Gonioscopic Angle Research Articles

Diagnostic criteria of anterior segment swept-source optical coherence tomography to detect gonioscopic angle closure

AimsTo 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.MethodsIn this multicentre...

Investigating the determinants of iridolenticular contact area: a novel parameter for angle closure

Background/aimsTo identify ocular determinants of iridolenticular contact area (ILCA), a recently introduced swept-source optical coherence tomography (SSOCT) derived parameter, and assess the association between ILCA and angle closure.MethodsIn this population-based...

PRIMARY OPEN ANGLE GLAUCOMA: MECHANISMS OF PATHOGENESIS AND GENETIC PREDISPOSITION. Review

Relevance. Primary open-angle glaucoma (POAG) is a progressive optic neuropathy with loss of retinal ganglion cells (RGCs) and narrowing of the visual fields in the eyes with a gonioscopic open angle. The main mechanisms of this are increased intraocular pressure (IOP), circulatory disorders, trabecular meshwork (TM), ischemic metabolic disorders and chronic inflammation. However, questions about the role of POAG genetic predisposition remain open.
 Objective: analysis of current data on the mechanisms of pathogenesis of progressive neuropathy in POAG and the role of genetic predisposition.
 Methods. The analysis of scientific publications in open international electronic scientometric databases: Scopus, PubMed, Web of Science, Google Scholar, SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase by keywords (a total of 67 sources). Search depth – 10 years (2012-2022).
 Results. There are more than 60 million glaucoma patients in the world, 20% of whom have an incurable stage. By 2040, the number of patients is projected to increase to 112 million, with POAG accounting for 75% of cases. Among the main mechanisms of glaucoma, an important role belongs to chronic inflammation and immune damage, which occur in response to ischemic injury. Prolonged inflammatory process leads to hypersecretion of inflammatory mediators and infiltration of inflammatory cells into ischemic tissue, which aggravates the effects of increased IOP and ischemia. It is known that mutations in the gene of Toll-like receptor 4 (TLR4) are associated with both infectious and non-infectious diseases, including POAG: activation of TLR4 initiates TM fibrosis, causes increased IOP, activates RGCs apoptosis in the model of acute glaucoma. TLR4 ligands, such as heat shock proteins and lipopolysaccharides are candidate antigens for glaucoma. TLR4 overexpression at retinal microglia and astrocytes induce an innate immune response through NF-κB activation, which enhances the expression of proinflammatory cytokines.
 Conclusions. A promising direction is to study the contribution of TLR4 mutations to the POAG mechanisms, which will identify the mechanisms of immune disorders and establish the genetic risk of individual mutations in different ethnic groups.

Angle closure extent, anterior segment dimensions and intraocular pressure

AimTo investigate the association between the extent of iridotrabecular contact and other quantitative anterior segment dimensions measured by swept-source optical coherence tomography (SS-OCT; CASIA SS-1000, Tomey, Nagoya, Japan) with intraocular...

Diagnostic Performance of Deep Learning Classifiers in Measuring Peripheral Anterior Synechia Based on Swept Source Optical Coherence Tomography Images.

PurposeTo develop deep learning classifiers and evaluate their diagnostic performance in detecting the static gonioscopic angle closure and peripheral anterior synechia (PAS) based on swept source optical coherence tomography (SS-OCT) images.Materials and MethodsSubjects were recruited from the Glaucoma Service at Zhongshan Ophthalmic Center of Sun Yat-sun University, Guangzhou, China. Each subject underwent a complete ocular examination, such as gonioscopy and SS-OCT imaging. Two deep learning classifiers, using convolutional neural networks (CNNs), were developed to diagnose the static gonioscopic angle closure and to differentiate appositional from synechial angle closure based on SS-OCT images. Area under the receiver operating characteristic (ROC) curve (AUC) was used as outcome measure to evaluate the diagnostic performance of two deep learning systems.ResultsA total of 439 eyes of 278 Chinese patients, which contained 175 eyes of positive PAS, were recruited to develop diagnostic models. For the diagnosis of static gonioscopic angle closure, the first deep learning classifier achieved an AUC of 0.963 (95% CI, 0.954–0.972) with a sensitivity of 0.929 and a specificity of 0.877. The AUC of the second deep learning classifier distinguishing appositional from synechial angle closure was 0.873 (95% CI, 0.864–0.882) with a sensitivity of 0.846 and a specificity of 0.764.ConclusionDeep learning systems based on SS-OCT images showed good diagnostic performance for gonioscopic angle closure and moderate performance in the detection of PAS.

