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Mercer R, Alaghband P. The value of virtual glaucoma clinics: a review. Eye (Lond) 2024; 38:1840-1844. [PMID: 38589461 PMCID: PMC11226713 DOI: 10.1038/s41433-024-03056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/04/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
Virtual clinics are being utilised to tackle the growing demand for glaucoma healthcare. We conducted a literature search on 28 February 2023 using MEDLINE (PubMed), EMBASE and Web of Science databases. We searched for studies on virtual glaucoma clinics, published in the English language between 2000 and 2023. Studies suggest that virtual glaucoma clinics are a safe and effective alternative to traditional face-to-face clinics for patients with stable and early-to-moderate glaucoma. Patient satisfaction is high across all clinics surveyed. Satisfaction appears to be linked to good communication, trust and improved waiting times. The majority of healthcare professionals are also content with virtual glaucoma clinics. There are no dedicated cost-benefit analyses for virtual glaucoma clinics in the UK. However, virtual clinics in other specialties have reported significant cost savings.
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Affiliation(s)
- Rachel Mercer
- Ophthalmology Department, York Hospital, Wigginton Road, York, YO318HE, UK
| | - Pouya Alaghband
- Ophthalmology Department, York Hospital, Wigginton Road, York, YO318HE, UK.
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Shamseldin Shalaby W, Reddy R, Razeghinejad R, Jay Katz L. Contemporary Approach to Narrow Angles. J Ophthalmic Vis Res 2024; 19:88-108. [PMID: 38638634 PMCID: PMC11022020 DOI: 10.18502/jovr.v19i1.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/12/2023] [Indexed: 04/20/2024] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Among all glaucoma types, primary angle closure glaucoma (PACG) affects approximately 23 million people worldwide, and is responsible for 50% of glaucoma-related blindness, highlighting the devastating consequences of this disease. The main mechanism of PACG is relative pupillary block. High-risk populations are female gender, Asian ethnicity, high hyperopia, short axial length, and a thick/anteriorly positioned lens. This review discusses the clinical diagnosis, classification, and management of patients with a narrow angle with and without intraocular pressure (IOP) elevation and glaucomatous optic nerve damage, including laser peripheral iridotomy (LPI), endocycloplasty (ECPL), lens extraction, and goniosynechialysis.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Rohit Reddy
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - L. Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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Zimmermann JA, Storp JJ, Merté RL, Heiduschka P, Eter N, Brücher VC. Position of the ISTENT Inject ® Trabecular Micro-Bypass System Visualized with the NIDEK GS-1 Gonioscope-A Postoperative Analysis. J Clin Med 2023; 12:5171. [PMID: 37629213 PMCID: PMC10455890 DOI: 10.3390/jcm12165171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Glaucoma is one of the leading causes of irreversible blindness globally and is characterized by the gradual loss of retinal ganglion cells. The primary risk factor for the development and progression of glaucoma is increased intraocular pressure (IOP). Numerous surgical interventions exist to lower IOP should conservative therapy fail. One trend in recent years has been minimally invasive glaucoma surgery (MIGS) as an alternative to traditional methods. The ISTENT inject® is an ab interno trabecular micro-bypass implant designed to be implanted through the trabecular meshwork into the Schlemm's canal to lower IOP. The aim of the study was the postoperative visualization and description of the positioning of the ISTENT inject® using automated circumferential goniophotography. Patients with symptomatic cataracts and mild to moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigment-dispersion glaucoma were included who underwent combined cataract surgery with the ISTENT inject® and received postoperative automated gonioscopy with the NIDEK Gonioscope GS-1 to visualize the location of the implant. Twenty-four implants of 14 eyes in 11 patients could be visualized. Out of the implants, 14.3% were in the trabecular meshwork, 46.4% were at the border between the trabecular meshwork and scleral spur, 25% were below the trabecular meshwork, and 14.3% of the implants were not detectable in the gonioscopy. In the overall cohort, a statistically significant IOP reduction was found over the 12-month postoperative observation period. Even in three eyes, in each of which both stents were located below the trabecular meshwork, an IOP reduction over 12 months was observed compared to the baseline IOP. In this study, vertical two-dimensional positioning of the ISTENT inject® was performed for the first time using NIDKE GS-1 automated 360° goniophotography. The method is suitable for postoperative visualization, control, and documentation of positioning after ISTENT inject® implantation. Further studies are needed to analyze the correlation between positioning of the ISTENT inject® in the chamber angle and postoperative IOP reduction.
