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Azuara-Blanco A, Lawrenson JG, King AJ, Foster PJ, Virgili G, Guiney M, Nolan W, Jindal A, Sharma M, O'Neill C, Cardwell CR, Clarke M. Technologies for the diagnosis of angle closure glaucoma (ACE): protocol of a prospective, multicentre, cross-sectional diagnostic study. BMJ Open 2023; 13:e073975. [PMID: 37793921 PMCID: PMC10551982 DOI: 10.1136/bmjopen-2023-073975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Angle-closure is responsible for half of all glaucoma blindness globally. Patients with suspected glaucoma require assessment of the drainage angle by an experienced clinician. The goal of this study is to evaluate the diagnostic performance and cost-effectiveness of two non-contact tests, anterior segment OCT (Optical Coherence Tomography) (AS-OCT) and limbal anterior chamber depth for patients referred to hospital with suspected angle closure compared with gonioscopy by ophthalmologist. METHODS AND ANALYSIS Study design: prospective, multicentre, cross-sectional diagnostic accuracy study. INCLUSION CRITERIA adults referred from community optometry to hospital with suspected angle closure. PRIMARY OUTCOME Sensitivity and specificity. SECONDARY OUTCOMES Positive/negative likelihood ratios, concordance, cost-effectiveness, proportion of patients requiring subsequent clinical assessment by ophthalmologist. SAMPLE SIZE 600 individuals who have been referred with suspected angle closure from primary care (community optometry). We will have a 95% probability of detecting the true sensitivity of either test to within ±3.5% based on a sensitivity of 90%. The study would also have a 95% probability of detecting the true specificity of either test to within ±5%, assuming a specificity of 75%. ETHICS AND DISSEMINATION Ethical Review Board approval was obtained. REC reference: 22/LO/0885. Our findings will be disseminated to those involved in eye care services. We will have a knowledge exchange event at the end of the study, published via the Health Technology Assessment web page and in specialist journals. The results will be presented at professional conferences and directly to patients via patient group meetings and the Glaucoma UK charity. TRIAL REGISTRATION NUMBER ISRCTN15115867.
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Affiliation(s)
| | - John G Lawrenson
- Department of Optometry and Visual Sciences, City University of London, London, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul J Foster
- Institute of Ophthalmology, Division of of Epidemiology, University College London, London, UK
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Mary Guiney
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Winnie Nolan
- NIHR Biomedical Research Centre, Moorfields and UCL Institute of Ophthalmology, London, UK
| | - Anish Jindal
- Glaucoma Service, Moorfields and Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
| | - Meenakshi Sharma
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast, Belfast, UK
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Ding X, Huang L, Peng C, Xu L, Liu Y, Yang Y, Wang N, Gu M, Sun C, Wu Y, Guo W. Evaluation of Schlemm's canal with swept-source optical coherence tomography in primary angle-closure disease. BMC Ophthalmol 2023; 23:256. [PMID: 37286943 DOI: 10.1186/s12886-023-03001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
PURPOSE To perform an in vivo evaluation of the changes in Schlemm's canal (SC) among patients with primary angle-closure disease (PACD) using swept-source optical coherence tomography (SS-OCT). METHODS Patients diagnosed with PACD who had not undergone surgery were recruited. The SS-OCT quadrants scanned herein included the nasal and temporal sections at 3 and 9 o'clock, respectively. The diameter and cross-sectional area of the SC were measured. A linear mixed-effects model was performed to analyze the effects of parameters on the SC changes. The hypothesis of interest was related to the angle status (iridotrabecular contact, ITC/open angle, OPN), which was further explored with pairwise comparisons of the estimated marginal means (EMMs) of the SC diameter and SC area. In the ITC regions, the relationship between the trabecular-iris contact length (TICL) percentage and SC parameters was also studied by a mixed model. RESULTS A total of 49 eyes of 35 patients were included for measurements and analysis. The percentage of observable SCs in the ITC regions was only 58.5% (24/41), whereas it was 86.0% (49/57) in the OPN regions (χ2 = 9.44, p = 0.002). ITC was significantly associated with a decreasing SC size. The EMMs for the diameter and cross-sectional area of SC at the ITC and OPN regions were 203.34 μm versus 261.41 μm (p = 0.006) and 3174.43 μm2 versus 5347.63 μm2 (p = 0.022), respectively. Sex, age, spherical equivalent refraction, intraocular pressure, axial length, extent of angle closure, history of acute attack and treatment with LPI were not significantly associated with SC parameters. In the ITC regions, a larger TICL percentage was significantly associated with a decrease in SC diameter and area (p = 0.003 and 0.019, respectively). CONCLUSIONS The morphologies of SC could be affected by the angle status (ITC/OPN) in patients with PACD, and ITC was significantly associated with a decreasing SC size. These changes in SC as described by OCT scans might help to elucidate the progression mechanisms of PACD.
