Japanese Journal of Ophthalmology

, Volume 55, Issue 4, pp 343–350 | Cite as

Assessment of narrow angles by gonioscopy, Van Herick method and anterior segment optical coherence tomography

  • Seong Bae Park
  • Kyung Rim Sung
  • Sung Yung Kang
  • Jung Woo Jo
  • Kyoung Sub Lee
  • Michael S. Kook
Clinical Investigation



To evaluate anterior chamber (AC) angles using gonioscopy, Van Herick technique and anterior segment optical coherence tomography (AS-OCT).


One hundred forty-eight consecutive subjects were enrolled. The agreement between any two of three diagnostic methods, gonioscopy, AS-OCT and Van Herick, was calculated in narrow-angle patients. The area under receiver-operating characteristic curves (AUC) for discriminating between narrow and open angles determined by gonioscopy was calculated in all participants for AS-OCT parameter angle opening distance (AOD), angle recess area, trabecular iris surface area and anterior chamber depth (ACD). As a subgroup analysis, capability of AS-OCT parameters for detecting angle closure defined by AS-OCT was assessed in narrow-angle patients.


The agreement between the Van Herick method and gonioscopy in detecting angle closure was excellent in narrow angles (κ = 0.80, temporal; κ = 0.82, nasal). However, agreement between gonioscopy and AS-OCT and between the Van Herick method and AS-OCT was poor (κ = 0.11–0.16). Discrimination capability of AS-OCT parameters between open and narrow angles determined by gonioscopy was excellent for all AS-OCT parameters (AUC, temporal: AOD500 = 0.96, nasal: AOD500 = 0.99). The AUCs for detecting angle closure defined by AS-OCT image in narrow angle subjects was good for all AS-OCT parameters (AUC, 0.80–0.94) except for ACD (temporal: ACD = 0.70, nasal: ACD = 0.63).


Assessment of narrow angles by gonioscopy and the Van Herick technique showed good agreement, but both measurements revealed poor agreement with AS-OCT. The angle closure detection capability of AS-OCT parameters was excellent; however, it was slightly lower in ACD.


