Agreement of Anterior Segment Biometrics Measured Using Image-Registered Swept-Source OCT and High-Frequency Ultrasound Biomicroscopy.

PURPOSE: To assess the inter-device agreement of ocular biometric parameters, including angle configuration, measured using swept-source anterior segment OCT (AS-OCT) and high-frequency ultrasound biomicroscopy (UBM). METHODS: Patients aged 18 years and older were consecutively enrolled and scanned with both the ANTERION AS-OCT and Insight 100 UBM systems under standardized lighting conditions to assess inter-device reproducibility. A subset of participants underwent repeat imaging to assess intra-device repeatability. Images acquired along the horizontal (temporal-nasal) meridian were analyzed. Pupillary diameter (PD), anterior chamber depth (ACD), anterior chamber width (ACW), lens vault (LV), angular opening distance (AOD500), and scleral spur angle (SSA500) were measured using automated, manufacturer-provided scleral spur detection software for the ANTERION AS-OCT while an expert grader manually assigned scleral spur localization for the Insight 100. Intraclass correlation coefficients (ICCs) were calculated to quantify agreement. RESULTS: 86 eyes of 62 participants were included in the inter-device analysis. Inter-device agreement was excellent for all biometric parameters (ICC: 0.75-0.99) except nasal AOD500 (ICC: 0.72). Greater AOD500 and nasal sector location were independently associated with greater inter-device disagreement in AOD500 measurement (P<0.001) on multivariable linear regression analysis. Intra-device repeatability (N=28) was excellent for all parameters measured using the ANTERION (ICC: 0.91-1.00) and Insight 100 (ICC: 0.85-1.00). CONCLUSIONS: The Insight 100 demonstrated excellent intra-device repeatability and good-to-excellent inter-device agreement with ANTERION measurements for most angle parameters. However, angle-based measurements, particularly in the nasal sector, were not interchangeable. These findings highlight the importance of device-specific interpretation when evaluating angle configuration across imaging modalities. PRECIS: The Insight 100, an arcuate-scanning ultrasound device, demonstrated excellent intra- and inter-device agreement with ANTERION OCT. However, variability in nasal anterior segment angle measurements suggests that these devices are not fully interchangeable.