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Affiliation(s)
- Xuming Ding
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Lulu Huang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Cheng Peng
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Li Xu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yixin Liu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yijie Yang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Ning Wang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Mengyang Gu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chengyang Sun
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yue Wu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Wenyi Guo
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China.
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Jibia G, Koki G, Bilong Y, Biangoup Nyamsi P, Afetane Evina T, Kagmeni G, Ellong A. Apport de la tomographie en cohérence optique dans l’évaluation de l’angle irido-cornéen du camerounais. J Fr Ophtalmol 2022; 45:1079-1087. [DOI: 10.1016/j.jfo.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/20/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
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Moving beyond the Slit-Lamp Gonioscopy: Challenges and Future Opportunities. Diagnostics (Basel) 2021; 11:diagnostics11122279. [PMID: 34943516 PMCID: PMC8700682 DOI: 10.3390/diagnostics11122279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022] Open
Abstract
After almost a century from its introduction in clinical practice, slit-lamp gonioscopy is still considered the reference standard for evaluating the anterior chamber angle (ACA). Gonioscopy is essential for diagnosing angle closure disease, and ACA features are included in glaucoma’s diagnostics and treatments algorithms. However, shortcomings of slit-lamp gonioscopy include a steep learning curve, lack of agreement between examiners and poor documentation. Thanks to advances in miniaturization and computing, new instruments for digital gonioscopy have been developed and marketed. This narrative review focuses on the Gonioscope GS-1, which permits semi-automated circumferential documentation of the ACA in real-colour photographs. Advantages and disadvantages of GS-1 compared with slit-lamp gonioscopy and other ACA imaging technologies such as optical coherence tomography are discussed. Finally, potential opportunities offered by this device for telemedicine, virtual clinics, and automatic classification with deep learning are presented.
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Diagnostic accuracy of AS-OCT vs gonioscopy for detecting angle closure: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021; 260:1-23. [PMID: 34223989 PMCID: PMC8255337 DOI: 10.1007/s00417-021-05271-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aims to review the literature that compares the accuracy of Anterior Segment-Optical Coherence Tomography (AS-OCT) against gonioscopy in detecting eyes with angle closure. It is currently unclear how AS-OCT fits into clinical practice for detecting angle closure. This is a systematic review and meta-analysis. Methods A literature search was performed on Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials to identify studies that investigated the diagnostic accuracy of AS-OCT in detecting eyes with angle closure as diagnosed by gonioscopy. Eligible studies included in the analysis met stringent inclusion criteria determining the sensitivity and specificity of AS-OCT. Results The initial search identified 727 studies, of which 23 were included in the final analysis. We found substantial variation in the parameters being studied and methodologies. The sensitivity of AS-OCT ranged from 46 to 100% (median 87%). Twenty-one studies identified parameters that showed sensitivity above 80%. The specificity ranged from 55.3 to 100% (median 84%). Conclusion AS-OCT demonstrates good sensitivity for detecting angle closure. It may provide an avenue to address high rates of undiagnosed angle closure, such as found in developing Asian countries. However, AS-OCT is not yet able to replace gonioscopy. Clinicians should consider whether the diagnostic accuracy of AS-OCT is acceptable for their specific clinical use before adopting it. More studies are needed to determine the utility of AS-OCT, including longitudinal studies to determine the significance of eyes classified to have closed angles by AS-OCT but open on gonioscopy. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-021-05271-4.
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Yavuz BS, Kargul B. Comparative evaluation of the spectral-domain optical coherence tomography and microhardness for remineralization of enamel caries lesions. Dent Mater J 2021; 40:1115-1121. [PMID: 33980748 DOI: 10.4012/dmj.2020-279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to evaluate the Cirrus high-definition (HD) spectral-domain optical coherence tomography (SD-OCT) for the remineralization of artificial enamel caries and to compare it with the comparison surface microhardness (SMH) analysis. Artificial caries lesions were produced on forty human enamel samples. Then, three different remineralization agents containing casein phosphopeptide amorphous calcium phosphate; casein phosphopeptide amorphous calcium fluoride phosphate; calcium glycerophosphate, magnesium chloride, and xylitol; and remineralization solution (control) were applied with pH cycling for six days. The optical depth of backscattered light and microhardness of enamel were measured using SD-OCT and SMH. All remineralization agents were significantly efficient in reducing optical lesion depth on enamels (p1=0.001, p2=0.002, p3=0.006, p4=0.025), and in increasing the SMH of enamels (p1-3=0.005, p4=0.017). However, the optical lesion depths of the enamel showed no correlation with the SMH in the groups. In conclusion, demineralization and remineralization of artificial lesions can be assessed with both SD-OCT and SMH.
