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Wide-field imaging comparable to gonioscopy in detecting angle closure
Invest Ophthalmol Vis Sci. 2010;doi:10.1167/iovs.09.4418.
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Wide-field imaging compared favorably with gonioscopy in detecting angle closure, according to a study, and detected more closed angles than standard gonioscopy in all quadrants.
"The EyeCam has potential for use in anterior segment imaging, particularly in the clinical setting for documentation of angle findings," the study authors said. "However, due to several inherent limitations, it cannot be recommended as a screening tool for detection of angle closure and cannot be used to distinguish [primary angle closure suspects] from [primary angle closure] or [primary angle closure glaucoma] as it cannot identify [peripheral anterior synechiae]."
The prospective study included 152 eyes of 152 subjects who underwent gonioscopy and EyeCam (Clarity Medical Systems) imaging. Mean patient age was 57.4 years.
The anterior chamber angle in a quadrant was considered closed if the trabecular meshwork could not be seen. An eye was considered to have angle closure if two or more quadrants were closed.
A single observer conducted gonioscopy and a separate operator conducted EyeCam imaging. Two masked observers graded EyeCam images.
Study data showed that agreement between EyeCam imaging and gonioscopy in detecting angle closure was 0.73 in the superior quadrant, 0.75 in the inferior quadrant, 0.76 in the nasal quadrant and 0.72 in the temporal quadrant.
EyeCam diagnosed angle closure in 41 eyes (27%) and gonioscopy diagnosed angle closure in 21 eyes (13.8%).
EyeCam obtained clear images of angles in 98.8% of eyes.
Limitations of the EyeCam include a steep learning curve, moderate to poor reproducibility, inability to distinguish appositional from synechial closure and degradation of images at the periphery, the authors said.