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Affiliation(s)
- Julian Alexander Zimmermann
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany; (J.J.S.); (R.-L.M.); (P.H.); (V.C.B.)
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Feasibility of Automated Gonioscopy Imaging in Clinical Practice. J Glaucoma 2023; 32:159-164. [PMID: 36877821 DOI: 10.1097/ijg.0000000000002162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/14/2022] [Indexed: 03/08/2023]
Abstract
PRCIS Automated gonioscopy provided good-quality images of the anterior chamber angle. There was a short learning curve for operators, and the examination was well tolerated by patients. Patients expressed a preference for automated gonioscopy compared with traditional gonioscopy. PURPOSE The purpose of this study was to assess the feasibility of using a desktop automated gonioscopy camera in glaucoma clinics by examining patient tolerability, ease of use, and image quality and comparing patient preference compared with traditional gonioscopy. PATIENTS AND METHODS A prospective study was conducted in a university hospital clinic. Traditional gonioscopy was performed followed by imaging of the iridocorneal angle (ICA) using the Nidek GS-1 camera by 2 glaucoma specialists. Participants were asked to rate the comfort of automated gonioscopy and which method they preferred. The clinicians graded the ease of acquisition for each patient, and the image quality was reviewed by a grader. RESULTS Forty-three eyes of 25 participants were included. Sixty-eight percent of participants viewed automated gonioscopy as "extremely comfortable," and the remainder reported it "comfortable". Forty percent preferred automated gonioscopy compared with traditional gonioscopy, while 52% were equivocal. Clinicians scored 32% of participants as "somewhat difficult" to the image. In 46% of eyes, good-quality photographs were obtained for 360 degrees of the ICA. Only 1 eye had no parts of the ICA clearly visible. Seventy-four percent of eyes had at least half of the ICA clearly visible in all 4 quadrants. CONCLUSION Automated gonioscopy provided good-quality images of the ICA for most patients. It was often not possible to image the entire 360 degrees at the first attempt, but the examination was comfortable for patients, and only 8% preferred traditional gonioscopy to the automated photographic examination.
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Porporato N, Bell KC, Perera SA, Aung T. Non-optical coherence tomography modalities for assessment of angle closure. Taiwan J Ophthalmol 2021; 12:409-414. [PMID: 36660111 PMCID: PMC9843576 DOI: 10.4103/tjo.tjo_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/26/2021] [Indexed: 01/22/2023] Open
Abstract
Primary angle closure glaucoma is a leading cause of irreversible blindness, particularly in Asia. Its pathophysiology is based in the closure of the anterior chamber angle (ACA). In addition to gonioscopy (current reference standard), in the past decade, anterior segment optical coherence tomography (AS-OCT) has been incorporated in routine ophthalmic practice to help assess the configuration of the ACA. Especially in nonspecialist ophthalmology practice, gonioscopy may be less frequently performed and AS-OCT may not be available, leading to the need of other anterior segment evaluation methods. Evaluating the anterior chamber depth (ACD) has long been recognized as screening tool for primary angle-closure glaucoma. It can be measured with several devices, such as Scheimpflug photography and the scanning peripheral ACD analyzer. It can also be estimated with the oblique flashlight test and van Herick technique (limbal ACD assessment). More recently, goniophotographic systems have been developed to produce images of the ACA similar to those seen with manual gonioscopy. NGS-1 automated gonioscope (NIDEK Co, Gamagori, Japan) and the RetCam (Natus Medical Incorporated, Pleasanton, CA) are commercially available. However, NGS-1 is the only one with a specialized software for ACA imaging. Several prototype devices are currently being developed, such as the GonioPEN and axicon lens assisted gonioscopy. This article aims to review different modalities of ACA assessment, beyond AS-OCT, and compare their relative advantages and disadvantages.