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Affiliation(s)
- Betul Sen Yavuz
- Department of Pediatric Dentistry, School of Dental Medicine, Bahcesehir University
| | - Betul Kargul
- Department of Pediatric Dentistry, School of Dentistry, Marmara University
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Montés-Micó R, Tañá-Rivero P, Aguilar-Córcoles S, Ruíz-Mesa R. Assessment of anterior segment measurements using a high-resolution imaging device. Expert Rev Med Devices 2020; 17:969-979. [PMID: 32847426 DOI: 10.1080/17434440.2020.1816463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the repeatability of several anterior segment parameters obtained with swept-source optical coherence tomography (SS-OCT). METHODS We measured 5-times consequently several parameters in 69 eyes using the ANTERION SS-OCT. White-to-white (WTW), angle-to-angle (ATA), spur-to-spur (STS), and lens vault distances were measured in the horizontal- and vertical-meridian. Anterior-chamber-angle (ACA), scleral-spur-angle (SSA), angle-opening-distance (AOD), and trabecular-iris-space-area (TISA) were measured at 500 and 750 μm for the superior-, nasal-,inferior-, and temporal-quadrants. Intrasubject standard deviation (Sw),coefficient of variation (CoV), coefficient of repeatability (CoR), and intraclass-correlation-coefficient (ICC) were calculated for each parameter. Bland-Altman analysis was done. RESULTS We have not found statistically significant differences between repeated measurements (p > 0.05). Repeatability was good for the different parameters evaluated. Sw values in distances and areas were low and ranged from 0.01 to 0.07. CoR values showed a similar pattern being larger for those metrics measuring angles. The same happened with CoV values, being very small for WTW,ATA, and STS distances (0.16-0.57%). ICC values for all parameters analyzed were > 0.97. Bland-Altman plots evidenced the narrow limits of agreement for all parameters. CONCLUSIONS The ANTERION SS-OCT demonstrated high repeatability measuring different distances, angles, and areas of the anterior segment of the eye.
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Affiliation(s)
- Robert Montés-Micó
- Oftalvist Clinic , Alicante, Spain.,Optics and Optometry & Vision Sciences Department, University of Valencia , Valencia, Spain
| | - Pedro Tañá-Rivero
- Optics and Optometry & Vision Sciences Department, University of Valencia , Valencia, Spain
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Dai Y, Zhang S, Shen M, Zhou Y, Wang M, Ye J, Zhu D. Modeling of gonioscopic anterior chamber angle grades based on anterior segment optical coherence tomography. EYE AND VISION 2020; 7:30. [PMID: 32518803 PMCID: PMC7268764 DOI: 10.1186/s40662-020-00196-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/12/2020] [Indexed: 01/15/2023]
Abstract
Background To quantitatively assess anterior chamber angle (ACA) structure by anterior segment optical coherence tomography (AS-OCT) and develop a model to evaluate angle width as defined by gonioscopy. Methods The ACAs of each quadrant were evaluated by gonioscopy, classified by the Scheie grading system, and assigned into one of the three grades: small angle (SA), moderate angle (MA), and large angle (LA). The eyes were imaged by AS-OCT, and ACA structural parameters including angle opening distance at the scleral spur (AODSS) and at 750 μm anterior to the scleral spur (AOD750), trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750), and a newly defined parameter “light intersection distance” (LID), were measured. The ACA structural data were used to construct an ordered logistic regression model for assignment of ACAs to one of the three angle grades. The validity of the model was then tested. Results A total of 169 quadrants from 53 subjects were included in the analysis, of which 111 quadrants were included in the modeling data and 58 in the testing data. In pairwise comparisons of SA, MA, and LA by ANOVA, the measured parameters were as follows: AOD750 (0.174 ± 0.060 vs. 0.249 ± 0.068 vs. 0.376 ± 0.114 mm; P < 0.001), TISA750 (0.075 ± 0.035 vs. 0.117 ± 0.036 vs. 0.181 ± 0.062 mm2; P < 0.001), and LID (− 0.300 ± 0.187 vs. -0.085 ± 0.170 vs. 0.122 ± 0.156 mm; P < 0.001). The ACA grading model based on LID showed a relatively high correction rate of 72.4%, and the model efficiency, calculated using the receiver operating characteristic, showed an area under the curve of 0.740. Weighted kappa statistics showed a good agreement for multiple ACA grades (0.772). Conclusions The AS-OCT-based multiple ACA grades model was demonstrated as a non-contact approach for ACA assessment with high speed and high spatial resolution, providing guidance for diagnosis of angle closure.
