Abstract
Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention. Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. Several new imaging techniques for angle evaluation have been developed in the recent years. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment’s structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.
Highlights
Evaluation of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination, instrumental to achieve pertinent relevant information on glaucoma patients as well as on non-glaucomatous subjects [1]
In China, it was estimated that 9 million people have a significant angle closure and more than 28 million people have an anatomic trait predisposing to primary angle closure glaucoma [5]
Angle closure was detected in 4.3% and in 23.4% of the eyes with NGS-1 automated gonioscopy and dynamic gonioscopy, respectively, in a study by Teixeira et al These results demonstrate that the instrument may have low sensitivity in comparison with gonioscopy [3]
Summary
Evaluation of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination, instrumental to achieve pertinent relevant information on glaucoma patients as well as on non-glaucomatous subjects [1]. It has been demonstrated that without an appropriate gonioscopic evaluation, the vast majority of chronic angle closure varieties may be mistaken for open-angle glaucoma [10,11] In this respect, Varma et al found that approximately 10% of patients diagnosed with primary open-angle glaucoma were affected by angle closure glaucoma [12]. It has been demonstrated that the repeatability of gonioscopy is higher when the examination is performed by highly experienced vs novice personnel, as the regular practice and the retraining are likely to improve and maintain the performance [14] This has been found in a collaborative care glaucoma clinic, where a “fair to moderate” agreement in gonioscopy was achieved between experienced optometrists and glaucoma specialists [15]. The aim of this paper is to give an overview of the emerging techniques for the evaluation of the ACA, focusing on their potential role in clinical practice, especially when compared to traditional techniques
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