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Noncontact Screening Methods for the Detection of Narrow Anterior Chamber Angles

Dabasia, PL; Edgar, DF; Murdoch, IE; Lawrenson, JG; (2015) Noncontact Screening Methods for the Detection of Narrow Anterior Chamber Angles. Investigative Opthalmology & Visual Science , 56 (6) pp. 3929-3935. 10.1167/iovs.15-16727. Green open access

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Abstract

PURPOSE: Comparing diagnostic accuracy of biomicroscope techniques (van Herick and Smith's tests, evaluating limbal and central anterior chamber depth, respectively) and advanced imaging (Visante OCT and Pentacam) for detection of gonioscopically narrow anterior chamber angles (ACAs). METHODS: A total of 78 subjects with narrow or open ACAs underwent four index tests, performed on both eyes by examiners masked to other test results. Diagnostic performance was compared with gonioscopy, using International Society of Geographical and Epidemiological Ophthalmology (ISGEO) definition of primary angle closure and a classification based on clinical opinion of occludability. Data were analyzed using both the eye and the individual as unit of analysis. Sensitivity, specificity, and partial area under the receiver operating characteristic curve (AUROC) were generated. RESULTS: Using the eye as the unit of analysis, the van Herick grading cutoff of 25% or less and ISGEO gonioscopic classification achieved 80% (confidence interval [CI] 65 to 89) sensitivity and 92% specificity (CI 80 to 97) for narrow angle detection, with specificity reaching 97% (CI 87 to 100) for a cutoff of less than or equal to 15%. Notably, with a gonioscopic classification based on clinical opinion of occludability, van Herick (≤25%) together with Smith's test (≤2.50 mm) detected 100% of narrow angle subjects. Of the three Pentacam parameters, anterior chamber volume achieved highest test sensitivity of 85% (CI 70 to 94) using the ISGEO definition. Visante OCT ACA had greatest partial AUROC at 90% specificity, also yielding sensitivity and specificity greater than 85% using the Youden-derived cutoff of less than or equal to 20.7°and ISGEO definition. CONCLUSIONS: Van Herick test and Visante OCT ACA exhibited best discrimination between narrow and open angles both alone, and in combination. Van Herick test affords advantages over Visante OCT, showing potential for identifying individuals who may benefit from further gonioscopic assessment in a case-finding or screening setting.

Type: Article
Title: Noncontact Screening Methods for the Detection of Narrow Anterior Chamber Angles
Open access status: An open access version is available from UCL Discovery
DOI: 10.1167/iovs.15-16727
Publisher version: http://dx.doi.org/10.1167/iovs.15-16727
Language: English
Additional information: Copyright © 2015 The Association for Research in Vision and Ophthalmology, Inc. This is the published version of record. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Gonioscopy, Van Herick Test, Advanced Anterior Segment Imaging, Diagnostic, Accuracy, Angle Closure Glaucoma
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/1513278
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