Ocular Biometric Determinants of Dark-to-Light Change in Angle Width: The Chinese American Eye Study

To assess ocular biometric determinants of dark-to-light change in anterior chamber angle width and identify dynamic risk factors in primary angle closure disease (PACD). Population-based cross-sectional study. Chinese American Eye Study (CHES) participants underwent anterior segment optical coherence tomography imaging in the dark and light. Static dark and light biometric parameters, including angle opening distance, 750 µm (AOD750), anterior chamber width (ACW), lens vault (LV), and pupillary diameter (PD) were measured, and dynamic dark-to-light changes were calculated. Contributions by static and dynamic parameters to dark-to-light changes in AOD750 were assessed using multivariable linear regression models with standardized regression coefficients (SRCs) and semipartial correlation coefficients squared (SPCC2). PACD was defined as ≥3 quadrants of gonioscopic angle closure. The analysis included 1011 participants. All biometric parameters differed between dark and light (P < .05). On multivariable regression analysis, change in ACW (SRC=-0.35, SPCC2=0.081) and PD (SRC=-0.46, SPCC2=0.072) were the strongest determinants of dark-to-light change in AOD750 (overall R2=0.40). Dark-to-light increase in AOD750 was less in eyes with than without PACD (0.081 mm and 0.111 mm, respectively; P < .001). ACW increased in eyes with PACD and decreased in eyes without PACD from dark to light (P < .025), whereas change in PD was similar (P=.28). Beneficial angle widening effects of transitioning from dark to light are attenuated in eyes with PACD, which appears related to aberrant dark-to-light change in ACW. These findings highlight the importance of assessing the angle in both dark and light to identify potential dynamic mechanisms of angle closure.

Generalisability and performance of an OCT-based deep learning classifier for community-based and hospital-based detection of gonioscopic angle closure

PurposeTo assess the generalisability and performance of a deep learning classifier for automated detection of gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images.MethodsA convolutional neural network (CNN)...

Anterior segment biometric measurements explain misclassifications by a deep learning classifier for detecting gonioscopic angle closure

Background/aimsTo identify biometric parameters that explain misclassifications by a deep learning classifier for detecting gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images.MethodsChinese American Eye Study (CHES) participants...

Predictive Equation for Angle Opening Distance at 750 μm After Laser Peripheral Iridotomy in Primary Angle Closure Suspects.

Aim: The aim of this study was to investigate the changes in anterior segment parameters as assessed by ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) and to propose a prediction equation for the width of the angle after LPI.Design: This was a prospective study.Participants: The participants included 100 subjects with primary angle closure suspect (PACS).Methods: Anterior segment UBM parameters were measured, whereas AOD750 was chosen to indicate the width of the angle associated with gonioscopic angle closure, as found in a prior study.Main Outcome Measures: Angle parameters, iris parameters, anterior chamber parameters and ciliary body parameters.Results: All angle parameters increased after LPI, including the mean angle opening distance at 750 μm (AOD750), mean angle opening distance at 500 μm from the scleral spur (AOD500), mean angle opening distance at 750 μm from the scleral spur (AOD750), and mean angle recess area at 750 μm from the scleral spur (ARA750). Among iris parameters and ciliary body parameters, the iris thickness at 2,000 μm (IT2000), iris curvature (IC), and trabecular-ciliary process distance (ICPD) were reduced after LPI. The final equation consisted of four parameters: anterior chamber depth (ACD), iris thickness at 750 μm from the scleral spur (IT750), AOD750, and lens vault (LV). This equation explained 42.7% of the variability in the angle opening indicator AOD750 after LPI, whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached the highest a maximum of 68.6%.Conclusions: There was an increase in angle opening and iris flattening after LPI. An equation involving four angle parameters was constructed, this equation which could explained 42.7% of the variability in the angle opening indicator AOD750 after LPI whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached a maximum of 68.6%.

