Diagnostic Accuracy of Anterior Segment Optical Coherence Tomography for Detection of Anterior Chamber Angle Closure: A Comparison with Gonioscopy

Shingrif  Shabbir; Abdul Rauf; Shabir  Ahmad; Muqaddas Noor; Teyyeb Azeem  Janjua; Aqsa Zahid

doi:10.51253/pafmj.v76i6.12952

Authors

Shingrif Shabbir Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Abdul Rauf Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Shabir Ahmad Department of Ophthalmology,Poonch medical college, Rawalakot Pakistan
Muqaddas Noor Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Teyyeb Azeem Janjua Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Aqsa Zahid Department of Ophthalmology, University of Lahore Teaching Hospital Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i6.12952

Keywords:

Angle closure glaucoma, Diagnostic accuracy, Glaucoma, Gonioscopy, Optical Coherence Tomography.

Abstract

Objectives: To determine the diagnostic accuracy of anterior segment OCT in the assessment of anterior chamber angle closure, keeping gonioscopy as the gold standard.

Study design: Cross-sectional study

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Pakistan Emirates Military Hospital, Rawalpindi, Pakistan, from Mar 23 to Feb 24.

Methodology: A total of 140 patients aged≥40 years diagnosed with or suspected of angle-closure glaucoma, having healthy corneas, were included in this study. Gonioscopy was conducted using a Goldmann 3-mirror lens under dim illumination. Anterior segment OCT imaging was conducted using a spectral-domain OCT device equipped with an anterior segment module lens. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of anterior segment OCT for determining anterior segment angle closure were calculated, keeping gonioscopy as the gold standard.

Results: The age range of patients in this study was 43-67 years, with a mean age of 56.61±6.8 years. Anterior segment OCT diagnosed 74(52.86%) of cases, while gonioscopy diagnosed 69(49.24%) of cases with anterior chamber angle closure. Anterior segment OCT showed sensitivity of 62.32%, specificity of 56.34%, positive predictive value of 58.12%, and negative predictive value of 60.61%. The diagnostic accuracy was 59.3% (p = 0.03).

Conclusion: The moderate performance of anterior chamber OCT suggests that this technique is a good non-invasive method for anterior chamber angle closure assessment, but relying on it alone poses risks of missed diagnoses and false positives. It should be used alongside gonioscopy for a more reliable evaluation.

Downloads

Download data is not yet available.

References

1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014; 121(11): 2081-2090.

https://doi.org/10.1016/j.ophtha.2014.05.013

2. Kang JM, Tanna AP. Glaucoma. Med Clin North Am 2021; 105(3): 493-510.

https://doi.org/10.1016/j.mcna.2021.01.004

3. Mahabadi N, Zeppieri M, Tripathy K. Open angle glaucoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK441887/

4. Wagner IV, Stewart MW, Dorairaj SK. Updates on the diagnosis and management of glaucoma. Mayo Clin Proc Innov Qual Outcomes 2022; 6(6): 618-635.

https://doi.org/10.1016/j.mayocpiqo.2022.09.007

5. Riva I, Micheletti E, Oddone F, Bruttini C, Montescani S, De Angelis G, et al. Anterior chamber angle assessment techniques: a review. J Clin Med 2020; 9(12): 3814.

https://doi.org/10.3390/jcm9123814

6. Kochupurakal RT, Srikanth K, Jha KN, Rajalakshmi A, Nagarajan S, Ezhumalai G. Role of optical coherence tomography in assessing anterior chamber angles. J Clin Diagn Res 2016; 10(4): NC18-NC20.

https://doi.org/10.7860/JCDR/2016/17879.7701

7. Cutolo CA, Bonzano C, Scotto R, Iester M, Bagnis A, Pizzorno C, et al. Moving beyond the slit-lamp gonioscopy: challenges and future opportunities. Diagnostics 2021; 11(12): 2279.

