Anterior Chamber Angle Evaluation Using Gonioscopy: Consistency and Agreement between Optometrists and Ophthalmologists (original) (raw)
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Journal of Optometry, 2013
Purpose: To compare the diagnostic performance of glaucoma specialists and experienced optometrists in gonioscopy and optic disc assessment. Methods: This study was done to validate the diagnostic performance of two experienced optometrists for using their skills of detecting glaucoma using gonioscopy and optic disc assessment in a major epidemiological study, the L V Prasad Eye Institute Glaucoma Epidemiology and Molecular Genetics Study (LVPEI-GLEAMS). Gonioscopic findings for 150 eyes were categorized as 0, 1 and 2 for open angle, primary angle closure suspect (PACS) and primary angle closure (PAC) respectively. Optic disc findings for 200 eyes were categorized as 0, 1 and 2 for normal, suspects and glaucomatous respectively. Weighted kappa () and diagnostic accuracy parameters were calculated. Tw o optometrists (#1 and #2) participated in the study. Results: Agreement between glaucoma specialists and optometrist for interpretation of gonioscopy to discriminate PACS and PA C from open angles and for interpretation of optic disc to discriminate glaucomatous and suspicious discs from normal, the kappa () was 0.92 and 0.84 and 0.90 and 0.89 for optometrists #1 and #2 respectively. Sensitivities and specificities were above 90% for gonioscopy. Optic disc evaluation had specificities greater than 95% to discriminate normal from glaucomatous discs while the sensitivities were 83% and 93% for optometrists #1 and #2 respectively. Conclusion: Agreement between optometrists and glaucoma specialists, in diagnostic performance of gonioscopy and optic assessment was excellent with high sensitivity and specificity.
Gonioscopy - a Simple Tool for Diagnostic, Prognostic and Therapeutic Evaluation of Glaucoma
International Journal of Bioassays, 2014
Treatment modalities for open/closed angle glaucoma’s differ considerably and gonioscopy is the most valuable and simple tool for classifying angle/glaucoma. This study aimed at finding variations in anatomy of angle of anterior chamber in various types of glaucoma patients. This prospective study was done from June 2011 to May2013. Gonioscopic examination of 100 glaucoma patients was done by Goldman 3-mirror goniolens by single examiner and findings were noted down using Shaffer’s grading. Out of 100, 37 were bilateral and 63 uniocular glaucoma patients, 54 were males and 46 were females. 51 patients had POAG and 39 patients had PACG and 10 patients had occludable angle. 15 patients were already operated. PAS were found in 17 patients. Pigmentation was found in 34 patients. Iris processes were found in 19 patients. Foreign body in the angle and blood in schlems-canal was found in 1 patient each. Out of the 15 operated patients, 11patients had patent scleral window. 4 patients had o...
Evaluation of glaucoma cases with gonioscopy and optical coherence tomography
IP innovative publication pvt ltd , 2020
Glaucoma is the second leading cause of blindness in the adult population of India. Diagnosis and management depends on categorization of Glaucoma into open or closed angle. Aims: To compare the accuracy of Gonioscopy and Anterior Segment Optical Coherence Tomography (ASOCT) in studying the structures of anterior chamber angle of the eye and find out the agreement between them in detecting angle closure. Settings and Design: Cross -sectional observational study. Materials and Methods: The present study is a hospital based cross-sectional study of patients between 20 to 80 years of age with Glaucoma attending the outdoor patient department in a tertiary care government hospital (New civil hospital), Surat. Patients having Corneal Opacity, and anti-Glaucoma surgeries done were excluded. All diagnosed cases of Glaucoma were evaluated by Gonioscopy in the dark with a Goldman 3 mirror lens Gonioscope at high (16x) magnification for static assessment (without indentation). A narrow slit beam, 2mm* 1mm, was cast during Gonioscopy, avoiding direct illumination over the pupil. The angle in each quadrant was graded with the Shaffer grading system. Anterior Segment OCT was done by TOPCON 3D OCT-1 MAESTRO machine. Imaging was performed in dark room conditions. Patients were imaged gazing straight ahead. Imaging of a single meridional section of the Anterior Chamber Angle at superior, inferior, temporal and nasal quadrants were performed. Grading of Anterior Chamber Angles on AS-OCT is termed as Closed if there is no visualization of Scleral Spur and/or any degree of iridotrabecular contact.
Gonioscopic features in patients with acute and chronic angle-closure glaucoma
Iranian journal of medical sciences, 2011
A number of ocular biometric parameters, iris hiotologic and anatomic characters have been suggested as inciting factors for converting patients with narrow angle to angle-closure glaucoma. This study was conducted to determine if there was any goniscopic difference between patients with acute angle-closure glaucoma (AACG) and chronic angle-closure glaucoma (CACG). The study is a retrospective analysis of the charts of 97 patients with asymmetric CACG and 15 patients with unilateral AACG. The age, sex, type of glaucoma, gonioscopic findings and optic nerve head cup/disc ratio were recorded for all patients. Dynamic gonioscopy and Spaeth's convention were used to grade the drainage angle. The eyes with AACG or more optic nerve damage in CACG groups were considered as involved eye, and the contralateral eyes in the AACG and CACG groups were considered as noninvolved and less-involved, respectively. There was no significant difference between patients with AACG and CACG in terms of...