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Affiliation(s)
- Natalia Porporato
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Department of Ophthalmology, DUKE-NUS Medical School, Singapore
| | - Katharina C. Bell
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Department of Ophthalmology, DUKE-NUS Medical School, Singapore
| | - Shamira A. Perera
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Department of Ophthalmology, DUKE-NUS Medical School, Singapore
| | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Department of Ophthalmology, DUKE-NUS Medical School, Singapore,Department of Visual Science, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Address for correspondence: Prof. Tin Aung, Singapore National Eye Center, 11, Third Hospital Avenue, 168751, Singapore. E-mail:
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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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Chiang M, Guth D, Pardeshi AA, Randhawa J, Shen A, Shan M, Dredge J, Nguyen A, Gokoffski K, Wong BJ, Song B, Lin S, Varma R, Xu BY. Glaucoma Expert-Level Detection of Angle Closure in Goniophotographs With Convolutional Neural Networks: The Chinese American Eye Study. Am J Ophthalmol 2021; 226:100-107. [PMID: 33577791 DOI: 10.1016/j.ajo.2021.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the performance of a novel convolutional neural network (CNN) classifier and human graders in detecting angle closure in EyeCam (Clarity Medical Systems, Pleasanton, California, USA) goniophotographs. DESIGN Retrospective cross-sectional study. METHODS Subjects from the Chinese American Eye Study underwent EyeCam goniophotography in 4 angle quadrants. A CNN classifier based on the ResNet-50 architecture was trained to detect angle closure, defined as inability to visualize the pigmented trabecular meshwork, using reference labels by a single experienced glaucoma specialist. The performance of the CNN classifier was assessed using an independent test dataset and reference labels by the single glaucoma specialist or a panel of 3 glaucoma specialists. This performance was compared to that of 9 human graders with a range of clinical experience. Outcome measures included area under the receiver operating characteristic curve (AUC) metrics and Cohen kappa coefficients in the binary classification of open or closed angle. RESULTS The CNN classifier was developed using 29,706 open and 2,929 closed angle images. The independent test dataset was composed of 600 open and 400 closed angle images. The CNN classifier achieved excellent performance based on single-grader (AUC = 0.969) and consensus (AUC = 0.952) labels. The agreement between the CNN classifier and consensus labels (κ = 0.746) surpassed that of all non-reference human graders (κ = 0.578-0.702). Human grader agreement with consensus labels improved with clinical experience (P = 0.03). CONCLUSION A CNN classifier can effectively detect angle closure in goniophotographs with performance comparable to that of an experienced glaucoma specialist. This provides an automated method to support remote detection of patients at risk for primary angle closure glaucoma.
