Diagnostic Accuracy of Van Herick Technique versus Gonioscopy in Eclipse Sign–Positive Eyes: A Cross-Sectional Study

Abstract

Purpose: To assess the diagnostic accuracy of the Van Herick technique (VHT) compared to gonioscopy in detecting Primary Angle Closure Suspects (PACS) among patients with a positive eclipse sign.

Methods: A cross-sectional study was conducted involving 100 eyes of 50 patients above 40 years of age presenting with a positive eclipse sign. Each eye underwent Van Herick grading (VHG) and gonioscopy using the Shaffer classification system. Diagnostic accuracy parameters—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy—were calculated with gonioscopy as the reference standard.

Results: Occludable angles (PACS) were identified in 70 eyes (70%). At VHG ≤ 2, VHT demonstrated 91.43% sensitivity, 43.33% specificity, 80.00% PPV, 66.67% NPV, and 77.00% overall accuracy. Female predominance was observed across all VHG grades.

Conclusion: VHT is a rapid, sensitive screening tool for detecting occludable angles in eclipse sign–positive eyes. However, due to its limited specificity, positive VHT results should be confirmed with gonioscopy before clinical decision-making.