Evaluation of the diagnostic performance of swept-source anterior segment optical coherence tomography in primary angle closure disease.

Abstract Purpose To evaluate the diagnostic performance of swept-source anterior segment optical coherence tomography (SS-OCT) in differentiating primary angle closure diseases (PACD) from control eyes, as well as primary angle closure (PAC) and primary angle closure glaucoma (PACG) from primary angle closure suspect (PACS) eyes. Design Multi-center cross-sectional study. Methods Chinese patients were classified into control, PACS and PAC/PACG groups. Area under the receiving operating characteristics curve (AUC) from logistic regression models was used to evaluate discriminating ability. Sensitivity and specificity were calculated and performance of the models was validated using an independent dataset. Results A total of 2,928 SS-OCT images from 366 eyes of 260 patients were recruited to develop diagnostic models. The validation dataset included 1,176 SS-OCT images from 147 eyes of 143 patients. For distinguishing PACD from control, average anterior chamber depth (ACD_mean) had the highest AUC of 0.94. With a cut-off of 2.2 mm for ACD_mean, the sensitivity and specificity were 90.2% and 85.2% in the training set. For distinguishing PACS from PAC/PACG, a multivariate model had an AUC of 0.83, with sensitivity and specificity of 82.0% and 62.8% in the training set. Validation set confirmed the findings. Conclusions Swept-source anterior segment OCT showed excellent diagnostic performance distinguishing PACD from normal eyes and moderate diagnostic ability distinguishing PAC/PACG from PACS. Anterior chamber depth alone may provide a simple and effective way to diagnose PACD from controls. As ACD can be obtained using other more available modalities, this has implications for early diagnosis of PACD.