The flashlight test and van Herick's test are poor predictors for occludable angles

Abstract

Objective: To determine the reliability and validity of the flashlight test and van Herick's test in detecting occludable anterior chamber angles.

Methods: The flashlight test, van Herick's test and gonioscopy were performed independently by two observers on 96 consecutive new patients in our outpatient clinic. Interobserver agreement was determined using the weighted Kappa statistic. Using the glaucoma specialist's assessment of occludability of the angle (assessed by gonioscopy) as a gold standard, the sensitivities and specificities of the two tests were calculated.

Results: All three tests showed good agreement (Kappa more than 0.75). The sensitivity and specificity on the flashlight test were 45.5% and 82.7% respectively. For the van Herick's test they were 61.9% and 89.3%.

Conclusion: The flashlight test and van Herick's test are of limited use as screening tests for occludable angles.