Gonioscopy Van Herick method Anterior segment optical coherence tomography 


  1. 1.
    Foster PJ, Baasanhu J, Alsbirk PH, Munkhbayar D, Uranchimeg D, Johnson GJ. Glaucoma in Mongolia: a population-based survey in Hovsgol Province, northern Mongolia. Arch Ophthalmol. 1996;114:1235–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Foster PJ, Oen FT, Machin D, Ng TP, Devereux JG, Johnson GJ, et al. The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol. 2000;118:1105–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Jacob A, Thomas R, Koshi SP, Braganza A, Muliyil J. Prevalence of primary glaucoma in an urban south Indian population. Indian J Ophthalmol. 1998;46:81–6.PubMedGoogle Scholar
  4. 4.
    Dandona L, Dandona R, Mandal P, Srinivas M, John RK, McCarty CA, et al. Angle closure glaucoma in an urban population in southern India: the Andhra Pradesh Eye Disease Study. Ophthalmology. 2000;107:1710–6.CrossRefPubMedGoogle Scholar
  5. 5.
    He M, Foster PJ, Ge J, Huang W, Zheng Y, Friedman DS, et al. Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan district, Guangzhou. Invest Ophthalmol Vis Sci. 2006;47:2782–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Foster PJ. The epidemiology of primary angle closure and associated glaucomatous optic neuropathy. Semin Ophthalmol. 2002;17:50–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Nolan WP, Foster PJ, Devereux JG, Uranchimeg D, Johnson GJ, Baasanhu J. YAG laser iridotomy treatment for primary angle closure in East Asian eyes. Br J Ophthalmol. 2000;84:1255–9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Alsagoff Z, Aung T, Ang LP, Chew PT. Long-term clinical course of primary angle-closure glaucoma in an Asian population. Ophthalmology. 2000;107:2300–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Foster PJ, Devereux JG, Alsbirk PH, Lee PS, Uranchimeg D, Machin D, et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol. 2000;84:186–92.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Gross G. Differential diagnose der Winkelblockglaukome. Der Augenspiegel. 1999;9:13–26.Google Scholar
  11. 11.
    Van Herick W, Shaffer RN, Schwartz A. Estimation of width of angle of anterior chamber incidence and significance of the narrow angle. Am J Ophthalmol. 1969;68:626–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Ishikawa H, Liebmann JM, Ritch R. Quantitative assessment of the anterior segment using ultrasound biomicroscopy. Curr Opin Ophthalmol. 2000;11:133–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Tello C, Liebmann J, Potash SD, Cohen H, Ritch R. Measurement of ultrasound biomicroscopy images: intraobserver and interobserver reliability. Invest Ophthalmol Vis Sci. 1994;35:3549–52.PubMedGoogle Scholar
  14. 14.
    Urbak SF, Pedersen JK, Thorsen TT. Ultrasound biomicroscopy II. Intraobserver and interobserver reproducibility of measurements. Acta Ophthalmol Scand. 1998;76:546–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, et al. Optical coherence tomography. Science. 1991;254:1178–81.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hoerauf H, Gordes RS, Scholz C, Wirbelauer C, Koch P, Engelhardt R, et al. First experimental and clinical results with transscleral optical coherence tomography. Ophthalmic Surg Lasers. 2000;31:218–22.PubMedGoogle Scholar
  17. 17.
    Radhakrishnan S, Rollins AM, Roth JE, Yazdanfar S, Westphal V, Bardenstein DS, et al. Real-time optical coherence tomography of the anterior segment at 1310 nm. Arch Ophthalmol. 2001;119:1179–85.CrossRefPubMedGoogle Scholar
  18. 18.
    Radhakrishnan S, Goldsmith J, Huang D, Westphal V, Dueker DK, Rollins AM, et al. Comparison of optical coherence tomography and ultrasound biomicroscopy for detection of narrow anterior chamber angles. Arch Ophthalmol. 2005;123:1053–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Nolan WP, See JL, Chew PT, Friedman DS, Smith SD, Radhakrishnan S, et al. Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes. Ophthalmology. 2007;114:33–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Scheie HG. Width and pigmentation of the angle of the anterior chamber: a system of grading by gonioscopy. Arch Ophthalmol. 1957;58:510–2.CrossRefGoogle Scholar
  21. 21.
    Westphal V, Rollins AM, Radhakrishnan S, Izatt JA. Correction of geometric and refractive image distortions in optical coherence tomography applying Fermat’s principle. Opt Express. 2002;10:397–404.CrossRefPubMedGoogle Scholar
  22. 22.
    Pavlin CJ, Harasiewicz K, Foster FS. Ultrasound biomicroscopy of anterior segment structures in normal and glaucomatous eyes. Am J Ophthalmol. 1992;113:381–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Alsbirk PH. Primary angle closure glaucoma: oculometry, epidemiology, and genetics in a high risk population. Acta Ophthalmol Suppl. 1976;127:5–31.Google Scholar
  24. 24.
    Alsbirk PH. Anterior chamber depth and primary angle closure glaucoma an epidemiological study in Greenland Eskimos. Acta Ophthalmol. 1975;53:89–104.CrossRefGoogle Scholar
  25. 25.
    Lowe RF. Aetiology of the anatomical basis for primary angle closure glaucoma: biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol. 1970;54:161–9.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sihota R, Lakshmaiah NC, Agarwal HC, Pandey RM, Titiyal JS. Ocular parameters in the subgroups of angle closure glaucoma. Clin Exp Ophthalmol. 2000;28:253–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Sakata LM, Lavanya R, Friedman DS, Aung HT, Seah SK, Foster PJ, et al. Assessment of the scleral spur in anterior segment optical coherence tomography images. Arch Ophthalmol. 2008;126:181–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Sakata LM, Lavanya R, Friedman DS, Aung HT, Gao H, Kumar RS, et al. Comparison of gonioscopy and anterior segment ocular coherence tomography in detecting angle closure in different quadrants of the anterior chamber angle. Ophthalmology. 2008;115:769–74.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2011

Authors and Affiliations

  • Seong Bae Park
    • 1
    • 2
  • Kyung Rim Sung
    • 1
    • 2
  • Sung Yung Kang
    • 1
    • 2
  • Jung Woo Jo
    • 1
    • 2
  • Kyoung Sub Lee
    • 1
    • 2
  • Michael S. Kook
    • 1
    • 2
  1. 1.BS Eye CenterSeoulRepublic of Korea
  2. 2.Department of Ophthalmology, College of MedicineUniversity of Ulsan, Asan Medical CenterSeoulRepublic of Korea

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