title: Angle assessment by EyeCam, goniophotography, and gonioscopy.
abstract: OBJECTIVE
  To compare EyeCam (Clarity Medical Systems, Pleasanton, CA) and goniophotography in detecting angle closure, using gonioscopy as the reference standard.
  
  
  METHODS
  In this hospital-based, prospective, cross-sectional study, participants underwent gonioscopy by a single observer, and EyeCam imaging and goniophotography by different operators. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. A masked observer categorized the eyes as per the number of closed quadrants, and an eye was classified as having angle closure if there were 2 or more quadrants of closure. Agreement between the methods was analyzed by κ statistic and comparison of area under receiver operating characteristic curves (AUC).
  
  
  RESULTS
  Eighty-five participants (85 eyes) were included, the majority of whom were Chinese. Angle closure was detected in 38 eyes (45%) with gonioscopy, 40 eyes (47%) using EyeCam, and 40 eyes (47%) with goniophotography (P=0.69 in both comparisons, McNemar test). The agreement for angle closure diagnosis (by eye) between gonioscopy and the 2 imaging modalities was high (κ=0.86; 95% Confidence Interval (CI), 0.75-0.97), whereas the agreement between EyeCam and goniophotography was not as good (κ=0.72; 95% CI, 0.57-0.87); largely due to lack of agreement in the nasal and temporal quadrants (κ=0.55 to 0.67). The AUC for detecting eyes with gonioscopic angle closure was similar for goniophotography and EyeCam (AUC 0.93, sensitivity=94.7%, specificity=91.5%; P>0.95).
  
  
  CONCLUSIONS
  EyeCam and goniophotography have similarly high sensitivity and specificity for the detection of gonioscopic angle closure.
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Center.
authors.forename: Mani
authors.initials: M
authors.lastname: Baskaran
authors.forename: Shamira A
authors.initials: SA
authors.lastname: Perera
authors.forename: Monisha E
authors.initials: ME
authors.lastname: Nongpiur
authors.forename: Tin A
authors.initials: TA
authors.lastname: Tun
authors.forename: Judy
authors.initials: J
authors.lastname: Park
authors.forename: Rajesh S
authors.initials: RS
authors.lastname: Kumar
authors.forename: David S
authors.initials: DS
authors.lastname: Friedman
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
mesh_terms: D000867:Anterior Chamber / Q000473:pathology; D002924:Ciliary Body / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis*; D006068:Gonioscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014129:Trabecular Meshwork / Q000473:pathology*