Abstract：
PURPOSE:To evaluate the diagnostic performance characteristics of the Van Herick assessment (VHA) for identifying angle closure compared to gold-standard gonioscopy, as conducted by trained observers of varying expertise. DESIGN:Reliability analysis. METHODS:Patients (n = 131) from a glaucoma referral clinic aged ≥50 years without prior ocular surgery or iridotomy underwent unilateral VHA by 1 of 11 trained ophthalmic technicians, followed by VHA and indirect gonioscopy by 1 of 15 ophthalmology residents and 1 of 4 glaucoma specialist attending physicians. Observers were masked to others' gradings. Cohen's kappa (κ) assessed test reproducibility. VHA sensitivity and specificity for identifying gonioscopic angle closure were calculated. RESULTS:Mean patient age was 62.0 ± 8.7 years, 56% of patients were male, and 84% were African American. Angles were gonioscopically closed in 14.5% of eyes. Moderate agreement was observed comparing technician or resident VHA to attending VHA (κ = 0.48 and κ = 0.56, respectively). Resident and attending gonioscopy demonstrated excellent agreement (κ = 0.94). Sensitivities of technician, resident, and attending VHA for detecting angle closure were 57.9% (95% confidence interval: 34.0%-78.9%), 78.9% (53.9%-93.0%), and 68.4% (43.5%-86.4%), respectively. Specificities were 88.5% (80.3%-93.6%), 88.2% (80.3%-93.3%), and 87.5% (79.6%-92.8%), respectively. CONCLUSIONS:VHA, even when performed by experienced ophthalmologists, misses a substantial proportion of angle closure while incorrectly identifying roughly 1 in 8 open-angle eyes as closed. These results suggest that clinical assessment of anterior chamber angle configuration is best accomplished with gonioscopy.
journal_name
Am J Ophthalmoljournal_title
American journal of ophthalmologyauthors
Johnson TV,Ramulu PY,Quigley HA,Singman ELdoi
10.1016/j.ajo.2018.07.026subject
Has Abstractpub_date
2018-11-01 00:00:00pages
63-71eissn
0002-9394issn
1879-1891pii
S0002-9394(18)30407-0journal_volume
195pub_type
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journal_title：American journal of ophthalmology
pub_type： 临床试验,杂志文章,随机对照试验
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journal_title：American journal of ophthalmology
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journal_title：American journal of ophthalmology
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journal_title：American journal of ophthalmology
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更新日期：2020-12-08 00:00:00
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更新日期：2005-05-01 00:00:00
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journal_title：American journal of ophthalmology
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更新日期：2005-06-01 00:00:00
