Disease Reviews - American Academy of Ophthalmology

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Micro-invasive Glaucoma Surgery in Childhood Glaucoma

APR 18, 2019 By Ta Chen Peter Chang, MD, Kara M Cavuoto MD

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…

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Techniques of Slit-Lamp Gonioscopy

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

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.

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Gonioscopic Grading Systems

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

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.

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The Normal Angle

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

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.

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Abnormalities Associated With an Open Angle

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

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.

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A Brief History of Gonioscopy

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

Gonioscopy is a relatively young science, having been developed entirely within the twentieth century. The Greek ophthalmologist Alexios Trantas, who first reported examination of the angle in 1907, viewed the angle in a patient with keratoglobus using a direct ophthalmo…

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Abnormalities Associated With a Closed Angle

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

Among the abnormalities associated with a closed angle are pupillary block, plateau iris, aqueous misdirection, and secondary pupillary block, Hyperopic eyes are at highest risk of angle closure; such eyes have shallow anterior chambers and small corneas.

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Gonioscopic Laser Surgery

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

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.

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Anatomy of the Angle

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

The purpose of gonioscopy is to permit visualization of the iridocorneal angle (or simply “angle”). Before exploring gonioscopic techniques and findings, it is important to review the anatomy and function of the structures of the angle.

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Developmental Abnormalities of the Angle

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

Primary infantile glaucoma results from failure of the angle to develop normally. The diagnosis of infantile glaucoma is usually made when parents notice photophobia with blepharospasm, tearing, cloudy corneas, or large eyes.

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Principles of Gonioscopy

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

Viewing the anterior chamber of a normal eye directly is not possible. Light from the junction of the iris and cornea strikes the tear–air interface at a shallow angle, and it is totally reflected back into the eye; this is the principle of total internal reflection.

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Anterior Segment Imaging

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

While gonioscopy remains the gold standard by which the angle is evaluated, numerous anterior segment imaging techniques exist to assist in determining anterior segment structure. The two most commonly employed techniques are ultrasound biomicroscopy (UBM) and slit-lamp…

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Color Atlas of Gonioscopy

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

Color Atlas of Gonioscopy, by Wallace L.M. Alward, MD, and Reid A. Longmuir, MD, is a brief, but comprehensive, introduction to gonioscopy. Gonioscopy is a visual science, so the greater part of the book is devoted to illustrations of gonioscopic and slit-lamp findings, norm…

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References

NOV 08, 2017 By Wallace L M Alward MD, Reid A Longmuir MD

This is the list of references for the Color Atlas of Gonioscopy.

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Secondary Glaucoma: Glaucoma Associated With Non-Acquired Ocular Anomalies

NOV 12, 2015 By Beth Edmunds, MD, PHD, Allison R Loh, MD, Cecilia Fenerty FRCOPHTH MBCHB MD, Maria Papadopoulos MBBS

Glaucoma may be associated with a variety of predominantly ocular anomalies present at birth. They may or may not be accompanied by systemic features. The risk of glaucoma is lifelong and the assessment of intraocular pressure (IOP) and its effects on the eye must be made th…

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Secondary Glaucoma: Glaucoma Associated with Acquired Conditions

NOV 12, 2015 By Beth Edmunds, MD, PHD, Allison R Loh, MD, Cecilia Fenerty FRCOPHTH MBCHB MD, Maria Papadopoulos MBBS

Many acquired conditions lead to glaucoma, which is by definition secondary glaucoma because it occurs as a result of the acquired condition. These conditions can primarily involve the eye, or be part of a wider systemic condition. Glaucoma may develop many years after the o…

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