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Intraobserver and interobserver agreement among anterior chamber angle evaluations using automated 360-degree gonio-photos. PLoS One 2021; 16:e0251249. [PMID: 33956906 PMCID: PMC8101769 DOI: 10.1371/journal.pone.0251249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the reproducibility for the iridocorneal angle evaluations using the pictures obtained by a gonioscopic camera, Gonioscope GS-1 (Nidek Co., Gamagori, Japan). Methods The pragmatic within-patient comparative diagnostic evaluations for 140 GS-1 gonio-images obtained from 35 eyes of 35 patients at four ocular sectors (superior, temporal, inferior, and nasal angles) were conducted by five independent ophthalmologists including three glaucoma specialists in a masked fashion twice, 1 week apart. We undertook the observer agreement and correlation analyses of Scheie’s angle width and pigmentation gradings and detection of peripheral anterior synechia and Sampaolesi line. Results The respective Fleiss’ kappa values for the four elements between manual gonioscopy and automated gonioscope by the glaucoma specialist were 0.22, 0.40, 0.32 and 0.58. Additionally, the respective intraobserver agreements for the four elements by the glaucoma specialist each were 0.32 to 0.65, 0.24 to 0.71, 0.35 to 0.70, and 0.20 to 0.76; the Fleiss’ kappa coefficients for the four elements among the three glaucoma specialists were, respectively, 0.31, 0.38, 0.31, and 0.17; the Fleiss’ kappa coefficients for the angle width and pigmentation gradings between the two glaucoma specialists each were 0.30 to 0.35, and 0.29 to 0.43, respectively. Overall, the Kendall’s tau coefficients for the angle gradings reflected the positive correlations in the evaluations. Conclusion Our findings suggested slight-to-substantial intraobserver agreement and slight-to-fair (among the three) or fair-to-moderate (between the two each) interobserver agreement for the angle assessments using GS-1 gonio-photos even by glaucoma specialists. Sufficient training and a solid consensus should allow us to perform more reliable angle assessments using gonio-photos with high reproducibility.
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Anterior Chamber Angle Assessment Techniques: A Review. J Clin Med 2020; 9:jcm9123814. [PMID: 33255754 PMCID: PMC7759936 DOI: 10.3390/jcm9123814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022] Open
Abstract
Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention. Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. Several new imaging techniques for angle evaluation have been developed in the recent years. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment’s structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.
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Porporato N, Baskaran M, Husain R, Aung T. Recent advances in anterior chamber angle imaging. Eye (Lond) 2020; 34:51-59. [PMID: 31666710 PMCID: PMC7002644 DOI: 10.1038/s41433-019-0655-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
Differentiating the two main forms of primary glaucoma (open-angle and closed-angle glaucoma) depends on the correct assessment of the anterior chamber angle (ACA). This assessment will determine the management plan and prognosis for the disease. The standard method of examining the angle has been, for many years, slit-lamp gonioscopy. This method, although clinically still useful, is less robust for patient follow up and clinical research, given its low reproducibility. Several imaging technologies have been developed in recent years to improve the evaluation of the ACA and overcome the shortcomings of gonioscopy. These recent advances include three-dimensional and 360° analysis by Swept-Source OCT (SS-OCT, CASIA, Tomey, Nagoya, Japan), the introduction of deep learning algorithms for automatic imaging classification and new goniophotographic systems. SS-OCT allows for the first time the assessment of the circumferential extension of angle closure with moderate to good diagnostic performance compared with gonioscopy. Deep learning algorithms are showing promising results for the automation of imaging analysis, and may potentially save physicians' time in regards of the interpretation of the images. Lastly, goniophotograph systems have the distinct advantage of recordability of gonioscopic findings and are most closely matched to the findings of slit-lamp gonioscopy.
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Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore.