Translational Vision Science & Technology
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.
Ophthalmic and Physiological Optics, 2014
Purpose: Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma were released by the Australian National Health and Medical Research Council in 2010. Comparable guidance has been made available by respective bodies in the USA and UK at a similar time. Key to successful translation of guidelines into clinical practice includes clinicians having the necessary skills to perform required tests. Optometrists in Australia and New Zealand were invited to participate in an online survey exploring these aspects. The results provide insights for improving glaucoma diagnosis and management by optometric primary eye care practitioners. Methods: An online questionnaire was developed to investigate glaucoma assessment of optometrists as a function of demographic details, educational background and experience. Key points to ascertain compliance with current guidelines were the availability of equipment, procedural confidence in techniques, and preferences in visual field tests. Chi square statistics was employed to support similarity to national averages and highlight differences between the two countries. Multivariate linear regression analysis identified variables significantly associated with individual tests being available to optometrists and their confidence in applying them. Results: Thirteen per cent of all Australian and 36% of the New Zealand optometrists responded to the survey in 2013, which reflected the demographics/geography of the practising populations. Techniques considered essential or preferred for glaucoma assessment were widely available in both countries with the exception of gonioscopy and pachymetry. After correcting for availability, regression models highlighted therapeutic endorsement and knowledge of glaucoma guidelines as the main variables to maintain high diagnostic confidence. Correlations to number of years in optometric practice mirrored a changed emphasis in teaching and technology over the past 10-15 years. Conclusions: Australian and New Zealand optometrists were well equipped to perform glaucoma assessments with the possible exception of gonioscopy. Advanced imaging modalities were not yet fully integrated into optometric practice, although optical coherence tomography has shown use by 23-32% of optometrists. A marked increase in use, availability and procedural confidence of gonioscopy and other techniques with therapeutically endorsed optometrists demonstrates the advantage and importance of additional training.
Ophthalmology, 2008
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). Design: Cross-sectional observational study. Participants: Five hundred two consecutive subjects more than 50 years of age with no previous ophthalmic problems recruited from a community clinic in Singapore. Methods: 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. Main Outcome Measures: 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. Results: 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 (PϽ0.001), with fair agreement between the two methods (ϭ 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. Conclusions: 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.
Vision Pan-America, The Pan-American Journal of Ophthalmology, 2016
Purpose: To compare the prevalence of angle closure disease (ACD) diagnoses in a glaucoma department of an ophthalmology teaching hospital at two cut points, before and after encouragement of a supervised, mandatory gonioscopy for all patients, during all visits as well as to profile patients with angle closure disease in terms of age, gender, intraocular pressure, visual acuity, cup-to-disc ratio and refractive error parameters when divided by Foster's classification. Study design: Retrospective, two cut-point observational study.
British journal of …, 2000
Aim-To evaluate the performance of limbal chamber depth estimation as a means of detecting occludable drainage angles and primary angle closure, with or without glaucoma, in an east Asian population, and determine whether an augmented grading scheme would enhance test performance. Method-A two phase, cross sectional, community based study was conducted on rural and urban areas of Hövsgöl and Ömnögobi provinces, Mongolia. 1800 subjects aged 40 to 93 years were selected and 1717 (95%) of these were examined. Depth of the anterior chamber at the temporal limbus was graded as a percentage fraction of peripheral corneal thickness. An "occludable" angle was one in which the trabecular meshwork was seen in less than 90°of the angle circumference by gonioscopy. Primary angle closure (PAC) was diagnosed in subjects with an occludable angle and either raised pressure or peripheral anterior synechiae. PAC with glaucoma (PACG) was diagnosed in cases with an occludable angle combined with glaucomatous optic neuropathy and consistent visual morbidity. Results-Occludable angles were identified in 140 subjects, 28 of these had PACG. The 15% grade (equivalent to the traditional "grade 1") yielded sensitivity and specificity of 84% and 86% respectively for the detection of occludable angles. The 5% grade gave sensitivity of 91% and specificity of 93% for the detection of PACG. The interobserver agreement for this augmented grading scheme was good (weighted kappa 0.76).
Open Journal of Ophthalmology, 2013
Gonioscopy allows us to examine the angle of anterior chamber and forms part of complete ophthalmic examination and it is mandatory for the diagnosis and management of glaucoma. Gonioscopy permits the identification of eyes at risk for closure and detects angle abnormalities that could have diagnostic and therapeutic implications. Principle, types and techniques of gonioscopy, various types of gonioscopic lenses used, indications of performing gonioscopy, gonioscopic anatomy and grading are discussed in this article.