Sir,
We thank Shah et al1 for their interest in the Portsmouth Glaucoma Refinement Scheme.2 The scheme also uses Van Herick grading for anterior chamber depth—all patients with a Van Herick peripheral limbal anterior chamber depth of less than 25% of corneal thickness were referred to the virtual clinic for assessment by an ophthalmologist. Approximately 10% of all of those accepted from the Refinement Scheme virtual clinic to HES (from a total of 11 out of 100 referred to the virtual clinic, from our audit) were due to narrow angles suspected through Van Herick grading. Of these, 25% subsequently required laser peripheral iridotomy, slightly higher than the 17% positive predictive value, for the suggestion of occludable angles by an initial Van Herick test, outlined by Foster.3
References
Shah B, Campbell P, Ford C, Goyal S, Lim KS . Re: The Portsmouth-based refinement scheme: a role for virtual clinics in the future? Eye 2013; 27 (7): 892–893.
Trikha S, Macgregor C, Jeffery M, Kirwan J . The Portsmouth-based refinement scheme: a role for virtual clinics in the future? Eye 2012; 26: 1288–1294.
Foster P . Advances in the understanding of primary angle-closure as a cause of glaucomatous optic neuropathy. Commun Eye Health 2001; 14 (39): 37–39.
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Trikha, S., Macgregor, C., Jeffrey, M. et al. Response to Shah et al. Eye 27, 893 (2013). https://doi.org/10.1038/eye.2013.68
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DOI: https://doi.org/10.1038/eye.2013.68