What the PACS?

About the session

CPD ref: C-108314


This lecture looks at Primary Angle Closure Glaucoma (PACG). It covers the difference between Primary Angle Closure Suspects (PACS) and PACS-plus disease. The presenter discusses the definition, diagnosis and mangement of the condition. The impact of the recent Royal College of Ophthalmologists guidelines are explored and the effect on patient management and referral.

Target audience

  • Optometrist.

Domains and learning outcomes

Clinical practice

s.5 Keep your knowledge and skills up to date

  • Understands PACS and PACS plus criteria and current guidelines for patients presenting as PACS.

s.6 Recognise and work within your limits of competence

  • Understands when patients presenting as PACS require referring to a specialist service.

s.7 Conduct appropriate assessments, examinations, treatments and referrals

  • Able to carry out appropriate assesments, examinations, treatments and referrals for patients presenting as PACS.


Nishani Amerasinghe

Ms Nishani Amerasinghe is a Consultant Ophthalmic Surgeon based at the University Hospital Southampton NHS Foundation Trust, specialising in glaucoma and cataract surgery. She is regarded as a leading expert and key opinion leader in the UK, employing the latest medical and surgical techniques including lasers, conventional glaucoma surgery and minimally invasive glaucoma surgery (MIGS). Additionally, Ms Amerasinghe has expertise in complex cataract surgeon. 

She became President of the UK & Eire Glaucoma Society in November 2023, testament of the respect she has within the glaucoma speciality. Ms Amerasinghe is an invited speaker for many national and international meetings with particular focus on angle closure disease and surgical treatment of glaucoma. She has won academic scholarships and prizes throughout her career as well as publishing many papers and reviewing for the major ophthalmology journals. 

After graduating from Imperial College School of Medicine at St Mary’s, London, Ms Amerasinghe went on to train on the Wessex Ophthalmology Rotation where she also completed an Advanced Speciality Training Opportunity (ASTO) between Southampton and Portsmouth Hospitals. Subsequently, She undertook a further two years advanced training as a Clinical Research Fellow at the world-renowned Singapore National Eye Centre, and a Clinical Glaucoma fellowship at the internationally acclaimed Moorfields Eye Hospital, London. 

Her research projects include a large study looking into the heritability of primary angle closure glaucoma which was a joint project with Singapore National Eye Centre and the Institute of Ophthalmology, University College of London. Recently she authored the British Medical Journal Best Practice of Primary Open Angle Glaucoma 2023. 

Ms Amerasinghe is currently the principal investigator of a large multi-centre research project looking at Real-World data into open angle glaucoma management. The importance of teaching and training is a passion of Ms Amerasinghe both locally, including trainees and allied healthcare professionals to international peers; for example training on the West African College of Surgeons/Moorfields Trabeculectomy Course, Ghana. This is reflected in consistently high feedback scores she receive. 

Ms Amerasinghe undertook the ultimate winter sports endurance challenge Everest in Alps, to raise money and awareness of glaucoma in March 2023.