July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Agreement between different levels of expertise for diagnosing angle closure with Swept-Source Optical Coherence Tomography
Author Affiliations & Notes
  • Claudio Ignacio Perez
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
    Fundacion Oftalmologica los Andes, Universidad de los Andes, Santiago, Chile
  • Anwell Nguyen
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Sunee Chansangpetch
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Marta Mora
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Mai Badr
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Travis Porco
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Shan C Lin
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Claudio Perez, None; Anwell Nguyen, None; Sunee Chansangpetch, None; Marta Mora, None; Mai Badr, None; Travis Porco, None; Shan Lin, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 4070. doi:https://doi.org/
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      Claudio Ignacio Perez, Anwell Nguyen, Sunee Chansangpetch, Marta Mora, Mai Badr, Travis Porco, Shan C Lin; Agreement between different levels of expertise for diagnosing angle closure with Swept-Source Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4070. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : There is need for understanding if glaucoma specialty training is necessary for evaluating iridotrabecular contact (ITC) using Swept-Source anterior segment optical coherence (AS-OCT) imaging. We performed a cross-sectional study of non-expert and expert interobserver agreement and diagnostic accuracy of AS-OCT images compared with gonioscopy for detecting angle closure.

Methods : 134 eyes of 134 patients were enrolled. We included patients over 40 years old and excluded patients with prior intraocular surgery or laser and poor quality images. Patients underwent dark-room gonioscopy exam with one glaucoma expert. Angle closure was defined if the posterior trabecular meshwork was not seen without indentation in 2 quadrants. Horizontal and vertical AS-OCT images were obtained in dark conditions with CASIA 2 angle analysis protocol. Two glaucoma-trained ophthalmologists and two medical doctors (non-glaucoma trained), graded all images in an independent manner. Angle closure by AS-OCT was assessed if 2 or more quadrants had ITC. Main outcome was interobserver agreement measured with Kappa score (κ) between experts, non-experts and gonioscopy. For diagnostic performance, area under receiver operating characteristic curve (AUC) was calculated using gonioscopy as the gold standard.

Results : Mean age of patients was 67.6 ± 10.1 years, 55.2% were female, and 24.6% had angle closure by gonioscopy. The agreement of closed angle between non-experts and gonioscopy was moderate (κ=0.45; 95% confidence interval (CI) 0.3–0.61 and κ=0.46; 95% CI 0.3–0.63, for each grader) and between experts and gonioscopy was moderate (κ=0.49; 95% CI 0.35–0.65 and κ=0.58; 95% CI 0.43–0.74, for each grader). Agreement between non-expert observers was moderate (κ=0.44; 95% CI 0.28–0.6) and between expert observers was excellent (κ=0.83; 95% CI 0.66–1.0). The diagnostic performance of the expert grader was better for detecting angle closure than the non-expert (AUC 0.85 vs. 0.78, respectively; P=0.019).

Conclusions : Although the level of expertise did not affect the agreement between observers and gonioscopy, the higher concordance between expert observers in comparison with non-expert observers, may explain the higher diagnostic performance for detecting angle closure in the glaucoma-trained graders. This suggests that more training may be helpful for assessing ITC in Swept-Source AS-OCT imaging.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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