Automated analysis of angle closure from anterior chamber angle images

Mani Baskaran, Jun Cheng, Shamira A. Perera, Tin A. Tun, Jiang Liu, Tin Aung

Research output: Journal PublicationArticlepeer-review

10 Citations (Scopus)


Purpose. To evaluate a novel software capable of automatically grading angle closure on EyeCam angle images in comparison with manual grading of images, with gonioscopy as the reference standard.

Methods. In this hospital-based, prospective study, subjects underwent gonioscopy by a single observer, and EyeCam imaging by a different operator. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. An eye was classified as having angle closure if there were two or more quadrants of closure. Automated grading of the angle images was performed using customized software. Agreement between the methods was ascertained by j statistic and comparison of area under receiver operating characteristic curves (AUC).

Results. One hundred forty subjects (140 eyes) were included, most of whom were Chinese (102/140, 72.9%) and women (72/140, 51.5%). Angle closure was detected in 61 eyes (43.6%) with gonioscopy in comparison with 59 eyes (42.1%, P ¼ 0.73) using manual grading, and 67 eyes (47.9%, P ¼ 0.24) with automated grading of EyeCam images. The agreement for angle closure diagnosis between gonioscopy and both manual (j ¼ 0.88; 95% confidence interval [CI), 0.81–0.96) and automated grading of EyeCam images was good (j ¼ 0.74; 95% CI, 0.63–0.85). The AUC for detecting eyes with gonioscopic angle closure was comparable for manual and automated grading (AUC 0.974 vs. 0.954, P ¼ 0.31) of EyeCam images.

Conclusions. Customized software for automated grading of EyeCam angle images was found to have good agreement with gonioscopy. Human observation of the EyeCam images may still be needed to avoid gross misclassification, especially in eyes with extensive angle closure.

Original languageEnglish
Pages (from-to)7669-7673
Number of pages5
JournalInvestigative Ophthalmology and Visual Science
Issue number11
Publication statusPublished - 9 Oct 2014
Externally publishedYes


  • Angle closure
  • Anterior chamber angle
  • Automated grading
  • EyeCam
  • Gonioscopy

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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