Diagnostic criteria of anterior segment swept-source optical coherence tomography to detect gonioscopic angle closure.
Guo Philip Yawen, Zhang Xiulan, Li Fei, Lin Chen, Nguyen Anwell, Sakata Rei, Higashita Risa, Okamoto Keiichiro, Yu Marco, Aihara Makoto
AI Summary
This study found that using normative angle measurement percentiles from OCT is more accurate than iris-trabecular contact for diagnosing gonioscopic angle closure, improving detection sensitivity and specificity.
Abstract
Aims
To compare the diagnostic performance of 360° anterior segment optical coherence tomography assessment by applying normative percentile cut-offs versus iris trabecular contact (ITC) for detecting gonioscopic angle closure.
Methods
In this multicentre study, 394 healthy individuals were included in the normative dataset to derive the age-specific and angle location-specific normative percentiles of angle open distance (AOD500) and trabecular iris space area (TISA500) which were measured every 10° for 360°. 119 healthy participants and 170 patients with angle closure by gonioscopy were included in the test dataset to investigate the diagnostic performance of three sets of criteria for detection of gonioscopic angle closure: (1) the 10th and (2) the 5th percentiles of AOD500/TISA500, and (3) ITC (ie, AOD500/TISA500=0 mm/mm 2 ). The number of angle locations with angle closure defined by each set of the criteria for each eye was used to generate the receiver operating characteristic (ROC) curve for the discrimination between gonioscopic angle closure and open angle.
Results
Of the three sets of diagnostic criteria examined, the area under the ROC curve was greatest for the 10th percentile of AOD500 (0.933), whereas the ITC criterion AOD500=0 mm showed the smallest area under the ROC (0.852) and the difference was statistically significant with or without adjusting for age and axial length (p<0.001). The criterion ≥90° of AOD500 below the 10th percentile attained the best sensitivity 87.6% and specificity 84.9% combination for detecting gonioscopic angle closure.
Conclusions
Applying the normative percentiles of angle measurements yielded a higher diagnostic performance than ITC for detecting angle closure on gonioscopy.
MeSH Terms
Shields Classification
Key Concepts4
The area under the receiver operating characteristic curve (AUROC) for detecting gonioscopic angle closure using the 10th percentile of Angle Open Distance at 500 microns (AOD500) was 0.933.
The area under the receiver operating characteristic curve (AUROC) for detecting gonioscopic angle closure using the Iris Trabecular Contact (ITC) criterion (AOD500=0 mm) was 0.852.
Applying normative percentiles of angle measurements (specifically, the 10th percentile of AOD500) yielded a statistically significantly higher diagnostic performance (AUROC 0.933) than Iris Trabecular Contact (ITC) (AUROC 0.852) for detecting angle closure on gonioscopy (p<0.001, with or without adjusting for age and axial length) in a multicentre study.
The criterion of ≥90° of Angle Open Distance at 500 microns (AOD500) below the 10th percentile achieved the best sensitivity of 87.6% and specificity of 84.9% for detecting gonioscopic angle closure in a multicentre study.
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