We thank Dr Kumar and colleagues for their interest in our work on the ACADEMIA.1 We fully agree that the independence of scleral spur identification limits the potential of the ACADEMIA to give a precise measurement in appositional angle closure. From the clinical point of view, it would be less meaningful to subject an image to angle measurement if it is already evident that the angle is appositionally closed, and this was addressed in our article. We would expect similar problems to occur whenever there is iridocorneal apposition at or above the level of the trabecular meshwork. Nevertheless, as long as there is no iridocorneal touch, most of the narrow angles can be correctly identified and measured by the algorithm. The ACADEMIA is a reproducible algorithm because any intraobserver or interobserver variability can be totally eliminated in reading any single image. We mentioned that measurement variability secondary to examiner's technique, different positions of the scanning probe, and different locations of the scanning position on the eyeball cannot be avoided.1 Illumination condition and pupil size certainly could affect the angle measurement. While the primary objective in the article was to describe the ACADEMIA, we are currently evaluating its clinical usefulness by comparing the correlations between the ACADEMIA angle, angle opening distance, and gonioscopy grading. We look forward to publishing this result in the near future and we are grateful to Dr Kumar and colleagues for their thoughtful comments.
Leung CK, Leung DY, Tham CC, Lam DS. Concerns Regarding ACADEMIA—Reply. Arch Ophthalmol. 2007;125(8):1140. doi:10.1001/archopht.125.8.1140-b