Gonioscopy is always essential
July 14, 2025

Gonioscopy is always essential

Angle closure is defined by iridotrabecular contact of ≥180° (1) and the presence or development of angle closure can change the treatment plan. Keep in mind that patients with pseudoexfoliative syndrome may also have closed angle (2), as shown by a prospective case-control study risk of PXF patients >70 years of age, in which PXF patients had an Odds Risk of 4.15 (95% CI, 0.91-23.87) of having angle closure (3). Patients with high-myopia (>6 diopters) can also have angle closure, as depicted in a retrospective study (4), and patients with a diagnosis of open-angle glaucoma may have undetected angle closure (5). Gonioscopy is not only a decisive diagnostic tool in glaucoma patients with shallow anterior chamber but it is fundamental to do gonioscopy for every patient with glaucoma, glaucoma suspicion, or ocular hypertension(1).


References

  1. European Glaucoma Society Terminology and Guidelines for Glaucoma, 6th Edition, Chapter II.2.4: Classification and terminology. Angle closure (2025;page 138).
  2. Ritch R. Exfoliation syndrome. Current opinion in ophthalmology. 2001;12(2):124-30.
  3. Al Owaifeer AM, AlObaida I, Alzuhairy S, Raheman SJ, Aljasim L, Edward DP. Frequency and risk factors of narrow angles in patients with pseudoexfoliation: a case-control study. Int Ophthalmol. 2022 Apr;42(4):1085-1091.
  4. Barkana Y, Shihadeh W, Oliveira C, Tello C, Liebmann JM, Ritch R. Angle closure in highly myopic eyes. Ophthalmology. 2006;113(2):247-54.
  5. Varma DK, Simpson SM, Rai AS, Ahmed IIK. Undetected angle closure in patients with a diagnosis of open-angle glaucoma. Canadian journal of ophthalmology Journal canadien d'ophtalmologie. 2017;52(4):373-8.


Contributor: Dr Ana Miguel; MD, PhD, FEBO, FEBO-Glaucoma Ophthalmologist (glaucoma) at Hôpital Privé de la Baie, Avranches, France Ophthalmologist (glaucoma, research) at Centre Hospitalier Universitaire de Caen, France.

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