Modified Dark Room Provocative Test for Primary Angle Closure

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Abstract

Purpose

To examine the diagnostic value of a modified dark room provocative test (DRPT) in detecting primary closure of the anterior chamber angle.

Methods

The cross-sectional observational prospective clinical study included suspects of primary angle closure. Using anterior segment optical coherence tomography (AS-OCT), we measured the anterior chamber angle configuration at room light and after 3 minutes of dark adaptation. Gonioscopy and Perkin's applanation tonometry were performed in room light conditions at baseline and after 1.5 hours of dark adaptation. The number of closed angle quadrants assessed on AS-OCT images and upon gonioscopy were recorded. The DRPT was positive, if intraocular pressure increased by ≥8 mm Hg after 1.5 hours of dark adaptation.

Results

The study included 76 subjects (76 eyes). Among 32 (42%) eyes with a positive DRPT, the number of eyes with an increased number of closed angle quadrants was significantly higher for the OCT examination at 3 minutes of dark adaptation than for gonioscopy at 1.5 hours of dark adaptation [29 (91%) eyes vs 21 (66%) eyes; P=0.01]. Kappa statistics showed a moderate agreement between increased closed angle quadrants obtained both after 3 minutes of dark adaptation (κ=0.44; P<0.001; sensitivity: 90.6%; specificity: 56.8%) and after 1.5 hours of dark room test (κ=0.45; P<0.001; sensitivity: 65.6%; specificity: 79.5%) compared with the final intraocular pressure elevation. Correspondingly, the area under the receiver operator characteristics curve was significantly larger for AS-OCT than for gonioscopy (0.86 vs 0.73; P<0.001) in predicting a positive dark room test.

Conclusions

A modified DRPT with an anterior chamber angle assessment by OCT at 3 minutes of dark adaptation as compared with a gonioscopic angle assessment after 1.5 hours of dark adaptation had a higher diagnostic precision in predicting primary angle closure.

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