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Affiliation(s)
- Yingying Dai
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Shaodan Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Yuheng Zhou
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Mengyi Wang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Jie Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Dexi Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
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Jindal A, Ctori I, Virgili G, Lucenteforte E, Lawrenson JG. Non-contact tests for identifying people at risk of primary angle closure glaucoma. Cochrane Database Syst Rev 2020; 5:CD012947. [PMID: 32468576 PMCID: PMC7390269 DOI: 10.1002/14651858.cd012947.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary angle closure glaucoma (PACG) accounts for 50% of glaucoma blindness worldwide. More than three-quarters of individuals with PACG reside in Asia. In these populations, PACG often develops insidiously leading to chronically raised intraocular pressure and optic nerve damage, which is often asymptomatic. Non-contact tests to identify people at risk of angle closure are relatively quick and can be carried out by appropriately trained healthcare professionals or technicians as a triage test. If the test is positive, the person will be referred for further specialist assessment. OBJECTIVES To determine the diagnostic accuracy of non-contact tests (limbal anterior chamber depth (LACD) (van Herick test); oblique flashlight test; scanning peripheral anterior chamber depth analyser (SPAC), Scheimpflug photography; anterior segment optical coherence tomography (AS-OCT), for identifying people with an occludable angle. SEARCH METHODS We searched the following bibliographic databases 3 October 2019: CENTRAL; MEDLINE; Embase; BIOSIS; OpenGrey; ARIF and clinical trials registries. The searches were limited to remove case reports. There were no date or language restrictions in the searches. SELECTION CRITERIA We included prospective and retrospective cross-sectional, cohort and case-control studies conducted in any setting that evaluated the accuracy of one or more index tests for identifying people with an occludable angle compared to a gonioscopic reference standard. DATA COLLECTION AND ANALYSIS Two review authors independently performed data extraction and quality assessment using QUADAS2 for each study. For each test, 2 x 2 tables were constructed and sensitivity and specificity were calculated. When four or more studies provided data at fixed thresholds for each test, we fitted a bivariate model using the METADAS macro in SAS to calculate pooled point estimates for sensitivity and specificity. For comparisons between index tests and subgroups, we performed a likelihood ratio test comparing the model with and without the covariate. MAIN RESULTS We included 47 studies involving 26,151 participants and analysing data from 23,440. Most studies were conducted in Asia (36, 76.6%). Twenty-seven studies assessed AS-OCT (analysing 15,580 participants), 17 studies LACD (7385 participants), nine studies Scheimpflug photography (1616 participants), six studies SPAC (5239 participants) and five studies evaluated the oblique flashlight test (998 participants). Regarding study quality, 36 of the included studies (76.6%) were judged to have a high risk of bias in at least one domain.The use of a case-control design (13 studies) or inappropriate exclusions (6 studies) raised patient selection concerns in 40.4% of studies and concerns in the index test domain in 59.6% of studies were due to lack of masking or post-hoc determination of optimal thresholds. Among studies that did not use a case-control design, 16 studies (20,599 participants) were conducted in a primary care/community setting and 18 studies (2590 participants) in secondary care settings, of which 15 investigated LACD. Summary estimates were calculated for commonly reported parameters and thresholds for each test; LACD ≤ 25% (16 studies, 7540 eyes): sensitivity 0.83 (95% confidence interval (CI) 0.74, 0.90), specificity 0.88 (95% CI 0.84, 0.92) (moderate-certainty); flashlight (grade1) (5 studies, 1188 eyes): sensitivity 0.51 (95% CI 0.25, 0.76), specificity 0.92 (95% CI 0.70, 0.98) (low-certainty); SPAC (≤ 5 and/or S or P) (4 studies, 4677 eyes): sensitivity 0.83 (95% CI 0.70, 0.91), specificity 0.78 (95% CI 0.70, 0.83) (moderate-certainty); Scheimpflug photography (central ACD) (9 studies, 1698 eyes): sensitivity 0.92 (95% CI 0.84, 0.96), specificity 0.86 (95% CI 0.76, 0.93) (moderate-certainty); AS-OCT (subjective opinion of occludability) (13 studies, 9242 eyes): sensitivity 0.85 (95% CI 0.76, 0.91); specificity 0.71 (95% CI 0.62, 0.78) (moderate-certainty). For comparisons of sensitivity and specificity between index tests we used LACD (≤ 25%) as the reference category. The flashlight test (grade 1 threshold) showed a statistically significant lower sensitivity than LACD (≤ 25%), whereas AS-OCT (subjective judgement) had a statistically significant lower specificity. There were no statistically significant differences for the other index test comparisons. A subgroup analysis was conducted for LACD (≤ 25%), comparing community (7 studies, 14.4% prevalence) vs secondary care (7 studies, 42% prevalence) settings. We found no evidence of a statistically significant difference in test performance according to setting. Performing LACD on 1000 people at risk of angle closure with a prevalence of occludable angles of 10%, LACD would miss about 17 cases out of the 100 with occludable angles and incorrectly classify 108 out of 900 without angle closure. AUTHORS' CONCLUSIONS The finding that LACD performed as well as index tests that use sophisticated imaging technologies, confirms the potential for this test for case-detection of occludable angles in high-risk populations. However, methodological issues across studies may have led to our estimates of test accuracy being higher than would be expected in standard clinical practice. There is still a need for high-quality studies to evaluate the performance of non-invasive tests for angle assessment in both community-based and secondary care settings.
