Choudhari Nikhil S, George Ronnie, Asokan Rashima, Khanna Rohit, Vijaya Lingam, Garudadri Chandra Sekhar
V S T Glaucoma Centre, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India.
Edward and Soona Brown Eye Centre, L V Prasad Eye Institute, Sattenapalle, India.
Ophthalmic Epidemiol. 2019 Dec;26(6):430-438. doi: 10.1080/09286586.2019.1650380. Epub 2019 Aug 7.
: To report on diagnostic accuracy of van Herick (vH) technique performed by a vision technician (VT) as well as on efficacy of a combination of vH technique and central anterior chamber depth (ACD) in detection of primary angle closure disease.: Data was obtained from two cohorts; rural clinic setting (n = 111), and rural population-based research setting (n = 888). Van Herick grading was performed by a VT in first cohort and a glaucoma specialist in second cohort. A reference standard four-mirror gonioscopy was performed by a glaucoma specialist in both cohorts. We did preferential sampling. Cut-off levels for vH technique and central ACD were grade 2 and 25 percentile value, respectively. Data from one eye per participant was analyzed.: Three hundred and forty (34%) eyes were gonioscopically occludable. Area under receiver operating characteristic curve (95% confidence interval) for vH test was 0.83 (0.76, 0.9) and 0.81 (0.78, 0.84) in first and second cohorts, respectively. Simultaneous testing achieved sensitivity of 87.8% while sequential testing achieved specificity of 99.3%. Negative predictive value* of simultaneous testing was 98.3% compared to 96.6% of vH technique while positive predictive value* of sequential testing was 86% compared to 49.3% of vH technique. (*at 10% prevalence of gonioscopically occludable angle): Diagnostic accuracy of vH grading was similar when performed by a VT and a glaucoma specialist. While test combination was effective to rule in, vH technique may suffice to rule out the disease. Implications of these findings for resource-constrained regions are discussed.
报告由视力技术员（VT）执行的范赫里克（vH）技术的诊断准确性，以及vH技术与中央前房深度（ACD）相结合在检测原发性闭角型青光眼方面的效果。数据来自两个队列；农村诊所环境（n = 111）和基于农村人口的研究环境（n = 888）。在第一个队列中由VT进行范赫里克分级，在第二个队列中由青光眼专家进行分级。在两个队列中均由青光眼专家进行参考标准的四镜房角镜检查。我们进行了优先抽样。vH技术和中央ACD的截断水平分别为2级和第25百分位数。分析了每位参与者一只眼睛的数据。340只（34%）眼睛经房角镜检查为可闭合的。在第一个和第二个队列中，vH测试的受试者操作特征曲线下面积（95%置信区间）分别为0.83（0.76，0.9）和0.81（0.78，0.84）。同时检测的敏感性为87.8%，而序贯检测的特异性为99.3%。同时检测的阴性预测值为98.3%，而vH技术为96.6%；序贯检测的阳性预测值为86%，而vH技术为49.3%。（*在房角镜检查可闭合角患病率为10%时）由VT和青光眼专家进行vH分级的诊断准确性相似。虽然联合检测有助于确诊，但vH技术可能足以排除该疾病。讨论了这些发现对资源有限地区的意义。
