In adult-onset glaucoma, surgery is offered after conservative therapies have proven inadequate, but in childhood glaucoma, surgery is frequently the first-line treatment. It stands to reason that bleb-less and hardware-free procedures may be particularly suitable for childr…

Human refraction is leptokurtic and negatively skewed (toward myopia). There is, however, a preponderance of emmetropia in the human population as compared with refractive errors, which suggests that there is a process for emmetropization of the human eye.

Ocular motor research in the past half-century has produced remarkable advances in our understanding of the underlying mechanisms of the several types of nystagmus seen in infancy and childhood. Research results to better enable the clinician to make accurate diagnoses and p…

Retinoblastoma (Rb) is a primary intraocular cancer that develops in the eyes of young children most often under the age of 5 years.Access to the acueous humor AH of eyes with active Rb has enabled the first-ever genetic analyses of Rb tumors in situ (ie, without enucleation…

Significant refractive error is found in approximately 50%-80% of children with Down syndrome, and there is substantial underaccommodation in these patients regardless of refractive error. Patients should be followed annually until age 5 evaluating for refractive errors, str…

Grading systems permit the recording of gonioscopic findings for communication and for future reference. The three primary alphanumeric systems that are currently used for grading the angle are those of Scheie, Shaffer, and Spaeth.

The eye should be examined carefully with the slit lamp before beginning gonioscopy. One might see a prominent Schwalbe’s line, atrophy of the iris, or evidence of previous inflammation, surgery, or trauma.

There are no characteristic gonioscopic abnormalities in primary open-angle glaucoma, ocular hypertension, or normal-tension glaucoma. Among the abnormalities that can occur with an open angle are pigment dispersion syndrome, and oculodermal melanocytosis.

Both laser and incisional surgery are performed with the aid of gonioscopic visualization of the angle. Incisional surgery includes goniotomy, goniosynechialysis, internally created filtration procedures, and internal revisions of filtration fistulas.

The best preparation for recognizing angle pathology is to become familiar with the many variations of normal. Careful gonioscopic evaluation of the anterior segment follows a routine that evaluates all visible structures in a systematic fashion.