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Affiliation(s)
- Anish Jindal
- Division of Optometry and Visual Science, City University London, London, UK
| | - Irene Ctori
- Division of Optometry and Visual Science, City University London, London, UK
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City University of London, London, UK
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Horton MB, Brady CJ, Cavallerano J, Abramoff M, Barker G, Chiang MF, Crockett CH, Garg S, Karth P, Liu Y, Newman CD, Rathi S, Sheth V, Silva P, Stebbins K, Zimmer-Galler I. Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition. Telemed J E Health 2020; 26:495-543. [PMID: 32209018 PMCID: PMC7187969 DOI: 10.1089/tmj.2020.0006] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/11/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022] Open
Abstract
Contributors The following document and appendices represent the third edition of the Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy. These guidelines were developed by the Diabetic Retinopathy Telehealth Practice Guidelines Working Group. This working group consisted of a large number of subject matter experts in clinical applications for telehealth in ophthalmology. The editorial committee consisted of Mark B. Horton, OD, MD, who served as working group chair and Christopher J. Brady, MD, MHS, and Jerry Cavallerano, OD, PhD, who served as cochairs. The writing committees were separated into seven different categories. They are as follows: 1.Clinical/operational: Jerry Cavallerano, OD, PhD (Chair), Gail Barker, PhD, MBA, Christopher J. Brady, MD, MHS, Yao Liu, MD, MS, Siddarth Rathi, MD, MBA, Veeral Sheth, MD, MBA, Paolo Silva, MD, and Ingrid Zimmer-Galler, MD. 2.Equipment: Veeral Sheth, MD (Chair), Mark B. Horton, OD, MD, Siddarth Rathi, MD, MBA, Paolo Silva, MD, and Kristen Stebbins, MSPH. 3.Quality assurance: Mark B. Horton, OD, MD (Chair), Seema Garg, MD, PhD, Yao Liu, MD, MS, and Ingrid Zimmer-Galler, MD. 4.Glaucoma: Yao Liu, MD, MS (Chair) and Siddarth Rathi, MD, MBA. 5.Retinopathy of prematurity: Christopher J. Brady, MD, MHS (Chair) and Ingrid Zimmer-Galler, MD. 6.Age-related macular degeneration: Christopher J. Brady, MD, MHS (Chair) and Ingrid Zimmer-Galler, MD. 7.Autonomous and computer assisted detection, classification and diagnosis of diabetic retinopathy: Michael Abramoff, MD, PhD (Chair), Michael F. Chiang, MD, and Paolo Silva, MD.
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Affiliation(s)
- Mark B. Horton
- Indian Health Service-Joslin Vision Network (IHS-JVN) Teleophthalmology Program, Phoenix Indian Medical Center, Phoenix, Arizona
| | - Christopher J. Brady
- Division of Ophthalmology, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Jerry Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Michael Abramoff
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, and The University of Iowa, Iowa City, Iowa
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa
- Department of Ophthalmology, Stephen A. Wynn Institute for Vision Research, The University of Iowa, Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- IDx, Coralville, Iowa
| | - Gail Barker
- Arizona Telemedicine Program, The University of Arizona, Phoenix, Arizona
| | - Michael F. Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | - Seema Garg
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Siddarth Rathi
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Veeral Sheth
- University Retina and Macula Associates, University of Illinois at Chicago, Chicago, Illinois
| | - Paolo Silva
- Beetham Eye Institute, Joslin Diabetes Center, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Kristen Stebbins
- Vision Care Department, Hillrom, Skaneateles Falls, New York, New York
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11
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Gan K, Liu Y, Stagg B, Rathi S, Pasquale LR, Damji K. Telemedicine for Glaucoma: Guidelines and Recommendations. Telemed J E Health 2020; 26:551-555. [PMID: 32209001 DOI: 10.1089/tmj.2020.0009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Glaucoma is the leading cause of irreversible blindness worldwide. Access to glaucoma specialists is challenging and likely to become more difficult as the population ages. Introduction: Using telemedicine for glaucoma (teleglaucoma) has the potential to increase access to glaucoma care by improving efficiency and decreasing the need for long-distance travel for patients. Results: Teleglaucoma programs can be used for screening, diagnostic consultation, and long-term treatment monitoring. Key components of teleglaucoma programs include patient history, equipment, intraocular pressure measurement, pachymetry, anterior chamber imaging/gonioscopy, fundus photography, retinal nerve fiber layer imaging, medical record and imaging software, and skilled personnel. Discussion: Teleglaucoma has tremendous potential to improve patient access to high-quality cost-effective glaucoma care. Conclusions: We have reviewed some special considerations needed to address the complexity of providing guideline-concordant glaucoma care.
