The flashlight test and van Herick's test are poor predictors for occludable angles

Thomas, Ravi; George, T.; Braganza, Andrew; Muliyil, Jayaprakash

doi:10.1111/j.1442-9071.1996.tb01588.x

Cited by 92 publications

(76 citation statements)

References 11 publications

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“…The measurement of peripheral anterior chamber depth has been previously reported to be effective for the detection of PACG patients by van Herick et al and others. 6,8,9 However, there are divergent opinions regarding the usefulness of peripheral anterior chamber depth measurement, 1,7 and there have also been reports indicating the usefulness of central anterior chamber depth measurement. 5 Consequently, a definite conclusion has yet to be reached concerning the usefulness of peripheral anterior chamber depth measurement.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of peripheral anterior chamber depth assessment in glaucoma screening

Kashiwagi

Tokunaga

Iwase

et al. 2004

Eye

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Purpose This study was conducted to determine the usefulness of peripheral anterior chamber depth assessment in angle-closure glaucoma (ACG) screening in Japanese subjects. Subjects and methods The subjects were 14 779 adults 40 years old or older. Eyes having peripheral anterior chamber depth that is 1/4 the peripheral corneal thickness (van Herick's classification: grade 2) and less than 1/4 the peripheral corneal thickness (van Herick's classification: grade 1) were extracted as narrow angle eyes, and those eyes were further examined. Results Of 14 779 subjects, 923 eyes of 505 subjects were diagnosed as narrow angle eyes (3.4%). Narrow angle eyes were observed in 4.9% of female subjects and 1.9% of male subjects, indicating a significantly higher frequency in women. The percentage of narrow angle eyes increased with age. Among the narrow angle eyes, 61 eyes of 32 subjects were diagnosed with ACG suspect (6.5%). In contrast to the frequency of ACG suspect in eyes classified as grade 1, according to van Herick's classification, being 17.9%, that in eyes classified as grade 2 was significantly lower at 5.6%. Conclusion Since the incidence of ACG suspect increases as the peripheral anterior chamber depth decreases, caution for the peripheral anterior chamber depth is required for the ACG screening.

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Section: Discussionmentioning

confidence: 99%

Usefulness of peripheral anterior chamber depth assessment in glaucoma screening

Kashiwagi

Tokunaga

Iwase

et al. 2004

Eye

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“…13 It is also known to be higher in Asian and Eskimo eyes. 14,15 However, the incidence of angle-closure is much lower (ranging from 0.7 to 2.1 per Management of patients with narrow angles and acute angle-closure glaucoma Fricke, Mantzioros and Vingrys cent) confirming that not all narrow angles go on to produce angle-closure glaucoma.…”

Section: Detecting Narrow Angles In Optometric Practicementioning

confidence: 99%

“…These include: positive personal or family history of glaucoma, 7 a large shadow (greater than 33 per cent) with a flashlight test ( Figure 5) 7,13 and a narrow van Herick ratio (equal to or less than 0.25). 7,13 Gonioscopy of those who fail any element of this screening will then identify those people who are at risk of closure. 7,13 Thomas and colleagues 13 considered the reliability and validity of several tests of angular geometry, including the van Herick ratio, the shadow test and gonioscopic appearance.…”

Section: Detecting Narrow Angles In Optometric Practicementioning

confidence: 99%

“…7,13 Gonioscopy of those who fail any element of this screening will then identify those people who are at risk of closure. 7,13 Thomas and colleagues 13 considered the reliability and validity of several tests of angular geometry, including the van Herick ratio, the shadow test and gonioscopic appearance. They concluded that all tests had a reasonable level of interobserver agreement (0.73 to 0.81) making them reliable in clinical applications.…”

Section: Detecting Narrow Angles In Optometric Practicementioning

confidence: 99%

“…Nevertheless, the negative predictive values of some of these tests were high, that is, that the tests could reliably predict those people who had open angles. The shadow test (criterion of greater than one-third shadow) 13 had the best negative predictive value (95 per cent) when applied in isolation but when it was combined with a narrow van Herick ratio (equal or less than 0.25) the negative predictive value increased to 98 per cent. This means that in combination, these tests are able to identify most of those people who do not have narrow angles.…”

