[Chamber Angle Assessment in Clinical Practice - A Comparison between Optical Coherence Tomography and Gonioscopy]

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Research

Background:

• Anterior chamber structures are crucial for glaucoma classification, therapy, progression, and prognosis.
• Anterior segment optical coherence tomography (AS-OCT) is increasingly relevant for evaluating these structures.
• This study compares the diagnostic performance of AS-OCT with gonioscopy for chamber angle assessment in glaucoma patients.

Purpose of the Study:

• To compare the diagnostic accuracy of AS-OCT and gonioscopy in assessing glaucoma chamber angles.
• To evaluate anterior chamber depth (ACD) measured by slit-lamp examination as a prognostic factor for chamber angle width (CAW).
• To determine the clinical utility of AS-OCT in routine glaucoma management.

Main Methods:

• 104 glaucoma patients underwent AS-OCT imaging.
• Chamber angle grading from AS-OCT was compared to gonioscopic grading (Shaffer system).
• Anterior chamber depth (ACD) was measured using slit-lamp examination and AS-OCT to assess its correlation with chamber angle width (CAW).

Main Results:

• AS-OCT revealed discrepancies with gonioscopy in 17% of wide angles and 35% of narrow angles.
• Anterior chamber depth (ACD) assessment is a strong predictor of CAW (correlation coefficient 0.83), with a critical ACD of 2.4 mm for angle closure risk.
• A 1 mm variation in ACD correlated with an 18.9° change in CAW; all angle closure glaucoma patients had ACD < 2.4 mm.

Conclusions:

• AS-OCT is an effective alternative to gonioscopy for chamber angle assessment in glaucoma.
• AS-OCT can be superior to gonioscopy in certain clinical situations, particularly with inexperienced practitioners or when gonioscopy is challenging.
• ACD measurement via AS-OCT provides valuable prognostic information for angle closure risk, complementing gonioscopy findings.