Diagnostic accuracy of swept source optical coherence tomography classification algorithms for detection of gonioscopic angle closure

PurposeTo evaluate the performance of swept source optical coherence tomography (SS-OCT) to detect gonioscopic angle closure using different classification algorithms.MethodsThis was a cross-sectional study of 2028 subjects without ophthalmic symptoms...

Towards ‘automated gonioscopy’: a deep learning algorithm for 360° angle assessment by swept-source optical coherence tomography

AimsTo validate a deep learning (DL) algorithm (DLA) for 360° angle assessment on swept-source optical coherence tomography (SS-OCT) (CASIA SS-1000, Tomey Corporation, Nagoya, Japan).MethodsThis was a reliability analysis from a...

Assessment of angle closure spectrum disease as a continuum of change using gonioscopy and anterior segment optical coherence tomography.

Studies examining the anterior chamber angle and angle closure disease often compare quantitative angle information obtained using anterior segment optical coherence tomography (ASOCT) with one of several ordinal scales derived using gonioscopy. We test the assumption that the ordinal gonioscopic angle grades have equal step sizes and can be analysed using metric statistics. The medical records of 214 consecutive patients who were referred for assessment of the anterior chamber angle were prospectively examined using gonioscopy and ASOCT (Spectralis Optical Coherence Tomography, OCT, www.heidelbergengineering.com). Anterior chamber angle parameters (angle opening distance, AOD, and trabecular-iris space area, TISA at 500 and 750 microns) were extracted from ASOCT images using a semi-automated segmentation algorithm written on MATLAB (www.mathworks.com). We first matched the quantitative values for each gonioscopic grade (0-4, from no structures visible to ciliary body visible) and described the frequency distributions to determine separability. We then applied a grade-agnostic clustering algorithm to determine the concordance between algorithm-clustered groups (using solely quantitative data) and those obtained using gonioscopy. The frequency distributions of the quantitative ASOCT parameters for each angle grade were mostly non-parametric and displayed unique distribution characteristics, with a floor effect seen for grade 0 and the lack of a ceiling effect seen for grades 3 and 4. Although we found significant differences in quantitative values across the five angle grades using the frequency distributions, some pairwise comparisons were indistinguishable (such as grades 0 and 1, and grades 3 and 4) due to the overlaps in distributions. On average, differences in quantitative values were consistent between gonioscopic grade steps, but there remained substantial variability that confounds prediction of change between ordinal steps. The clustering algorithm showed approximately 10% of cases with the same group assignment as that of the gonioscopic grade, improving slightly to 30% when the top 5% of quantitative data were excluded from analysis. Our results do not necessarily support the assumption that the ordinal scales used in gonioscopy can be interpreted using an interval scale. We highlight the need for better methods of describing the course and risk of angle closure spectrum disease to identify disease progression and conversion, where gonioscopy remains the gold standard.

Gonioscopic iridocorneal angle morphology and incidence of postoperative ocular hypertension and glaucoma in dogs following cataract surgery.

To investigate the relationship between gonioscopic iridocorneal angle (ICA) morphology and the incidence of postoperative ocular hypertension (POH) and postoperative glaucoma in dogs undergoing cataract surgery. Retrospective analysis of 138 eyes of 78 canine patients who underwent phacoemulsification at North Carolina State University from December 1, 2015 through April 30, 2017. Medical records of all phacoemulsification patients with preoperative RetCam gonioscopic images were reviewed for preoperative, intraoperative, and postoperative variables. Gonioscopic angle indices were calculated using a novel (ZibWest) angle grading system, and these indices were analyzed for outcome-related significance. Increased surgeon experience was associated with increased probability of POH and vision loss. Higher average ZibWest Angle indices (ie, more open angles with less pectinate ligament dysplasia/ abnormality) were associated with a significantly decreased probability of medically unresponsive glaucoma. Increased patient age was significantly associated with an increased probability of both postoperative glaucoma and vision loss. Female dogs were significantly more likely to experience postoperative glaucoma compared to male dogs. Increased surgery time was significantly associated with increased probability of vision loss. The ZibWest angle index may predict increased risk for developing medically unresponsive glaucoma with cataract surgery. Female sex, and increased patient age, surgical time, and surgeon experience were associated with increased postoperative morbidity.

