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      Quantitative Evaluation of Gonioscopic and EyeCam Assessments of Angle Dimensions Using Anterior Segment Optical Coherence Tomography

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          To evaluate the relationship between angle dimensions assessed by gonioscopy or EyeCam and anterior segment optical coherence tomography (AS-OCT).


          Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES). Each subject underwent a complete ocular exam, including gonioscopy, AS-OCT, and EyeCam. Angle closure was defined as three or more quadrants in which pigmented trabecular meshwork could not be visualized. Angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA) were measured in each AS-OCT image.


          709 eyes (272 angle closure, 437 open angle) from 709 subjects were analyzed. Mean gonioscopy and EyeCam grades tended to increase as AS-OCT measurements increased. There were strong correlations overall between AS-OCT measurements and gonioscopy ( r > 0.73) and EyeCam ( r > 0.68) grades. However, correlations with AS-OCT measurements were weak for gonioscopy ( r < 0.38) and EyeCam ( r < to 0.27) among eyes with angle closure. Mean AS-OCT measurements differed for eyes with Shaffer grade 0 in all four quadrants among eyes with varying degrees of angle closure on gonioscopy ( P < 0.01) but did not differ among eyes with varying degrees of angle closure on EyeCam ( P > 0.27).


          Angle assessments by gonioscopy and EyeCam are weakly related to angle dimensions in eyes with angle closure.

          Translational Relevance

          AS-OCT imaging raises concerns about current clinical methods that rely on direct visualization of ACA structures to assess the degree of angle closure.

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          Most cited references 27

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          Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography.

          To demonstrate a new diagnostic technique, optical coherence tomography, for high-resolution cross-sectional imaging of structures in the anterior segment of the human eye in vivo. Optical coherence tomography is a new, noninvasive, noncontact optical imaging modality that has spatial resolution superior to that of conventional clinical ultrasonography ( 90 dB). Survey of intraocular structure and dimension measurements. Laboratory. Convenience sample. Correlation with range of accepted normal intraocular structure profiles and dimensions. Direct in vivo measurements with micrometer-scale resolution were performed of corneal thickness and surface profile (including visualization of the corneal epithelium), anterior chamber depth and angle, and iris thickness and surface profile. Dense nuclear cataracts were successfully imaged through their full thickness in a cold cataract model in calf eyes in vitro. Optical coherence tomography has potential as a diagnostic tool for applications in noncontact biometry, anterior chamber angle assessment, identification and monitoring of intraocular masses and tumors, and elucidation of abnormalities of the cornea, iris, and crystalline lens.
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            Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan District, Guangzhou.

            To assess the prevalence and mechanism of glaucoma in adults living in an urban area of southern China. Random clustering sampling was used to identify adults aged 50 years and over in Liwan District, Guangzhou. Glaucoma was diagnosed with the ISGEO (International Society of Geographical and Epidemiological Ophthalmology) classification scheme. All subjects underwent gonioscopy. In the study, 1504 subjects (75.3% participation rate) were examined, with a crude prevalence of all glaucoma of 3.8% (95% confidence interval [CI], 2.8%-4.8%). Primary open-angle glaucoma (POAG) was found in 2.1% (95% CI, 1.4%-2.8%) and primary angle-closure glaucoma (PACG) in 1.5% (95% CI, 0.8%-2.1%). The prevalence of all glaucoma was significantly higher in older people and men. POAG was more common than PACG in this southern Chinese population, with rates similar to those reported in Chinese Singaporeans. The age-adjusted rate of POAG was similar to that found in European-derived populations, but PACG was more common among Chinese, indicating that there is a large burden of glaucoma in the Chinese people.
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              Comparison of gonioscopy and anterior segment ocular coherence tomography in detecting angle closure in different quadrants of the anterior chamber angle.

              To compare the performance of gonioscopy and anterior segment (AS) optical coherence tomography (OCT) in detecting angle closure in the different quadrants of the anterior chamber angle (ACA). Cross-sectional observational study. Five hundred two consecutive subjects more than 50 years of age with no previous ophthalmic problems recruited from a community clinic in Singapore. All subjects underwent gonioscopy and AS OCT imaging in the dark. Using gonioscopy, the ACA was graded using the Scheie system by a single examiner masked to AS OCT findings. The ACA in a particular quadrant was classified as closed if the posterior trabecular meshwork could not be seen on gonioscopy. A closed ACA on AS OCT imaging was defined by the presence of any contact between the iris and angle wall anterior to the scleral spur. After excluding eyes with poor image quality, a total of 423 right eyes were included in the analysis. A closed angle in at least 1 quadrant was observed in 59% of the eyes by AS OCT and in 33% of the eyes by gonioscopy (P<0.001), with fair agreement between the two methods (kappa = 0.40). The frequency of closed angles by AS OCT and gonioscopy were 48% versus 29% superiorly, 43% versus 22% inferiorly, 18% versus 14% nasally, and 12% versus 20% temporally, respectively. Of the 119 of 1692 quadrants that were closed on gonioscopy but open on AS OCT, a steep iris profile was present in 61 (51%) of 119 quadrants on AS OCT, and of the 276 of 1692 quadrants that were open on gonioscopy but closed on AS OCT, 196 (71%) of 276 quadrants showed short iridoangle contact on AS OCT. The highest rates of closed angles on gonioscopy and AS OCT images were observed in the superior quadrant. Anterior segment OCT tended to detect more closed ACAs than gonioscopy, particularly in the superior and inferior quadrants. Variations in the iris profile and level of iridoangle contact also may explain some of the differences seen between gonioscopy and AS OCT.

                Author and article information

                Transl Vis Sci Technol
                Transl Vis Sci Technol
                Transl Vis Sci Technol
                Translational Vision Science & Technology
                The Association for Research in Vision and Ophthalmology
                November 2018
                27 December 2018
                : 7
                : 6
                [1 ]USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
                [2 ]Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
                [3 ]Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
                Author notes
                Correspondence: Benjamin Xu, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, 1450 San Pablo St, 4th Floor, Suite 4700, Los Angeles, CA 90033, USA. e-mail: benjamin.xu@ 123456med.usc.edu
                tvst-07-06-40 TVST-18-1095
                Copyright 2018 The Authors

                This work is licensed under a Creative Commons Attribution 4.0 International License.



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