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Affiliation(s)
- Kenman Gan
- Department of Ophthamology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Brian Stagg
- John Moran Eye Center, University of Utah, Salt Lake City, Utah
| | | | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karim Damji
- Department of Ophthamology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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12
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Porporato N, Baskaran M, Perera S, Tun TA, Sultana R, Tan M, Quah JH, Allen JC, Friedman D, Cheng CY, Aung T. Evaluation of meridional scans for angle closure assessment with anterior segment swept-source optical coherence tomography. Br J Ophthalmol 2020; 105:131-134. [DOI: 10.1136/bjophthalmol-2019-315461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/28/2020] [Accepted: 02/20/2020] [Indexed: 11/04/2022]
Abstract
Background/aimsAs swept-source optical coherence tomography (SS-OCT) simultaneously obtains 128 meridional scans, it is important to identify which scans are playing the main role in classifying gonioscopic angle closure to simplify the analysis. We aimed to evaluate the diagnostic performance of every meridional scan in its ability to detect gonioscopic angle closure.MethodsObservational study with 2027 phakic subjects consecutively recruited from a community polyclinic. Gonioscopy and SS-OCT were performed. Gonioscopic angle closure was defined as non-visibility of the posterior trabecular meshwork in ≥180° of the angle, while SS-OCT was defined as iridotrabecular contact anterior to the scleral spur. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic performance of each single scan, the sequential anticlockwise cumulative effect of those single scans and different combinations of them.ResultsThe AUCs of each scan ranged from 0.73 to 0.82. The single scan at 80°–260° had the highest AUC (0.82, 95% CI 0.79 to 0.84) and performed significantly better than most of the temporonasal scans (from 0° to 52° and from 153° to 179°). The superoinferior scans achieved higher AUCs compared with the temporonasal ones. When assessing the cumulative effect of adding individual scans consecutively, the peak AUC (0.80) was obtained when considering the superoinferior scans closer to 80°–85°, but no further positive cumulative effect was seen when adding the rest of the temporonasal scans of the circumference.ConclusionsIn conclusion, the single SS-OCT scan at 80°–260° had the highest diagnostic performance. Our study suggests that the 360° evaluation may not translate to better clinical utility for detection of gonioscopic angle closure.
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13
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Kudsieh B, Fernández-Vigo JI, Vila-Arteaga J, Urcola JA, Martínez-de-la-Casa JM, García-Feijóo J, Ruiz-Moreno JM, Fernández-Vigo JÁ. Update on the usefulness of optical coherence tomography in assessing the iridocorneal angle. ACTA ACUST UNITED AC 2019; 94:478-490. [PMID: 31371112 DOI: 10.1016/j.oftal.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The iridocorneal angle, due to its implications in the physiopathology of aqueous humour drainage, is a fundamental structure of the anterior chamber. Anterior segment optical coherence tomography is a rapid and non-invasive technique that obtains images in vivo. The high resolution allows it to analyse the normal anatomy of the angle, any alterations, and the changes that occur after different therapeutic interventions. Anterior segment optical coherence tomography technology has evolved to provide images that allow the identification and quantification of the angular structures in healthy subjects and in glaucoma patients, and especially the trabecular meshwork and the Schlemm's canal. It also enables the angle width to be quantified, with some objective parameters that have been standardised in recent years, such as the trabecular-iris angle, the angle opening distance, and the trabecular-iris area. This technique has multiple uses in the study of the different mechanisms of angle closure, the evaluation of changes after a laser peripheral iridotomy or iridoplasty after cataract surgery, as well as after the implantation of phakic lenses.