Evaluation of meridional scans for angle closure assessment with anterior segment swept-source optical coherence tomography

Background/aimsAs swept-source optical coherence tomography (SS-OCT) simultaneously obtains 128 meridional scans, it is important to identify which scans are playing the main role in classifying gonioscopic angle closure to simplify...

Deep Learning Classifiers for Automated Detection of Gonioscopic Angle Closure Based on Anterior Segment OCT Images

To develop and test deep learning classifiers that detect gonioscopic angle closure and primary angle closure disease (PACD) based on fully automated analysis of anterior segment OCT (AS-OCT) images. Subjects were recruited as part of the Chinese-American Eye Study (CHES), a population-based study of Chinese Americans in Los Angeles, California, USA. Each subject underwent a complete ocular examination including gonioscopy and AS-OCT imaging in each quadrant of the anterior chamber angle (ACA). Deep learning methods were used to develop 3 competing multi-class convolutional neural network (CNN) classifiers for modified Shaffer grades 0, 1, 2, 3, and 4. Binary probabilities for closed (grades 0 and 1) and open (grades 2, 3, and 4) angles were calculated by summing over the corresponding grades. Classifier performance was evaluated by 5-fold cross-validation and on an independent test dataset. Outcome measures included area under the receiver operating characteristic curve (AUC) for detecting gonioscopic angle closure and PACD, defined as either 2 or 3 quadrants of gonioscopic angle closure per eye. A total of 4036 AS-OCT images with corresponding gonioscopy grades (1943 open, 2093 closed) were obtained from 791 CHES subjects. Three competing CNN classifiers were developed with a cross-validation dataset of 3396 images (1632 open, 1764 closed) from 664 subjects. The remaining 640 images (311 open, 329 closed) from 127 subjects were segregated into a test dataset. The best-performing classifier was developed by applying transfer learning to the ResNet-18 architecture. For detecting gonioscopic angle closure, this classifier achieved an AUC of 0.933 (95% confidence interval, 0.925-0.941) on the cross-validation dataset and 0.928 on the test dataset. For detecting PACD based on 2- and 3-quadrant definitions, the ResNet-18 classifier achieved AUCs of 0.964 and 0.952, respectively, on the test dataset. Deep learning classifiers effectively detect gonioscopic angle closure and PACD based on automated analysis of AS-OCT images. These methods could be used to automate clinical evaluations of the ACA and improve access to eye care in high-risk populations.

Novel and Semiautomated 360-Degree Gonioscopic Anterior Chamber Angle Imaging in Under 60 Seconds

Obtaining slit-lamp gonioscopic images requires a high level of expertise and can be time consuming. The images typically are limited to 4 quadrants with limited resolution and can be affected by different lighting conditions. Our goal was to study the ability of the novel imaging system to quickly and easily document the full 360 degrees of the anterior chamber angle in a standardized manner. Cross-sectional cohort study. Eighty-four eyes from 50 subjects were included in this study, including 26 eyes from 17 normal participants and 58 eyes from 33 patients diagnosed with glaucoma. A newly introduced, commercially available gonioscope (GS-1, NIDEK Co, Gamagori, Japan) was utilized to perform semiautomated imaging of the full 360-degree iridocorneal angle on participants under an institutional review board-approved study. Topical proparacaine was administered to the eye to anesthetize the eye and imaging was completed using the 16-mirror, machine-attached gonioscopic lens coupled with lubricating ophthalmic gel ointment. The first step of the 2-step image acquisition process is analogous to manual gonioscopy, whereas the second step is performed by the instrument in an automated fashion. First, the instrument is manually moved forward by the operator to allow the machine-attached lens to make contact with the patient's corneal surface (time= 30 seconds). Second, the instrument automatically achieves fine focus on the iridocorneal angle and takes 16 sequential high-resolution photographs at multiple different focal planes (time= less than 30 seconds). Successful qualitative imaging of anterior chamber iridocorneal angle in normal and glaucomatous eyes including visualization of various implanted devices within angle before and after surgery in less than 1 minute per eye. In this pilot study, the full 360 degrees of iridocorneal angle of 84 eyes from 50 normal participants or glaucoma patients were successfully imaged using NIDEK GS-1 in under 60 seconds. All eyes were able to be imaged in 1 sitting, and we were able to image the full spectrum of angle from narrow/closed to fully open. The 360-degree views of the images were able to be displayed in 3 available formats (16-section display, a circular display, or a linear display). Successful imaging was also achieved of surgical devices and postsurgical conditions including CyPass, iStent, XEN, Baerveldt tube shunt, angle recession with iridodialysis, angle neovascularization, pigment dispersion, posttrabeculectomy sclerostomy and surgical iridectomy, and post-laser peripheral iridotomy. The newly introduced, semiautomated imaging system was able to document the full 360-degree iridocorneal angle views in normal and glaucoma eyes in less than 1 minute, which may allow longitudinal evaluation in a standardized manner. Furthermore, this system allows the ability to easily evaluate post-angle surgery changes and assess positions of implanted devices in the anterior chamber angle.