https://doi.org/10.3390/diagnostics11122279

8. Asam JS, Polzer M, Tafreshi A. Anterior segment OCT. In: Bille JF, editor. High Resolution Imaging in Microscopy and Ophthalmology: New Frontiers in Biomedical Optics [Internet]. Cham: Springer; 2019: p. 285-301.

https://doi.org/10.1007/978-3-030-16638-0_13

9. Kavitha S, Zebardast N, Venkatesh R. Assessment of angle width using anterior segment optical coherence tomography. Ann Eye Sci 2020; 5: 31.

https://doi.org/10.21037/aes-20-129

10. Xu BY, Lifton J, Burkemper B, Jiang X, Pardeshi AA, Moghimi S, et al. Ocular biometric determinants of anterior chamber angle width in Chinese Americans: the Chinese American Eye Study. Am J Ophthalmol 2020; 220: 19-26.

https://doi.org/10.1016/j.ajo.2020.07.030

11. Ang M, Baskaran M, Werkmeister RM, Chua J, Schmidl D, Aranha Dos Santos V, et al. Anterior segment optical coherence tomography. Prog Retin Eye Res 2018; 66: 132-156.

https://doi.org/10.1016/j.preteyeres.2018.04.002

12. Jaseena K, Rekha PS. Agreement of gonioscopy and anterior segment optical coherence tomography in the assessment of the anterior chamber angle: a cross-sectional study. Kerala J Ophthalmol 2022; 34(1): 27-31.

https://doi.org/10.4103/kjo.kjo_91_21

13. Kong X, Foster PJ, Huang Q, Zheng Y, Huang W, Cai X, et al. Appositional closure identified by ultrasound biomicroscopy in population-based primary angle-closure glaucoma suspects: the Liwan Eye Study. Invest Ophthalmol Vis Sci 2011; 52(7): 3970-3975.

https://doi.org/10.1167/iovs.10-6412

14. Namba M, Xu BY. Anterior segment optical coherence tomography imaging in angle closure: advances in diagnosis and care. Curr Opin Ophthalmol 2026; 37(2): 108-115.

https://doi.org/10.1097/ICU.0000000000001196.

15. Shan J, DeBoer C, Xu BY. Anterior segment optical coherence tomography: applications for clinical care and scientific research. Asia Pac J Ophthalmol 2019; 8(2): 146-157.

https://doi.org/10.22608/APO.201910

16. Seth PK, Senthil S, Das AV, Garudadri C. Prevalence of glaucoma types, clinical profile and disease severity at presentation: tertiary institute-based cross-sectional study from South India. Indian J Ophthalmol 2023; 71(10): 3305-3312.

https://doi.org/10.4103/IJO.IJO_3305_22

17. Baskaran M, Iyer JV, Narayanaswamy AK, He Y, Sakata LM, Wu R, et al. Anterior segment imaging predicts incident gonioscopic angle closure. Ophthalmology 2015; 122(12): 2380-2384.

https://doi.org/10.1016/j.ophtha.2015.07.030

18. Pradhan S, Sah RK, Bhandari G, Bhandari S, Byanju R, Kandel RP, et al. Anterior segment OCT for detection of narrow angles: a community-based diagnostic accuracy study. Ophthalmol Glaucoma 2024; 7(2): 148-156.

https://doi.org/10.1016/j.ogla.2023.08.005

19. Imran K, Khan NA, Jahanzaib HF, Nazir F, Khalid A. Comparison of gonioscopy and anterior segment OCT for detecting angle closure in different quadrants of anterior chamber angle in angle-closure glaucoma. Pak J Ophthalmol 2023;39(2):123-127.

https://doi.org/10.36351/pjo.v39i2.1539

20. Desmond T, Tran V, Maharaj M, Carnt N, White A. Diagnostic accuracy of AS-OCT vs gonioscopy for detecting angle closure: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2022;260(1):1-23.

https://doi.org/10.1007/s00417-021-05271-4