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Dark Room Provocative Test and Extent of Angle Closure: An Anterior Segment OCT Study

Wang, Bingsong MD; Congdon, Nathan G. MD, MPH; Wang, Ningli MD, PhD; Lei, Kun MSc; Wang, Lan PhD; Aung, Tin MBBS, PhD, FRCSEdin

doi: 10.1097/IJG.0b013e3181aae749
Original Studies

Purpose To clarify the risk parameters measured by anterior segment optical coherence tomography (AS-OCT) for elevated intraocular pressures (IOP) provoked by the darkroom test and to provide recommendations for its clinical usage.

Methods Subjects aged >40 years and whose peripheral anterior chambers were ≤1/4 corneal thickness were recruited. The anterior segment of the eye was imaged in sitting position and under both light and dark conditions and biometry was performed using anterior segment optical coherence tomography. The analyzed parameters were: (1) central anterior chamber depth (ACD); (2) anterior chamber width; (3) pupil diameter; (4) iris curvature; (5) lens thickness; and (6) number of meridians with closed angles (NCA). Then the darkroom test was performed and a positive provocative test result was defined as a rise in IOP ≥8 mm Hg after the test. Statistical analyses included: (1) the difference in parameters between positive and negative eyes; (2) the association between posttest IOP and the parameters; and (3) the difference in parameters between the 2 eyes in subjects with the asymmetric results.

Results A total of 70 subjects were recruited. ACD (P=0.022), NCA in light (P<0.001), and NCA in dark (P<0.001) were different significantly between eyes with positive and negative results. There was a strong association between NCA in dark (r=0.755, P<0.001) and the posttest IOP. Among subjects with asymmetric results between the 2 eyes, the ACD was shallower and the lens thickness was larger in the positive eye.

Conclusions The posttest IOP is determined by the extent of functionally closed angles in the dark. The test may be useful in the early diagnosis of primary angle closure. At the same time, angle configuration should be evaluated to remove false positive result.

Tongren Eye Center, Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, PR China

Reprints: Ningli Wang, MD, PhD, Tongren Eye Center, Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, PR China (e-mail:

Received for publication June 16, 2008

accepted April 21, 2009

© 2010 Lippincott Williams & Wilkins, Inc.