Predictors of Short-Term Intraocular Pressure Change after Laser Peripheral Iridotomy: A Prospective Randomized Study

To describe short-term intraocular pressure (IOP) changes after laser peripheral iridotomy (LPI) and identify factors predicting IOP lowering. Multicenter, prospective randomized study. Four hundred fifty-five South Indian eyes of 455 participants 30 years of age or older with a diagnosis of primary angle-closure suspect (PACS), primary angle closure (PAC), or PAC glaucoma (PACG). Participants were randomized to superior or nasal/temporal LPI. Multivariate regression models were used to determine preoperative features and LPI parameters associated with change in IOP from baseline to the 2-week postoperative examination. Change in IOP at 2 weeks after LPI compared with baseline. Among all treated eyes, 11.0% of eyes demonstrated a 20% or more decrease in IOP after LPI, whereas 19.6% demonstrated at least a 20% increase in IOP. Intraocular pressure changes occurring after LPI did not differ by LPI location (P > 0.5 for all comparisons). Although the anterior chamber angle widened after LPI (P < 0.001) and was classified as open after laser in most eyes (64% in all 4 quadrants), there was no significant association between gonioscopic angle opening and LPI-induced IOP change (P= 0.7). Linear regression analysis demonstrated more IOP lowering with higher baseline IOP (3.2 mmHg more lowering per 10-mmHg higher baseline IOP; 95% confidence interval [CI], 2.3-4.1 mmHg) and PAC/PACG diagnosis (1.4 mmHg more IOP lowering vs. PACS diagnosis; 95% CI, 0.2-2.6 mmHg) predicted a lower IOP after LPI. After multivariate adjustment, only higher baseline IOP predicted lower IOP after LPI (P < 0.001). Features not associated with IOP lowering included demographic, visual, and A-scan measures; baseline gonioscopic angle width; total laser energy; LPI area; and LPI location (P > 0.08 for all). Eyes with PAC/PACG, as compared with PACS, demonstrated more IOP lowering after LPI (1.2±1.7 mmHg vs. -0.4±1.0 mmHg; P < 0.001) after adjusting for baseline IOP. Neither LPI location nor degree of gonioscopic angle opening was associated with statistically significant change in IOP after LPI. Although significant IOP lowering after LPI was uncommon in the overall cohort, higher baseline IOP and PAC/PACG diagnosis predicted lower postoperative IOP.

Low Sensitivity of the Van Herick Method for Detecting Gonioscopic Angle Closure Independent of Observer Expertise

To evaluate the diagnostic performance characteristics of the Van Herick assessment (VHA) for identifying angle closure compared to gold-standard gonioscopy, as conducted by trained observers of varying expertise. Reliability analysis. Patients (n= 131) from a glaucoma referral clinic aged ≥50 years without prior ocular surgery or iridotomy underwent unilateral VHA by 1 of 11 trained ophthalmic technicians, followed by VHA and indirect gonioscopy by 1 of 15 ophthalmology residents and 1 of 4 glaucoma specialist attending physicians. Observers were masked to others' gradings. Cohen's kappa (κ) assessed test reproducibility. VHA sensitivity and specificity for identifying gonioscopic angle closure were calculated. Mean patient age was 62.0 ± 8.7 years, 56% of patients were male, and 84% were African American. Angles were gonioscopically closed in 14.5% of eyes. Moderate agreement was observed comparing technician or resident VHA to attending VHA (κ= 0.48 and κ= 0.56, respectively). Resident and attending gonioscopy demonstrated excellent agreement (κ= 0.94). Sensitivities of technician, resident, and attending VHA for detecting angle closure were 57.9% (95% confidence interval: 34.0%-78.9%), 78.9% (53.9%-93.0%), and 68.4% (43.5%-86.4%), respectively. Specificities were 88.5% (80.3%-93.6%), 88.2% (80.3%-93.3%), and 87.5% (79.6%-92.8%), respectively. VHA, even when performed by experienced ophthalmologists, misses a substantial proportion of angle closure while incorrectly identifying roughly 1 in 8 open-angle eyes as closed. These results suggest that clinical assessment of anterior chamber angle configuration is best accomplished with gonioscopy.

