher risk of late detection. A need exists for increased disease awareness among providers and more accessible tools to detect patients at risk of developing PACG., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)