The objective of the systematic review [B900] was to assess the published literature to determine whether anterior segment imaging provides sufficient information to be considered a substitute for gonioscopy. Literature searches of the PubMed and Cochrane Library databases were last conducted on July 6, 2011. The searches yielded 371 unique citations. Members of the Ophthalmic Technology Assessment Committee Glaucoma Panel reviewed the titles and abstracts of these articles and selected 134 of possible clinical significance for further review of which 79 studies met the inclusion criteria. The level of evidence was assessed using the scheme adopted by the American Academy of Ophthalmology.
Quantitative and qualitative parameters defined from ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (OCT), Scheimpflug photography, and the scanning peripheral anterior chamber depth analyzer (SPAC) demonstrate a strong association with the results of gonioscopy. There is substantial variability in the type of information obtained from each imaging method. Imaging of structures posterior to the iris is possible only with UBM. Direct imaging of the anterior chamber angle (ACA) is possible using UBM and OCT. The ability to acquire OCT images in a completely dark environment allows greater sensitivity in detecting eyes with appositional angle closure. Noncontact imaging using OCT, Scheimpflug photography, or SPAC makes these methods more attractive for large-scale PAC screening than contact imaging using UBM.
Authors’ conclusions: Although there is evidence suggesting that anterior segment imaging provides useful information in the evaluation of PAC, none of the imaging methods provides sufficient information about the ACA anatomy to be considered a substitute for gonioscopy.