Single versus sequential testing with scanning peripheral anterior chamber depth analyser, IOLMaster and anterior segment optical coherence tomography for the detection of narrow angles.
BACKGROUND
Scanning peripheral anterior chamber depth analyser (SPAC), IOLMaster and anterior segment optical coherence tomography (AS-OCT) are devices that can screen non-invasively for narrow angles (NAs) and may reduce the need for gonioscopy, especially where the availability of ophthalmologists is limited. When used individually to detect NAs, neither SPAC, AS-OCT nor IOLMaster were able to achieve both high sensitivity and specificity when using gonioscopy as a gold standard.


OBJECTIVE
To assess whether sequential testing improves discrimination of NAs over single testing.


METHODS
In a prospective community-based cross-sectional study in Singapore, 2047 phakic right eyes underwent SPAC, IOLMaster and AS-OCT. NA eyes were defined as present when Shaffer scores were 0 or 1 in ≥ 2 quadrants on gonioscopy. Sensitivities and specificities of single and sequential testing were compared.


RESULTS
At a fixed specificity of 95%, sensitivities in detecting NA eyes were 57.8% (95% CI 52.7% to 62.7%) for SPAC, 43.3% (95% CI 38.3% to 48.3%) for IOLMaster and 52.1% (95% CI 46.4% to 57.7%) for AS-OCT. After sequential testing using SPAC followed by AS-OCT, the sensitivity rose to 70.3% (95% CI 65.5% to 74.8%) while specificity remained at 94.3% (95% CI 93.1% to 95.4%), with sensitivity significantly higher than single testing alone (p<0.001).


CONCLUSIONS
Sequential testing significantly improves the accuracy of detecting NAs and may be useful in screening settings.
Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, USA.
Dolly S
DS
Chang
Lisandro M
LM
Sakata
Tin
T
Aung
Ming-Guang
MG
He
Raghavan
R
Lavanya
Kenji
K
Kashiwagi
David S
DS
Friedman
D000368:Aged; D000869:Anterior Eye Segment / Q000473:pathology*; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation*; D005189:False Positive Reactions; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis*; D006068:Gonioscopy; D006801:Humans; D007368:Interferometry / Q000295:instrumentation; D007429:Intraocular Pressure; D008027:Light; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000295:instrumentation; D014065:Tonometry, Ocular