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Phu J, Wang H, Khou V, Zhang S, Kalloniatis M. Remote Grading of the Anterior Chamber Angle Using Goniophotographs and Optical Coherence Tomography: Implications for Telemedicine or Virtual Clinics. Transl Vis Sci Technol 2019; 8:16. [PMID: 31588379 PMCID: PMC6761908 DOI: 10.1167/tvst.8.5.16] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/04/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the agreement and accuracy of grading goniophotographs and anterior segment optical coherence tomography (AS-OCT) results for assessment of the anterior chamber angle, and elicit factors driving concordance between perceived grade and ground truth. METHODS Three clinicians evaluated the goniophotographs and AS-OCT results of 75 patients. Graders' impressions of the angle grade, trabecular pigmentation, and iris contour were compared with the ground truth gonioscopic examination result when physically performed by a senior optometrist. Percentage agreement and kappa statistics were calculated. Binary logistic regression was used to elicit factors for accurate grading. RESULTS Exact angle matches and binary (open or closed) evaluations were above guessing rate for all graders. There was a systematic bias toward underestimating the angle structure across all graders, especially at the superior angle, by approximately 1 ordinal unit. Kappa statistics showed fair-moderate agreement for exact (0.387-0.520) and binary (0.347-0.520) angle evaluations. Agreement was unchanged when using a multimodal approach (0.373-0.523). Factors driving concordance were primarily related to the extremes of the anterior chamber angle configuration (shallow or deep structures, and iris contour). However, prediction models did not fully explain the levels of concordance with the ground truth (maximum R 2 amongst models 0.177). CONCLUSIONS Although moderate agreement between graders and ground truth could be obtained under binary evaluations, angle grades were generally underestimated. Factors affecting concordance were primarily the extremes of the ground truth angle and iris contour. TRANSLATIONAL RELEVANCE We highlight factors affecting accuracy of grading goniophotography and AS-OCT images of the anterior chamber angle.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Henrietta Wang
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Vincent Khou
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Sophia Zhang
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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Shi Y, Yang X, Marion KM, Francis BA, Sadda SR, Chopra V. Novel and Semiautomated 360-Degree Gonioscopic Anterior Chamber Angle Imaging in Under 60 Seconds. ACTA ACUST UNITED AC 2019; 2:215-223. [DOI: 10.1016/j.ogla.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
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Xu BY, Pardeshi AA, Burkemper B, Richter GM, Lin SC, McKean-Cowdin R, Varma R. Differences in Anterior Chamber Angle Assessments Between Gonioscopy, EyeCam, and Anterior Segment OCT: The Chinese American Eye Study. Transl Vis Sci Technol 2019; 8:5. [PMID: 30941263 PMCID: PMC6438105 DOI: 10.1167/tvst.8.2.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/12/2019] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Bruce Burkemper
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Shan C Lin
- Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Rohit Varma
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
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Xu BY, Pardeshi AA, Burkemper B, Richter GM, Lin SC, McKean-Cowdin R, Varma R. Quantitative Evaluation of Gonioscopic and EyeCam Assessments of Angle Dimensions Using Anterior Segment Optical Coherence Tomography. Transl Vis Sci Technol 2018; 7:33. [PMID: 30619653 PMCID: PMC6314106 DOI: 10.1167/tvst.7.6.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the relationship between angle dimensions assessed by gonioscopy or EyeCam and anterior segment optical coherence tomography (AS-OCT). METHODS Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES). Each subject underwent a complete ocular exam, including gonioscopy, AS-OCT, and EyeCam. Angle closure was defined as three or more quadrants in which pigmented trabecular meshwork could not be visualized. Angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA) were measured in each AS-OCT image. RESULTS 709 eyes (272 angle closure, 437 open angle) from 709 subjects were analyzed. Mean gonioscopy and EyeCam grades tended to increase as AS-OCT measurements increased. There were strong correlations overall between AS-OCT measurements and gonioscopy (r > 0.73) and EyeCam (r > 0.68) grades. However, correlations with AS-OCT measurements were weak for gonioscopy (r < 0.38) and EyeCam (r < to 0.27) among eyes with angle closure. Mean AS-OCT measurements differed for eyes with Shaffer grade 0 in all four quadrants among eyes with varying degrees of angle closure on gonioscopy (P < 0.01) but did not differ among eyes with varying degrees of angle closure on EyeCam (P > 0.27). CONCLUSIONS Angle assessments by gonioscopy and EyeCam are weakly related to angle dimensions in eyes with angle closure. TRANSLATIONAL RELEVANCE AS-OCT imaging raises concerns about current clinical methods that rely on direct visualization of ACA structures to assess the degree of angle closure.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Shan C Lin
- Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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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: 18] [Impact Index Per Article: 3.0] [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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