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. 2019 Mar 26;8(2):5.
doi: 10.1167/tvst.8.2.5. eCollection 2019 Mar.

Differences in Anterior Chamber Angle Assessments Between Gonioscopy, EyeCam, and Anterior Segment OCT: The Chinese American Eye Study

Benjamin Y Xu  1 , Anmol A Pardeshi  1 , Bruce Burkemper  2 , Grace M Richter  1 , Shan C Lin  3 , Roberta McKean-Cowdin  1   4 , Rohit Varma  2
Affiliations

Differences in Anterior Chamber Angle Assessments Between Gonioscopy, EyeCam, and Anterior Segment OCT: The Chinese American Eye Study

Benjamin Y Xu et al. Transl Vis Sci Technol. .

Abstract

Purpose: To quantify interquadrant differences in anterior chamber angle (ACA) configuration assessed on gonioscopy, EyeCam, and anterior segment optical coherence tomography (AS-OCT) in a cohort of Chinese Americans.

Methods: Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES), a population-based epidemiologic study in Los Angeles, CA. Each subject underwent a complete ocular exam, including gonioscopy, EyeCam, and AS-OCT, under dark ambient lighting. Gonioscopy and AS-OCT imaging and EyeCam image grading were performed by trained ophthalmologists.

Results: Seven hundred nine eyes from 709 subjects were analyzed. Less anatomic variation among the quadrants was detected on gonioscopy and EyeCam compared with AS-OCT (P < 0.05). The mean gonioscopy grade, EyeCam grade, and AS-OCT measurement for each quadrant varied by up to 10.3%, 6.4%, and 46.2% of the superior quadrant value, respectively. There were significant interquadrant differences (P < 0.05) among mean AOD750 measurements when grouping by quadrant and gonioscopy or EyeCam grade. Mean AOD750 measurements were smallest for the superior quadrant by between 14.3% and 38.1% and 17.4% and 37.9% on gonioscopy and EyeCam, respectively, compared with other quadrants.

Conclusions: Gonioscopy and EyeCam significantly underrepresent anatomic variations of the ACA compared with AS-OCT. Gonioscopy or EyeCam grades from different quadrants do not appear to be comparable or interchangeable, which supports reconsideration of current definitions and methods used to diagnose and manage primary angle closure disease.

Translational relevance: AS-OCT imaging raises concerns about current clinical definitions and methods that rely gonioscopy or EyeCam to assess the ACA.

Keywords: angle closure, gonioscopy, anterior segment OCT, ocular anatomy, anterior chamber angle.

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Figures

Figure 1
Figure 1
Amounts of anatomic variation detected on gonioscopy, EyeCam, and AS-OCT. Mean gonioscopy grade, EyeCam grade, or AOD750 measurement with standard deviation (error bars) plotted by quadrant. Matching numbers of triangles, circles, or asterisks, indicate significant interquadrant differences in mean quadrant grades or measurements on pair-wise comparison (Tukey HSD, P < 0.05).
Figure 2
Figure 2
Relative amounts of anatomic variation detected on gonioscopy, EyeCam, and AS-OCT. Mean gonioscopy grade, EyeCam grade, or AOD750 normalized as percentage of superior quadrant grade or measurement (reference standard) and plotted by quadrant.
Figure 3
Figure 3
Interquadrant differences in ACA configuration measured on AS-OCT for gonioscopy. Mean AOD750 measurement with standard deviation (error bars) plotted by quadrant and gonioscopy grade (0–4). Numbers above error bars indicate number of significant interquadrant differences among mean AOD750 measurements on pair-wise comparison (Tukey HSD, P < 0.05). Numbers at top indicate number of subjects represented by each bar.
Figure 4
Figure 4
Interquadrant differences in AVI for gonioscopy. AVI values plotted by quadrant for each gonioscopy grade (0–4). AVI = superior quadrant AOD750 / quadrant-specific AOD750.
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