These results may be justified, at least partially, if the low rate of progression from primary angle closure suspicion to angle-closure glaucoma found in this study is properly taken into account.
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In a recent randomized controlled trial on patients with primary angle closure suspicion, prophylactic peripheral iriditomy had little effect on preventing the progression towards primary angle closure. It should be noted that the management of occludable angles is also poorly defined. reported that this definition should be reconsidered, and suggested that angles between 10° and 20° should be defined as angles with a “probable” and a “possible” risk of closure, respectively. According to the most widely used classification, an occludable angle is defined as an angle in which the TM is not gonioscopically identifiable in more than 90° of angle circumference. Despite these data, the definition of “occludable angle” is in fact unclear both in the literature and in the authoritative clinical guidelines on glaucoma. In China, it was estimated that 9 million people have a significant angle closure and more than 28 million people have an anatomic trait predisposing to primary angle closure glaucoma (an “occludable” drainage angle). Īlthough less prevalent worldwide than primary open-angle glaucoma, primary angle-closure glaucoma prevalence has been estimated to be 22 million people in 2013, with the highest numbers in people of Asian ancestry. Several findings may be associated with an impaired aqueous humor outflow, among them abnormal iris insertion, abnormal pigmentation of the trabecular meshwork (TM), presence of synechiae, blood in the Schlemm’s canal (SC), angle recession, abnormal blood vessels in the angle, evidence of anterior segment dysgenesis, and other abnormalities. In patients with glaucoma or glaucoma suspicion, a careful assessment of the ACA should always be performed, allowing direct visualization of the main structures cause of the aqueous humor drainage, directly affecting intraocular pressure. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.Įvaluation of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination, instrumental to achieve pertinent relevant information on glaucoma patients as well as on non-glaucomatous subjects. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment’s structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy.
This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. Several new imaging techniques for angle evaluation have been developed in the recent years.
Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention.
Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination.
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