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‘Van Herick Plus’: a modified grading scheme for the assessment of peripheral anterior chamber depth and angle
  1. Ramanjit Sihota1,
  2. Neha Kamble1,
  3. Ajay K Sharma1,
  4. Anju Bhari1,
  5. Amisha Gupta1,
  6. Neha Midha1,
  7. Harathy Selvan1,
  8. Tanuj Dada1,
  9. Viney Gupta1,
  10. Ravindra M Pandey2
  1. 1 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Neha Kamble, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110 029, India; nehakamble.24{at}gmail.com

Abstract

Aim To evaluate the accuracy of a new, modified grading scheme involving a short vertical slit beam, at the inferior angle for peripheral anterior chamber depth (PAC) and angle estimation and its correlation with anterior segment optical coherence tomography (ASOCT).

Methods A cross-sectional study of consecutive phakic patients, above 40 years of age, was performed. Using a short, vertical slit beam not reaching the pupil, the inferior angle at the sclerolimbal junction was evaluated, photographed and assessed by a ratio of peripheral anterior chamber depth to peripheral corneal thickness (PAC:PCT) and iridocorneal angle (ICA) on ImageJ software. The inferior angle at the same meridian was also recorded on ASOCT.

Results Based on the PAC:PCT ratio, the subjects were divided into four groups: I (<1/4), II (1/4-1/2), III (>1/2–1) and IV (>1). The clinically assessed angle by short vertical slit beam correlated well with ASOCT values, trabecular-iris angle (TIA) (r=0.918; p<0.001) and scleral spur angle (r=0.903, p<0.001). The mean difference between ICA and TIA on ASOCT was 0.7970; 95% limits of agreement:−5.7670 to 7.3610 (±1.96 SD). For angles graded narrow on ASOCT (TIA <200), using a cut-off of peripheral PAC:PCT <1/4, the area under the curve was 0.918 with a sensitivity of 85.2% and a specificity of 88.2%. There was good agreement between ImageJ parameters with those assessed subjectively on photograph of the slit beam examination by a glaucoma fellow (weighted kappa=0.74) as compared with a general ophthalmologist, where there was moderate agreement (weighted kappa=0.57).

Conclusion A short, vertical slit lamp beam evaluation at the inferior angle is an easy and relatively accurate method for both peripheral anterior chamber depth and angle assessment. It correlated well with ASOCT and can be used as a more reliable screening tool to identify eyes with possibly occludable angles.

  • angle
  • diagnostic tests/investigation
  • glaucoma
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Footnotes

  • Contributors RS: concept, design interpretation, revising critically and overall responsibility. NK, AKS, AB and AG: data collection, manuscript drafting, final approval and agreement to be accountable. NM and HS: data analysis, interpretation, manuscript drafting, final approval and agreement to be accountable. TD: interpretation, critical revision, final approval and agreement to be accountable. VG: interpretation, manuscript drafting, final approval and agreement to be accountable. RMP: analysis, interpretation, drafting, final approval and agreement to be accountable.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Ethics Committee – All India Institute of Medical Sciences, New Delhi, India.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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