title: Automated analysis of angle closure from anterior chamber angle images.
abstract: OBJECTIVE
  To evaluate a novel software capable of automatically grading angle closure on EyeCam angle images in comparison with manual grading of images, with gonioscopy as the reference standard.
  
  
  METHODS
  In this hospital-based, prospective study, subjects underwent gonioscopy by a single observer, and EyeCam imaging by a different operator. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. An eye was classified as having angle closure if there were two or more quadrants of closure. Automated grading of the angle images was performed using customized software. Agreement between the methods was ascertained by κ statistic and comparison of area under receiver operating characteristic curves (AUC).
  
  
  RESULTS
  One hundred forty subjects (140 eyes) were included, most of whom were Chinese (102/140, 72.9%) and women (72/140, 51.5%). Angle closure was detected in 61 eyes (43.6%) with gonioscopy in comparison with 59 eyes (42.1%, P = 0.73) using manual grading, and 67 eyes (47.9%, P = 0.24) with automated grading of EyeCam images. The agreement for angle closure diagnosis between gonioscopy and both manual (κ = 0.88; 95% confidence interval [CI), 0.81-0.96) and automated grading of EyeCam images was good (κ = 0.74; 95% CI, 0.63-0.85). The AUC for detecting eyes with gonioscopic angle closure was comparable for manual and automated grading (AUC 0.974 vs. 0.954, P = 0.31) of EyeCam images.
  
  
  CONCLUSIONS
  Customized software for automated grading of EyeCam angle images was found to have good agreement with gonioscopy. Human observation of the EyeCam images may still be needed to avoid gross misclassification, especially in eyes with extensive angle closure.
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.
authors.forename: Mani
authors.initials: M
authors.lastname: Baskaran
authors.affiliation: Institute of Infocomm Research, Singapore.
authors.forename: Jun
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.
authors.forename: Shamira A
authors.initials: SA
authors.lastname: Perera
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.
authors.forename: Tin A
authors.initials: TA
authors.lastname: Tun
authors.affiliation: Institute of Infocomm Research, Singapore.
authors.forename: Jiang
authors.initials: J
authors.lastname: Liu
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
mesh_terms: D000328:Adult; D000867:Anterior Chamber / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis* / Q000503:physiopathology; D006068:Gonioscopy / Q000379:methods*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods; D011446:Prospective Studies; D012372:ROC Curve; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: EyeCam; angle closure; anterior chamber angle; automated grading; gonioscopy