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Editors Selection IGR 9-4

Structure Tests and Anatomy: Visante OCT and scleral spur

Comment by Wallace Alward on:

25230 Assessment of scleral spur visibility with anterior segment optical coherence tomography, Liu S; Li H; Dorairaj S et al., Journal of Glaucoma, 2010; 19: 132-135

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The scleral spur is an important landmark when evaluating the width of the iridocorneal angle with an imaging device. Measures of angle width utilizing ultrasound biomicroscopy rely upon the identification of the scleral spur. However, prior studies with anterior segment optical coherence tomography (ASOCT) were only able to identify the scleral spur in 70% of eyes. Liu and colleagues (204) furthered the evaluation of the scleral spur with the Visante ASOCT. Liu et al. studied 60 volunteers with varying angle widths. ASOCT measurements were made at each clock hour. Images were given a scleral spur visibility score (SSVS) of 0 to 2. Two independent examiners graded the images and their assessments correlated well. The SSVS scores were compared to demographic and anatomic measures and to an algorithm (ACADMEIA) that calculates angle width without relying upon the identification of the scleral spur. The scleral spur was most readily visible nasally and least visible inferiorly. There was little variability in SSVS within an eye or between eyes of an individual. The scleral spur was harder to identify in eyes with small anterior chamber diameters, short axial eye lengths, advanced age and narrow angles; although angle width was the only factor that remained after multivariate analysis. Interestingly, we are not told the percentage of eyes in which the scleral spur could be found. Inability to see the scleral spur with ASOCT is correlated with a narrow iridocorneal angle. (H and F) This paper is not likely to help those in clinical practice, but is another piece in the development of automated means of assessing angle width. Were I to write an abstract conclusion for this paper, I would say that inability to see the scleral spur with ASOCT is correlated with a narrow iridocorneal angle. This is probably more helpful than their conclusion that 'the visibility of the scleral spur is an important determinant of the dimension of the anterior chamber angle.'

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