• Angle
• Glaucoma
• Imaging

• Humans
• Tomography, Optical Coherence/methods
• Gonioscopy
• Glaucoma, Angle-Closure/diagnosis
• Male
• Female
• Middle Aged
• Aged
• Anterior Eye Segment/diagnostic imaging
• Anterior Eye Segment/pathology
• ROC Curve
• Adult
• Intraocular Pressure/physiology
• Iris/diagnostic imaging
• Iris/pathology
• Trabecular Meshwork/diagnostic imaging
• Trabecular Meshwork/pathology
• Aged, 80 and over
• Young Adult

• angle
• anterior chamber
• diagnostic tests/investigation
• glaucoma

• Humans
• Tomography, Optical Coherence/methods
• Male
• Female
• Sclera/diagnostic imaging
• Sclera/anatomy & histology
• Sclera/pathology
• Aged
• Biometry/methods
• Middle Aged
• Algorithms
• Anterior Eye Segment/diagnostic imaging
• Deep Learning
• Reproducibility of Results
• Intraocular Pressure/physiology
• Aged, 80 and over
• Glaucoma, Angle-Closure/diagnosis

• K23 EY029763 NEI NIH HHS
• R01 EY030501 NEI NIH HHS
• the National Eye Institute, National Institute of Health, Bethesda, Maryland

• Anterior eye segment
• Glaucoma, angle-closure
• Sensitivity and specificity
• Tomography, optical

• Humans
• Tomography, Optical Coherence/methods
• Cross-Sectional Studies
• Glaucoma, Angle-Closure/diagnosis
• Trabecular Meshwork
• Sensitivity and Specificity
• Glaucoma/diagnosis

• UG1 EY028097 NEI NIH HHS

Glaucoma patients require lifelong management, and the prevalence of glaucoma is expected to increase, resulting in capacity problems in many hospital eye departments. New models of care delivery are needed to offer requisite capacity. This review evaluates two alternative schemes for glaucoma care within a hospital, i.e., shared care (SC) and virtual clinics (VCs), whereby non-medical staff are entrusted with more responsibilities, and compares these schemes with the “traditional” ophthalmologist-led outpatient service (standard care). A literature search was conducted in three large bibliographic databases (PubMed, Embase, and Trip), and the abstracts from the prior five annual meetings of the Association for Research in Vision and Ophthalmology were consulted. Twenty-nine were included in the review (14 on SC and 15 on VCs). Patients with low risk of vision loss were considered suitable for these approaches. Among the non-medical staff, optometrists were the most frequently involved. The quality of both schemes was good and improved with the non-medical staff being trained in glaucoma care. No evidence was found on patients feeling disadvantaged by the lack of a doctor visit. Both schemes increased the hospital’s efficiency. Both SC and VCs are promising approaches to tackle the upcoming capacity problems of hospital-based glaucoma care.

• allied health personnel
• collaborative care
• glaucoma
• ocular hypertension
• outpatient clinic
• patient care
• shared care
• user computer interface
• virtual clinic
• virtual system

• continuing education
• medical education
• optical coherence tomography
• retinal nerve fibre layer
• teaching

• physical examination
• health occupations
• epidemiology

• Aged
• Child
• Child, Preschool
• Female
• Glaucoma, Angle-Closure/surgery
• Gonioscopy
• Humans
• Infant
• Infant, Newborn
• Intraocular Pressure
• Iris
• Laser Therapy
• Longitudinal Studies
• Massachusetts
• Retrospective Studies

• R01 AG060942 NIA NIH HHS
• K23 EY024921 NEI NIH HHS
• K23 EY029246 NEI NIH HHS
• Research to Prevent Blindness (RPB)
• U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
• U.S. Department of Health & Human Services | NIH | National Eye Institute (NEI)
• Carl Zeiss Meditec AG (Carl Zeiss Meditec)
• Novartis Pharmaceuticals Corporation (NPC)

• Clinical pathways
• collaborative care
• eye diseases
• integrated care model
• optometry

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.

• angle closure glaucoma
• anterior chamber angle
• diagnosis
• iridocorneal angle
• trabecular meshwork

• Anterior chamber angle
• Automatic classification
• Ultrasound biomicroscopy

• angle closure
• anterior segment optical coherence tomography
• glaucoma
• gonioscopy
• narrow angles

Glaucoma is an irreversible optic neuropathy with the loss of visual field and decrease of vision. The variable clinical manifestations may result in differential diagnostic difficulties. The early screening and diagnosis of glaucoma are currently experiencing a demand for anterior segment analysis tools that can gather more information with one short measurement. Therefore, we analyzed the agreement, difference, and correlation of chamber angle parameters such as angel opening distance at 500 μm (AOD500) and trabeculo-iris space area at 500 μm² (TISA500) measured by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM).

To compare the differences, correlation, and agreement in measuring AOD500 and TISA500 by AS-OCT and UBM.

