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Joe G. Devereux, FRCOphth; Paul J. Foster, FRCSE; Jamyanjav Baasanhu, MD, DCEH; Davaatseren Uranchimeg, MD; Pak-Sang Lee, MSc; T. Erdenbeleig, MD; David Machin, MSc, PhD; Gordon J. Johnson, MD, FRCSC; Poul Helge Alsbirk, MD

Arch Ophthalmol. 2000;118:257-263.

Objective  To evaluate anterior chamber depth measurement as a method of screening for primary angle-closure glaucoma in an East Asian population.

Design  Two-phase, cross-sectional, community-based study.

Setting  Rural and urban locations in the Hövsgöl and Ömnögobi provinces, Mongolia.

Participants  Nine hundred forty-two (94.2%) of 1000 individuals in Hövsgöl (1995) and 775 (96.9%) of 1000 individuals in Ömnögobi (1997) aged 40 years or older were examined.

Main Outcome Measures  Anterior chamber depth was measured by optical pachymetry, slitlamp-mounted A-mode ultrasound, and handheld ultrasound. Gonioscopy was used to detect occludable angles, defined as one in which the trabecular meshwork was visible for less than 90° of angle circumference. Primary open-angle glaucoma was diagnosed in subjects with an occludable angle and glaucomatous optic neuropathy with visual morbidity. The area under the curve in a receiver operating characteristic plot was used to compare test performance.

Results  Optical pachymetry outperformed the slitlamp-mounted ultrasound method of anterior chamber depth measurement (area under the curve, 0.93 and 0.90, respectively; z test, P = .001). Handheld ultrasound (area under the curve, 0.86) was inferior to optical measurement (z test, P = .001) but did not differ significantly from slitlamp ultrasound (z test, P = .06). The optical method gave sensitivity of 85% and specificity of 84% at a screening cutoff of less than 2.22 mm for detecting occludable angles.

Conclusions  Measurement of axial anterior chamber depth can detect occludable angles in this Asian population and therefore may have a role in population screening for primary angle-closure glaucoma.

From the Department of Preventive Ophthalmology, Institute of Ophthalmology, University College London, London, England (Drs Devereux, Foster, and Johnson and Mr Lee); Department of Ophthalmology, Medical University Central Hospital, Ulaanbaatar, Mongolia (Drs Baasanhu, Uranchimeg, and Erdenbeleig); Clinical Trials and Epidemiology Research Unit, National Medical Research Council, Singapore (Dr Machin); and Department of Ophthalmology, Hillerød Hospital, Hillerød, Denmark (Dr Alsbirk). Drs Devereux and Foster are now with the Glaucoma Service, Singapore National Eye Centre.

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