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Comparison of anterior segment optical coherence tomography versus technician led gonioscopy as a triage tool for anterior chamber angle status

Eye volume 39, pages 2474–2478 (2025)Cite this article

Subjects

Abstract

Objective

Can anterior segment optical coherence tomography (AS-OCT) replace gonioscopy as the preferred triage tool for angle assessments in virtual glaucoma clinics?

Subjects/Methods

Every new referral into Sheffield Teaching Hospital’s glaucoma service over a five-month period were subject to gonioscopy and AS-OCT assessment of their angles. Appropriately trained ophthalmic science practitioners (OSPs) performed the gonioscopy and labelled angles as ‘open’ or ‘closed’. Two glaucoma-subspecialty ophthalmologists reviewed the AS-OCT images independently on a different day and graded the angles as ‘open’ or ‘closed’.

Results

There was an angle assessment of 384 eyes, with statistical analysis of 358 eyes due to 26 eyes being unable to have gonioscopy. AS-OCT was found to have a sensitivity of 97.11% ± 1.32% and a specificity of 36.17% ± 9.71% for identifying an open angle. The positive predictive value of the test was 95.70% ± 0.63%, while the negative predictive value was 46.08% ± 13.13%.

Conclusions

As a triage tool, specialist assessment of the angle on AS-OCT is a safe, effective alternative to OSP-led gonioscopy.

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Data availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

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Acknowledgements

The authors would like to acknowledge the mathematics students of High Storrs School, Sheffield. Under the guidance of their statistician teacher Mr Ben Lowe, they engaged in developing the statistical analysis of the paper.

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Authors and Affiliations

  1. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    Amit Dhalla, Thomas Evans & Graham Auger

  2. Harrogate and District NHS Foundation Trust, Harrogate, UK

    Joshua Pilling

Authors
  1. Amit Dhalla
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  2. Thomas Evans
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  3. Joshua Pilling
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  4. Graham Auger
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Contributions

GA was responsible for designing the study, registering it with the University of Sheffield Clinical Research and Innovation Office, ensuring the design passed Independent Scientific Review, reviewed the completed manuscript and offered feedback. GA and JP analysed the AS-OCT images as per the study design. JP also reviewed the completed manuscript and offered feedback. TE created the AS-OCT scan reports, assigned the data for analysis, coordinated to ensure AS-OCT image analysis was blinded and independent between the two assessors, collated the data for analysis, reviewed the completed manuscript and offered feedback. AD analysed the data, interpreted the results and wrote the manuscript. There was no use of Artificial Intelligence (AI) Assisted Technology at any point through the study or writing of the manuscript.

Corresponding author

Correspondence to Amit Dhalla.

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Dhalla, A., Evans, T., Pilling, J. et al. Comparison of anterior segment optical coherence tomography versus technician led gonioscopy as a triage tool for anterior chamber angle status. Eye 39, 2474–2478 (2025). https://doi.org/10.1038/s41433-025-03906-y

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