Both AS-OCT and UBM were performed to measure AOD500 and TISA500 in 45 subjects (72 eyes). All subjects without glaucoma were collected from October 2015 to August 2016 at the Ophthalmology Department of the Fourth Affiliated Hospital of China Medical University. Data of the two groups (AOD500 and TISA500) were compared by nonparametric tests. Pearson correlative analysis and Bland–Altman analysis were used to compare the correlation and agreement.

There were no significant differences between AS-OCT and UBM in measuring AOD500 (P1 = 0.110, P2 = 0.633, P3 = 0.078, and P4 = 0.474) and TISA500 (P1 = 0.584, P2 = 0.889, P3 = 0.297, and P4 = 0.550) of the four quadrants of the anterior chamber angle. There was a high correlation in measuring AOD500 (r1 = 0.562, r2 = 0.671, r3 = 0.635, and r4 = 0.720; P < 0.001) and TISA500 (r1 = 0.584, r2 = 0.889, r3 = 0.297, and r4 = 0.550; P < 0.001). There was a good agreement in measuring AOD500 and TISA500 by the two modalities.

There is a high correlation and agreement between AOD500 and TISA500 measurements by AS-OCT and UBM. They are interchangeable under some circumstances. AS-OCT proves to be a better early screening tool for glaucoma.

• Anterior segment-optical coherence tomography
• Primary angle closure glaucoma
• Anterior chamber angle
• Angel opening distance at 500 m
• Trabeculo-iris space area at 500 m²

To identify patterns of age‐, gender‐ and refractive‐ related changes in Scheimpflug‐based anterior chamber depth across the central 8 mm of chamber width, to derive normative models, potentially useful for angle closure disease diagnosis.

This was a retrospective, cross‐sectional study. Scheimpflug photography was used to obtain anterior chamber depth measurements at 57 points across the central 8 mm of the chamber width from one eye of each healthy subject (male Caucasians (n = 189), female Caucasians (n = 186), male Asians (n = 165) and female Asians (n = 181)). Sliding window and nonlinear regression analysis was used to identify the age‐related changes in chamber depth. Hierarchical cluster analysis was used to identify test locations with statistically identical age‐related shifts, which were used to perform age‐correction for all subjects, resulting in normative distributions of chamber depth across the chamber width. The model was examined with and without the contribution of spherical equivalent refractive error.

Distinct clusters, demonstrating statistically indistinguishable age‐related changes of chamber depth over time, were identified. These age‐related changes followed a nonlinear regression (fifth or sixth order polynomial). Females tended to have a greater rate of chamber depth shallowing. Incorporating refractive error into the model produced minimal changes to the fit relative to the ground truth. Comparisons with cut‐offs for angle closure from the literature showed that ageing alone was insufficient for identifying angle closure disease.

Age‐, ethnicity‐ and gender‐related differences need to be acknowledged in order to utilise anterior chamber depth data for angle closure disease diagnosis correctly. Ageing alone does not adequately account for the angle closure disease process.

• Pentacam
• Scheimpflug imaging
• angle closure
• angle closure disease
• glaucoma
• narrow angles

To quantitatively assess anterior chamber angle (ACA) structure by anterior segment optical coherence tomography (AS-OCT) and develop a model to evaluate angle width as defined by gonioscopy.

The ACAs of each quadrant were evaluated by gonioscopy, classified by the Scheie grading system, and assigned into one of the three grades: small angle (SA), moderate angle (MA), and large angle (LA). The eyes were imaged by AS-OCT, and ACA structural parameters including angle opening distance at the scleral spur (AODSS) and at 750 μm anterior to the scleral spur (AOD750), trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750), and a newly defined parameter “light intersection distance” (LID), were measured. The ACA structural data were used to construct an ordered logistic regression model for assignment of ACAs to one of the three angle grades. The validity of the model was then tested.

A total of 169 quadrants from 53 subjects were included in the analysis, of which 111 quadrants were included in the modeling data and 58 in the testing data. In pairwise comparisons of SA, MA, and LA by ANOVA, the measured parameters were as follows: AOD750 (0.174 ± 0.060 vs. 0.249 ± 0.068 vs. 0.376 ± 0.114 mm; P < 0.001), TISA750 (0.075 ± 0.035 vs. 0.117 ± 0.036 vs. 0.181 ± 0.062 mm²; P < 0.001), and LID (− 0.300 ± 0.187 vs. -0.085 ± 0.170 vs. 0.122 ± 0.156 mm; P < 0.001). The ACA grading model based on LID showed a relatively high correction rate of 72.4%, and the model efficiency, calculated using the receiver operating characteristic, showed an area under the curve of 0.740. Weighted kappa statistics showed a good agreement for multiple ACA grades (0.772).

The AS-OCT-based multiple ACA grades model was demonstrated as a non-contact approach for ACA assessment with high speed and high spatial resolution, providing guidance for diagnosis of angle closure.

• Anterior chamber
• Glaucoma
• Imaging

• angle closure
• anterior segment optical coherence tomography
• glaucoma
• gonioscopy
• narrow angles