Modeling of gonioscopic anterior chamber angle grades based on anterior segment optical coherence tomography

BACKGROUND: 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. METHODS: 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. RESULTS: 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 mm(2); 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). CONCLUSIONS: 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.