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Purpose To develop and evaluate the performance of a 3-dimensional (3D) deep-learning–based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans. Design International, cross-sectional, multicenter study. Participants A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively). Methods For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference. Main Outcome Measures The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated. Results In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933–0.953), 0.867 (0.838–0.895), and 0.878 (0.859–0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818–0.985), 0.900 (0.714–1.000), and 0.890 (0.841–0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836–0.933), 0.912 (0.816–1.000), and 0.700 (0.660–0.741), respectively, on the external testing set at clock-hour level. Conclusions The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG.

To determine the changes in optical coherence tomography (OCT) color probability codes and diagnostic ability for peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) analysis after applying Chinese and white subjects normative databases.Cross-sectional study.This study enrolled 219 healthy eyes (108 white and 111 Chinese patients) to construct an ethnicity-specific normative database for pRNFL and macular GCC thickness, which was tested then in 180 eyes with or without glaucoma (102 white and 78 Chinese patients). The percent of change of color probability codes were evaluated after applying the original built-in and the ethnicity-specific normative databases, respectively. Sensitivity and specificity were calculated to evaluate the change in diagnostic ability to detect glaucoma.Healthy white subjects had a thinner pRNFL than Chinese subjects in the overall average thickness as well as the superior, inferior, and temporal quadrants (P.001). Macular GCC did not differ between ethnicities. After applying an ethnicity-specific normative database, the percent of pRNFL abnormal color code labels decreased significantly for the overall average thickness in the white subjects. This resulted in a significant increase in the specificity to detect glaucoma in the white population (P.001). No significant changes were seen when applying an ethnicity-specific normative database for macular GCC thickness.After applying an ethnicity-specific normative database, the percent of pRNFL abnormal color codes decreased significantly, improving the specificity to detect glaucoma in the white population. These findings suggest there may be utility in having ethnicity-specific normative databases for pRNFL thickness.

PURPOSE: To evaluate the difference in anterior segment optical coherence tomography (AS-OCT) parameters among ethnic Vietnamese, Chinese, and whites. DESIGN: Cross-sectional study. METHODS: We prospectively recruited phakic nonglaucomatous participants (based on intraocular pressure

Purpose To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy. Design Literature review and perspective. Methods Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy. Results Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies—including 3-dimensional imaging—have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future. Conclusions Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure.

Purpose To report a case of ciliary body metastasis with uncontrolled glaucoma that was successfully treated with micropulse transscleral laser therapy (MPTLT). Observations A case of a 44-year-old female with uncontrolled glaucoma secondary to ciliary body metastasis from pulmonary adenocarcinoma. Antiglaucoma medications, intravitreal ranibizumab injection and local radiotherapy were ineffective in reducing her intraocular pressure (IOP) and ocular pain. MPTLT using a power setting of 2,000 mW, 31.3% duty cycle, and 140 seconds over 180 degrees demonstrated favorable IOP reduction (from 31 to 8 mmHg) on the first postoperative day without either ocular pain or postoperative complications. IOP remained controlled until she died from hemoperitoneum 18 days after hospital discharge. Conclusions and importance MPTLT can be a safe and effective procedure for IOP control in intraocular metastasis patients with uncontrolled glaucoma.

Purpose To report a case of daratumumab-induced bilateral angle closure glaucoma and myopia that showed no recurrence after repeated drug administration with prophylactic cycloplegia. Observations A 63-year-old man with relapsing multiple myeloma presented with acute bilateral eye pain and blurred vision 14 hours after first daratumumab infusion. Eye examination revealed raised intraocular pressure and shallow anterior chamber. Anterior segment ocular coherence tomography and ultrasound biomicroscopy showed ciliochoroidal effusions in both eyes. The diagnosis of bilateral acute angle closure glaucoma and induced myopia was made. Cycloplegia- and intraocular-pressure-lowering medications were given, which gradually deepened the anterior chambers and normalized intraocular pressure and refraction. The ciliochoroidal effusions completely resolved on day 14. The cycloplegic was given as a premedication for subsequent infusions. There was no recurrence of effusion throughout his 6-month daratumumab treatment course. Conclusions and importance Daratumumab can induce ciliochoroidal effusion, which results in acute secondary angle closure and myopia. The potential prophylactic effect of the cycloplegic drug may enable continuation of daratumumab infusion under close monitoring.