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Affiliation(s)
- B Kudsieh
- Departamento de Oftalmología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | - J I Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J Vila-Arteaga
- Hospital La Fe, Valencia, España; Clínica Vila-Innova Ocular, Valencia, España
| | - J Aritz Urcola
- Departamento de Oftalmología, Hospital Universitario de Álava, Vitoria, España; Begitek Clínica Oftalmológica, Innova Ocular, Donostia-San Sebastián, España
| | - J M Martínez-de-la-Casa
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J García-Feijóo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J M Ruiz-Moreno
- Departamento de Oftalmología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - J Á Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Universidad de Extremadura, Badajoz, España
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14
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Domínguez-Vicent A, Brautaset R. Agreement and Repeatability of Two Biometers to Measure Anterior Segment Components: Refractive Error Effect. Med Sci Monit 2018; 24:8056-8063. [PMID: 30414377 PMCID: PMC6240168 DOI: 10.12659/msm.907683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To assess the repeatability and agreement between a new high-resolution optical coherence tomographer (OCT) and a Scheimpflug topographer. MATERIAL AND METHODS Sixty phakic and healthy participants were measured in this study, and one eye per participant was analyzed. Depending on their refractive error, each participant was allocated into a myopic, hyperopic, or emmetropic group. The Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Jena, Germany), and the Sirius Scheimpflug topographer (Costruzione Strumenti Oftalmici, Florence, Italy) were used to take all measurements. RESULTS The repeatability of these instruments to measure the anterior chamber depth, angle-to-angle, thinnest pachymetry, and both nasal and temporal angles was smaller than 0.15 mm, 0.40 mm, 10 µm, and 10 degrees, respectively. However, the repeatability of the Scheimpflug instrument to measure the apex pachymetry was about 15 µm, and for the OCT, it was about 4 µm for all groups. On average, the Sirius Scheimpflug instrument measured shallower anterior chamber depth (about 0.10 mm), shorter angle-to-angle (about 0.5 mm), thinner corneas (approximately 10 µm), and narrower angles (around 5 degrees) for all refractive groups. CONCLUSIONS The repeatability of the Cirrus OCT and Sirius Scheimpflug instrument was good and independent of the refractive error. Nevertheless, to judge whether these instruments could be used interchangeable, clinical criteria are needed.
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Affiliation(s)
- Alberto Domínguez-Vicent
- Unit of Optometry, Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Rune Brautaset
- Unit of Optometry, Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
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15
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Teixeira F, Sousa DC, Leal I, Barata A, Neves CM, Pinto LA. Automated gonioscopy photography for iridocorneal angle grading. Eur J Ophthalmol 2018; 30:112-118. [PMID: 30360660 DOI: 10.1177/1120672118806436] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study is to assess the agreement between manual and automated gonioscopy for iridocorneal angle opening. METHODS The research is a cross-sectional observational study. Manual and automated gonioscopy were performed to consecutive patients in a glaucoma clinic. Iridocorneal angle opening grading was performed according to Shaffer's classification. Automated gonioscopy was performed with NGS-1 automated gonioscope (NIDEK Co., Gamagori, Japan). The automated gonio-photos were graded by two independent observers. Agreement between automated and manual gonioscopy and also among raters was ascertained by Fleiss' kappa statistic and comparison of area under curve. RESULTS In total, 88 eyes of 47 subjects were analysed. Mean age was 63 ± 10 years. Twenty eyes (22.7%) were excluded from grading due to poor quality images. Angle closure was detected in 23.4% with dynamic gonioscopy in comparison with 4.3% using automated image grading. The agreement for angle closure diagnosis between dynamic and automated gonioscopy was low (κ = 0.09 ± 0.10; p = 0.18). The area under curve for detecting eyes with angle closure showed poor accuracy between automated and manual methods (area under curve: 0.53 ± 0.05, 95% confidence interval: 0.44-0.62). There was modest inter-rater agreement for angle opening assessment of automated images with Fleiss' kappa of 0.17 (95% confidence interval: 0.035-0.238). CONCLUSION Manual and automated gonioscopy showed only slight agreement for the assessment of iridocorneal angle opening status. Further improvements of the NGS-1 automated gonioscopy and technique are desired for widespread use in a real-life setting.
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Affiliation(s)
- Filipa Teixeira
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - David C Sousa
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Leal
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - André Barata
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos M Neves
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Luís A Pinto
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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16
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Ang M, Baskaran M, Werkmeister RM, Chua J, Schmidl D, Aranha dos Santos V, Garhöfer G, Mehta JS, Schmetterer L. Anterior segment optical coherence tomography. Prog Retin Eye Res 2018; 66:132-156. [DOI: 10.1016/j.preteyeres.2018.04.002] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/20/2018] [Accepted: 04/04/2018] [Indexed: 02/03/2023]
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17
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Razeghinejad MR, Myers JS. Contemporary approach to the diagnosis and management of primary angle-closure disease. Surv Ophthalmol 2018; 63:754-768. [PMID: 29777727 DOI: 10.1016/j.survophthal.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
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Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Poostchi Ophthalmology Research Center, Shiraz University of Medcial Sciences, Shiraz, Iran.
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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18
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Chansangpetch S, Rojanapongpun P, Lin SC. Anterior Segment Imaging for Angle Closure. Am J Ophthalmol 2018; 188:xvi-xxix. [PMID: 29352976 DOI: 10.1016/j.ajo.2018.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/01/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy. DESIGN Literature review and perspective. METHODS Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy. RESULTS Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies-including 3-dimensional imaging-have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future. CONCLUSIONS Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure.
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Affiliation(s)
- Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California
| | - Prin Rojanapongpun
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California.
