We were very interested to read the article by Leung et al1 in which they described a novel algorithm for qualitative and quantitative analysis of the anterior chamber angle. They should be commended for this promising new automated approach to angle assessment, but certain methodological limitations need to be addressed.
As the ACADEMIA (anterior chamber angle detection with edge measurement and identification algorithm) only detects edge points where there is a contrast between black and white in ultrasound biomicroscopy images and does not require scleral spur identification, its usefulness will be limited in narrow angles with some degree of iridocorneal apposition. The profiles obtained from such eyes would vary depending on the extent of this apposition. Owing to the variability in the location where the iris profiling is performed, some narrow angles in which the apex of the angle is located above the level of the trabecular meshwork would be mistakenly classified as open by the proposed algorithm. This would limit the software from its primary function, which is to discriminate eyes at risk for angle closure.
Kumar RS, Sakata LM, Aung T. Concerns Regarding ACADEMIA. Arch Ophthalmol. 2007;125(8):1140. doi:10.1001/archopht.125.8.1140-a