Comparison of Gonioscopy with Cirrus and Visante Optical Coherence Tomography (OCT) for Anterior Chamber Angle Assessment in Glaucoma Patients

Abstract

Purpose: Assessment of the anterior chamber angle is essential in the management of narrow-angle and closed-angle glaucomas. Gonioscopic grading, the gold standard, is a semiquantitative assessment and results may vary between clinicians. Biometric analysis with OCT may provide a more objective assessment. In this prospective study, we aimed to compare gonioscopy with Cirrus and Visante OCT for determination of angle closure risk.

Methods: Gonioscopy grading using Spaeth Classification and determination of angle closure risk were performed on one eye for 39 phakic patients by 3 glaucoma specialists. Images of this same angle using both Cirrus and Visante OCT were obtained and graded. Inter-rater agreement for gonioscopy and imaging using Kendall’s coefficient of concordance (W) and Cohen’s kappa (K) was determined.

Results: Of these 39 patients, 54% were female, 64% were Caucasian and average age was 60. Most patients were diagnosed with narrow-angle (48%) or primary open angle (34%) glaucoma. Gonioscopy demonstrated substantial agreement in angle grade (W=0.78) and angle closure risk assessment (W=0.83) between the 3 specialists. Cirrus and Visante showed substantial agreement in determining if the angle was open or closed (K=0.73), but only fair agreement with gonioscopy (Cirrus K=0.37, Visante K=0.44).

Conclusions: Cirrus and Visante OCT had good agreement with each other, but only fair agreement with gonioscopy for angle assessment.

Keywords: 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 421 anterior segment