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Understanding diagnostic disagreement in angle closure assessment between anterior segment optical coherence tomography and gonioscopy
  1. Natalia Porporato1,
  2. Mani Baskaran1,
  3. Tin A Tun1,
  4. Rehena Sultana2,
  5. Marcus Tan3,
  6. Joanne HuiMin Quah4,
  7. John C Allen2,
  8. Shamira Perera1,
  9. David S Friedman5,
  10. Ching Yu Cheng1,
  11. Tin Aung1
  1. 1 Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
  2. 2 Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
  3. 3 Ophthalmology, National University Hospital, Singapore
  4. 4 Outram Polyclinic, SingHealth Polyclinics, Singapore
  5. 5 Glaucoma, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  1. Correspondence to Dr Tin Aung, Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; aung.tin{at}


Background/aims Although being a more objective tool for assessment and follow-up of angle closure, reliability studies have reported a moderate diagnostic performance for anterior segment optical coherence tomography (OCT) technologies when comparing with gonioscopy as the reference standard. We aim to determine factors associated with diagnostic disagreement in angle closure when assessed by anterior segment swept source OCT (SS-OCT, CASIA SS-1000; Tomey, Nagoya, Japan) and gonioscopy.

Methods Cross-sectional study. A total of 2027 phakic subjects aged ≥50 years, with no relevant previous ophthalmic history, were consecutively recruited from a community polyclinic in Singapore. Gonioscopy and SS-OCT (128 radial scans) for the entire circumference of the angle were performed for each subject. A two-quadrant closed gonioscopic definition was used. On SS-OCT images, angle closure was defined as iridotrabecular contact (ITC) to the extent of ≥35%, ≥50% and ≥75% of the circumferential angle. Diagnostic disagreements between both methods, that is, false positives or overcalls and false negatives or undercalls were defined, respectively, as gonioscopic open/closed angles inversely assessed as closed/open by SS-OCT.

Results Two hundred and seventy-two (14.7%) resulted in overcall results (false positives) when ≥50% of the angle circumference was closed using SS-OCT. These eyes had significantly wider (anterior chamber width, 11.7 vs 11.6 mm, p<0.001) and deeper (anterior chamber depth (ACD), 2.4 vs 2.2 mm, p<0.001) anterior chambers than eyes assessed by both methods as closed (true positives). Deeper ACD (OR 9.31) and lower lens vault (LV) (OR 0.04) were significantly associated with a false positive diagnosis in the multivariate analysis. Most of these cases had short (52.6%) or irregular (39%) ITC in SS-OCT images.

Conclusions We found that anterior chamber dimensions, determined by ACD and LV, were factors significantly associated with diagnostic disagreement between anterior segment SS-OCT and gonioscopy in angle closure assessment.

  • angle
  • anterior chamber
  • glaucoma
  • imaging

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  • Contributors Conception and design of the work: NP, MB, SP, DSF, CYC and TA. Acquisition, analysis or interpretation of data for the work: NP, MB, TAT, RS, MT, JHQ, JCA and TA. Drafting the work: NP Revising the work: NP, MB, SP, DSF, CYC, TA, TAT, RS, MT, JHQ and JCA. All authors have approved the version to be published and agreed to be accountable for all aspects of the work.

  • Funding This work was supported by National Medical Research Council and Biomedical Research Council, Singapore (grant No. 10/1/35/19/674).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study had the approval of the SingHealth ethics review board.

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

  • Data availability statement Data are available on request.

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