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Editors Selection IGR 10-3

Examination methods: Noncontact goniometry

Comment by David Friedman on:

12028 Noncontact goniometry with optical coherence tomography, Wirbelauer C; Karandish A; Haberle H et al., Archives of Ophthalmology, 2005; 123: 179-185

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Wirbelauer et al. (119) in this study modified a slit lamp to allow imaging of the anterior chamber angle using optical coherence tomography (OCT) in 138 eyes of 109 patients. For technical reasons the authors limited imaging to the nasal and temporal angles. Using an image analysis program, the authors then calculated anterior chamber parameters including anterior chamber angle (ACA) and angle opening distance at 500 microns. The authors compared these findings to standard gonioscopy and found strong correlations between OCT parameters and gonioscopy grades. Finally, the authors assessed the sensitivity and specificity of the OCT for detecting 'occludable' angles (defined in this study as gonioscopy angle width of twenty degrees or less, presumably in either the nasal or temporal angles), and reported sensitivity over 90% and specificity over 85% for both parameters.

OCT measurements of the anterior chamber angle gave results similar to those obtained with conventional gonioscopy

This paper is the first published to confirm that OCT measurements of the anterior chamber angle give results similar to those obtained with conventional gonioscopy, and successfully identifies a high proportion of individuals felt to be at risk of angle closure. This finding supports further development of this technology. OCT has many advantages over conventional gonioscopy. It does not require contact with the eye, can be performed by a technician, and almost certainly will be able to give more reproducible results than gonioscopy once the process of acquiring and analyzing images is further automated to reduced variation in grading. OCT may even be better than gonioscopy since it can be performed in near complete darkness, which will allow for observation of the angle structures in their most crowded state.

While additional work is still required to automate image capture and analysis, this paper demonstrates that anterior segment imaging by OCT will almost certainly become an important tool in the diagnosis and management of glaucoma.

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