Section: Detecting Narrow Angles In Optometric Practicementioning

confidence: 99%

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Management of patients with narrow angles and acute angle‐closure glaucoma

Fricke

Mantzioros

Vingrys

1998

Clinical and Experimental Optometry

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Background: Acute closure of the anterior chamber angle can have catastrophic consequences for vision when it occurs in an unsupervised situation. Visual debilitation is much less likely to result when angle-closure occurs in a well-controlled environment that allows appropriate management. Therefore, it is desirable for optometrists to undertake a complete ocular health assessment, including mydriatic fundus examination, on patients who have narrow anterior chamber angles, provided that appropriate precautions and procedures are followed. Case report: We report on the case of a 59-year-old white female whose anterior chamber angles closed in response to mydriatic drops instilled during an optometric examination. Her optic discs and visual field results from before and four years after the angle-closure attack do not show any significant changes. Conclusion: We conclude that the optimal standard of care for patients presenting to an optometric practice, and who are subsequently found to have narrow anterior chamber angles, includes pupillary dilatation to allow stereoscopic visualisation of the optic nerve head. Precautions must be followed to ensure that, in the unlikely event of an ensuing angle-closure episode, the attack occurs under clinically supervised conditions. (Clin Exp Optom 1998; 81: 6: 255-266)

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Potentially Missed Opportunities in Prevention of Acute Angle-Closure Crisis

Stein

Shah

2022

JAMA Ophthalmol

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If an anatomic narrow angle is not appropriately diagnosed and treated, it can result in acute angle-closure crisis (AACC) and lead to substantial vision loss.OBJECTIVE To identify patients who presented with AACC and assess for factors that may have been associated with risk of developing it. DESIGN, SETTING, AND PARTICIPANTSThis population-based retrospective cohort study conducted from January 1, 2001, to December 31, 2015, included a 20% nationwide sample of 1179 Medicare beneficiaries. Patients aged 40 years or older with AACC were identified with billing codes. A 2-year lookback period from the date of initial presentation of AACC was used to identify patients who had at least 1 eye care visit, received a diagnosis of open-angle glaucoma (OAG) or suspected OAG, or received at least 1 medication associated with risk of AACC. Of the patients who had at least 1 eye care visit, those who underwent gonioscopy, received a diagnosis of an anatomic narrow angle before developing AACC, or both were identified.MAIN OUTCOMES AND MEASURES Proportions of patients who had at least 1 eye care visit, had OAG or suspected OAG, received at least 1 medication associated with risk of AACC, underwent gonioscopy, or received a diagnosis of an anatomic narrow angle before development of AACC.RESULTS A total of 1179 patients had a confirmed diagnosis of AACC. The mean (SD) age of patients with AACC was 66.7 (11.8) years (range, 40-96 years), 766 were women (65.0%), 57 were Asian (4.8%), 109 were Black (9.2%), 126 were Latino (10.7%), 791 were White (67.1%), and 96 were other race and ethnicity (8.1%). Of these patients, only 796 (67.5%) consulted an optometrist or ophthalmologist at least once during the 2-year lookback period. A total of 464 individuals (39.4%) had OAG or suspected OAG, and 414 (35.1%) had received at least 1 medication associated with increased risk of AACC before developing it. Of the 796 patients who consulted an optometrist or ophthalmologist in the lookback period, less than one-third underwent gonioscopy in the 2 years before developing AACC (n = 264 [33.2%]), and less than one-half of all patients undergoing gonioscopy received a diagnosis of an anatomic narrow angle (n = 113 [42.8%]). Most patients underwent gonioscopy in the 1 to 4 weeks preceding the AACC. CONCLUSIONS AND RELEVANCEIn this group of Medicare patients, there appear to have been multiple opportunities for interventions that may have averted AACC. Interventions aimed at addressing risk factors associated with AACC and improving performance of gonioscopy might be associated with reduced risk for ocular morbidity.

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The flashlight test and van Herick's test are poor predictors for occludable angles

Cited by 92 publications

References 11 publications

Usefulness of peripheral anterior chamber depth assessment in glaucoma screening

Usefulness of peripheral anterior chamber depth assessment in glaucoma screening

Management of patients with narrow angles and acute angle‐closure glaucoma

Potentially Missed Opportunities in Prevention of Acute Angle-Closure Crisis

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