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Epidemiology and Biostatistics
February 2000

Anterior Chamber Depth Measurement as a Screening Tool for Primary Angle-closure Glaucoma in an East Asian Population

Author Affiliations

From the Department of Preventive Ophthalmology, Institute of Ophthalmology, University College London, London, England (Drs Devereux, Foster, and Johnson and Mr Lee); Department of Ophthalmology, Medical University Central Hospital, Ulaanbaatar, Mongolia (Drs Baasanhu, Uranchimeg, and Erdenbeleig); Clinical Trials and Epidemiology Research Unit, National Medical Research Council, Singapore (Dr Machin); and Department of Ophthalmology, Hillerød Hospital, Hillerød, Denmark (Dr Alsbirk). Drs Devereux and Foster are now with the Glaucoma Service, Singapore National Eye Centre.

Arch Ophthalmol. 2000;118(2):257-263. doi:10.1001/archopht.118.2.257

Objective  To evaluate anterior chamber depth measurement as a method of screening for primary angle-closure glaucoma in an East Asian population.

Design  Two-phase, cross-sectional, community-based study.

Setting  Rural and urban locations in the Hövsgöl and Ömnögobi provinces, Mongolia.

Participants  Nine hundred forty-two (94.2%) of 1000 individuals in Hövsgöl (1995) and 775 (96.9%) of 1000 individuals in Ömnögobi (1997) aged 40 years or older were examined.

Main Outcome Measures  Anterior chamber depth was measured by optical pachymetry, slitlamp-mounted A-mode ultrasound, and handheld ultrasound. Gonioscopy was used to detect occludable angles, defined as one in which the trabecular meshwork was visible for less than 90° of angle circumference. Primary open-angle glaucoma was diagnosed in subjects with an occludable angle and glaucomatous optic neuropathy with visual morbidity. The area under the curve in a receiver operating characteristic plot was used to compare test performance.

Results  Optical pachymetry outperformed the slitlamp-mounted ultrasound method of anterior chamber depth measurement (area under the curve, 0.93 and 0.90, respectively; z test, P = .001). Handheld ultrasound (area under the curve, 0.86) was inferior to optical measurement (z test, P = .001) but did not differ significantly from slitlamp ultrasound (z test, P = .06). The optical method gave sensitivity of 85% and specificity of 84% at a screening cutoff of less than 2.22 mm for detecting occludable angles.

Conclusions  Measurement of axial anterior chamber depth can detect occludable angles in this Asian population and therefore may have a role in population screening for primary angle-closure glaucoma.