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19
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Thompson AC, Vu DM, Cowan LA, Asrani S. Risk Factors Associated with Missed Diagnoses of Narrow Angles by the Van Herick Technique. Ophthalmol Glaucoma 2018; 1:108-114. [PMID: 32672561 DOI: 10.1016/j.ogla.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To identify which factors are associated with a deep-appearing anterior chamber on slit-lamp examination by the Van Herick (VH) technique in eyes with a diagnosis of narrow angle (NA) on gonioscopy. DESIGN Retrospective review. PARTICIPANTS One thousand three hundred fourteen eyes in 696 participants with NA on indirect gonioscopy. METHODS All included eyes were graded as narrow with iridotrabecular contact on indirect gonioscopy in a darkened room by a single trained glaucoma specialist. Before gonioscopy, eyes were graded as narrow or deep by VH slit-lamp examination technique. Demographic and clinical factors predictive of a deep VH grading were assessed using logistic regression with generalized estimating equations. MAIN OUTCOME MEASURES Factors associated with deep versus narrow VH grade. RESULTS Using the VH technique, 13.7% of eyes (n = 180/1314) with NA on gonioscopy were classified as deep. Eyes with primary angle-closure glaucoma (PACG; odds ratio, 2.43; P < 0.001) and primary angle closure (PAC; odds ratio, 1.38; P = 0.006) were significantly more likely to be graded as deep by the VH technique relative to eyes that were primary angle-closure suspects (PACSs). In multivariate analysis, male gender (odds ratio, 2.22; P < 0.001), myopia (odds ratio, 1.4; P = 0.048), and black (odds ratio, 4.11; P < 0.001) and Asian (odds ratio, 2.24; P = 0.044) race were independent risk factors for a deep grading with the VH technique in eyes with NA on gonioscopy. CONCLUSIONS Patients with NAs on gonioscopy who are men, myopic, and of black or Asian race are at increased risk of being misdiagnosed with deep angles if examined with the VH technique alone. Eyes with PACG and PAC may be more likely than those with PACS to be misdiagnosed as deep with the VH technique. It is possible that by being missed by the VH technique, these eyes could have progressed from PACS to PAC and PACG. Patients with these demographic and clinical characteristics in the presence of other risk factors for glaucoma should undergo careful gonioscopy.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Daniel M Vu
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Lisa A Cowan
- Department of Ophthalmology, Southern California Permanente Medical Group, Bakersfield, California
| | - Sanjay Asrani
- Department of Ophthalmology, Duke University, Durham, North Carolina.
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20
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Porporato N, Baskaran M, Aung T. Role of anterior segment optical coherence tomography in angle-closure disease: a review. Clin Exp Ophthalmol 2017; 46:147-157. [DOI: 10.1111/ceo.13120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
| | - Tin Aung
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
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21
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Effect of Lateral Decubitus Body Posture on Anterior Chamber Angle in Healthy Subjects: An Anterior Segment Optical Coherence Tomography Study. J Glaucoma 2017; 26:608-612. [PMID: 28369003 DOI: 10.1097/ijg.0000000000000678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the effect of the lateral decubitus (LD) position on the anterior chamber (AC) angle in healthy subjects. MATERIALS AND METHODS Twenty-three healthy young subjects were included in this prospective observational study. We measured AC angle parameters in the sitting and the left LD positions using anterior segment optical coherence tomography (Visante OCT): trabecular-iris angle (TIA), angle opening distance (AOD500), trabecular-iris space area (TISA500), anterior chamber width, lens vault, and anterior chamber depth. The Wilcoxon signed-rank test was used to compare the parameters between different body positions. Interobserver reproducibility of AC angle measurements was assessed by intraclass correlation coefficients. RESULTS Postural alterations from sitting to the left LD position significantly reduced the AC angle on the temporal side in right eyes (TIA: 39.53±2.38 to 38.31±3.47 degrees; AOD500: 0.72±0.13 to 0.65±0.08; TISA500: 0.25±0.06 to 0.22±0.04; all P<0.05), whereas no significant changes were noted on the nasal side. Contrastingly, a significant decrease in the AC angle on the nasal side was noted for left eyes (TIA: 39.49±2.24 to 38.17±2.76 degrees; AOD500: 0.68±0.09 to 0.64±0.10; TISA500: 0.23±0.04 to 0.21±0.03; all P<0.05). Anterior chamber width and anterior chamber depth were unaffected by postural alterations, but lens vault significantly was reduced following a shift to the left LD position. CONCLUSIONS The AC angle parameters on the nondependent side of the eye in the LD position were significantly reduced compared with those in the sitting position. Therefore, postural shift from sitting to the LD position may induce alterations in the AC angle.
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22
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Diagnostic Imaging of the Anterior Segment in Glaucoma: An Update. Int Ophthalmol Clin 2017; 57:125-136. [PMID: 28590286 DOI: 10.1097/iio.0000000000000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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