Residual Angle Closure One Year After Laser Peripheral Iridotomy in Primary Angle Closure Suspects

To determine the incidence and baseline clinical and anterior segment optical coherence tomography (AS-OCT) predictors associated with residual angle closure as assessed by gonioscopy 1 year after laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS). Subanalysis of randomized controlled trial data. AS-OCT images from 181 PACS subjects ≥50 years of age were analyzed using customized software before and 1 year after LPI. Other parameters assessed were intraocular pressure (IOP) and axial length (Axl). Residual angle closure was defined as the inability to see the posterior trabecular meshwork for at least 2 quadrants on gonioscopy after LPI. Multivariate regression analysis determined the baseline predictors of residual angle closure 1 year after LPI. The mean age of participants was 62.4 (standard deviation 9.9) years. The majority were female (137, 75.7%) and Chinese (174, 96.1%). At 1 year post LPI, 148 (81.8%) subjects had gonioscopic residual angle closure. Univariate analysis showed that baseline Axl, anterior chamber area, anterior chamber volume, angle opening distance at 750μm from the scleral spur, and angle recess area were smaller while baseline lens vault and iris curvature were larger in residual angle closure subjects (all P < .05). Multivariate analysis revealed that baseline iris volume (B=-0.08, P= .035) and baseline IOP (B= 0.23, P= .032) were predictors for residual angle closure. One year after LPI, >80% of PACS had gonioscopic residual angle closure. Greater baseline iris volume and higher IOP at baseline are independent risk factors for residual gonioscopic angle closure.

Automated gonioscopy photography for iridocorneal angle grading

PurposeThis study aims to assess inter‐device and inter‐observer agreement of iridocorneal angle grading using automatic gonio‐photography and dynamic gonioscopy.MethodsCross sectional single‐center observational study. Consecutive patients from Glaucoma Clinic were recruited to perform two types of gonioscopy. Manual gonioscopy (MG) was performed using a dynamic gonio lens, while the automatic Gonio‐Photography (AG) was done using a contact‐gonioscope prototype (from NIDEK). AG images were graded by two masked observers (glaucoma specialist and resident). Criteria for classification was similar in both methods. An eye was classified with angle closure when the posterior trabecular meshwork couldn't be seen in two or more quadrants. Inter‐device agreement (AG vs MG) was ascertained by κ statistic and comparison of area under receiver operating characteristic curves (AUC). Agreement among raters was ascertained by Fleiss’ κ statistic and intraclass correlation coefficient (ICC).ResultsForty‐eight eyes were analyzed. Mean age was 63 ± 16 years. Angle closure was detected in 11 eyes (23.4%) with MG in comparison with 2 eyes (4.3%) using AG images grading. The agreement for angle closure diagnosis between MG and AG was poor (κ=0.09 ± 0.10; p = 0.18). The AUC for detecting eyes with gonioscopic angle closure showed poor accuracy between automated and manual methods (AUC=0.53 ± 0.05, confidence interval (CI) 95%: 0.44‐0.62). The ICC for iridocorneal angle grading between the two raters was 0.34 [CI 95%: 0.10‐0.51] and Fleiss’ kappa coefficient for opening status was 0.13 [CI 95%: 0.04‐0.30].ConclusionsOnly slight agreement was found when comparing automated with manual dynamic gonioscopy and also when comparing two raters. Manual dynamic gonioscopy is the gold standard and further technological development is desired for promising automated gonioscopy.