Diagnostic Accuracy of Van Herick Technique to Detect Pre-Disease States of Primary Angle Closure Glaucoma in a Resource Constraint Region

ABSTRACT

Objectives: To critically evaluate diagnostic accuracy of the van Herick (vH) technique in detection of gonioscopically occludable angle in a rural population and to explore ways to improve accuracy of the technique

Methods: The study cohort was formed by two-stage cluster random sampling. Peripheral anterior chamber depth grading was performed, using both traditional and modified (photographic comparison) vH techniques, under dark adapted and standard lighting conditions by a comprehensive ophthalmologist masked to the clinical features. The cut-off criterion for vH test was 25% of peripheral corneal thickness. The reference standard was dark room 4-mirror indentation gonioscopy performed by an experienced glaucoma specialist. This study adhered to the STARD guidelines for reporting diagnostic accuracy studies.

Results: We studied 111 eyes of 111 participants. The median age was 62 years. The angle was occludable by gonioscopy in 69 (62%) eyes; 58 eyes were primary angle closure suspects and 11 were primary angle closure patients. The likelihood ratio (95% confidence interval (CI)) of the positive (LR+) and negative (LR‒) result by the traditional vH technique was 5.17 (2.43, 11) and 0.30 (0.20, 0.46), respectively. The LR+ by reducing and LR‒ by elevating the cut-off grade of the traditional vH technique were 9.4 (2.3, 37.4) and 0.08 (0.02, 0.31), respectively. The area under receiver operating characteristic curve did not differ significantly by photographic comparison or lighting condition (p = 0.13).

Conclusions: vH grading can be considered as a triage test before gonioscopy. The value of the vH technique to the diagnostic strategy is discussed.

KEYWORDS:

• van Herick technique
• limbal anterior chamber depth
• primary angle closure glaucoma
• positive predictive value
• glaucoma screening

Acknowledgments

We thank Ms. Shaik Shaheda, administrator and Mr. Kokilligadda Akhil, vision technician for their help at various stages in the execution of the study.