In primary angle closure suspects without cataracts, how do you approach the discussion about LPIs, given the relatively low risk of an acute angle closure attack?

In primary angle closure suspects without cataracts, I will have a discussion about aqueous humor dynamics and outflow mechanisms of the eye, and how that relates to risk stratification in the patient's case. We are fortunate in glaucoma to have a fair bit of evidence to guide us in our clinical decision-making in such situations. In this case, the ZAP (Zhongshan Angle Closure Prevention) trial is central to the discussion, and I will often quote the findings from this study as a result. I expla...

ZAP showed us that acute angle attacks are rarer than we thought previously, so I risk-stratify. I ask about family history of acute attacks - if positive, then I am much more likely to recommend LPI. If they need regular dilated fundus exams for any reason, then I will recommend it. I also ask, "Are you the type of person that doesn't want to do anything unless absolutely necessary, or do you want to do everything possible to reduce your risk of an extremely rare but possibly devastating event?...