‘Van Herick Plus’: a modified grading scheme for the assessment of peripheral anterior chamber depth and angle

Aim To evaluate the accuracy of a new, modified grading scheme involving a short vertical slit beam, at the inferior angle for peripheral anterior chamber depth (PAC) and angle estimation and its correlation with anterior segment optical coherence tomography (ASOCT). Methods A cross-sectional study of consecutive phakic patients, above 40 years of age, was performed. Using a short, vertical slit beam not reaching the pupil, the inferior angle at the sclerolimbal junction was evaluated, photographed and assessed by a ratio of peripheral anterior chamber depth to peripheral corneal thickness (PAC:PCT) and iridocorneal angle (ICA) on ImageJ software. The inferior angle at the same meridian was also recorded on ASOCT. Results Based on the PAC:PCT ratio, the subjects were divided into four groups: I ( 1/2–1) and IV (>1). The clinically assessed angle by short vertical slit beam correlated well with ASOCT values, trabecular-iris angle (TIA) (r=0.918; p 0 ; 95% limits of agreement:−5.767 0 to 7.361 0 (±1.96 SD). For angles graded narrow on ASOCT (TIA 0 ), using a cut-off of peripheral PAC:PCT Conclusion A short, vertical slit lamp beam evaluation at the inferior angle is an easy and relatively accurate method for both peripheral anterior chamber depth and angle assessment. It correlated well with ASOCT and can be used as a more reliable screening tool to identify eyes with possibly occludable angles.