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Editors Selection IGR 10-4

Clinical examination methods: Infrared gonioscopy

Comment by Minguang He on:

12427 New gonioscopy system using only infrared light, Sugimoto K; Ito K; Matsunaga K et al., Journal of Glaucoma, 2005; 14: 264-266

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Sugimoto et al. (487) present a slit lamp gonioscopy system using infrared light. By this device, the gonioscopic examination on the drainage angle can be performed in a completely dark room, therefore, the artificial miosis induced by illumination on the pupil when using routine gonioscopy is avoided. The authors are able to demonstrate the changes on the gonioscopic visibility of angle landmarks from miosis induced by pupil illumination to 'natural mydriasis' by infrared gonioscopy. This new device is particularly useful in 'static' gonioscopy. Although it is still opinion rather than evidence-based, it is believed that eyes with 'appositional closure' of the drainage angle are at risk of

Infrared light gonioscopy permits evaluation of angle closure in the dark

acute attack and should undergo prophylactic laser iridotomy (Wilensky JT, et al. Surv Ophthalmol 1996; 41: 31-36). However, the identification of the contact between peripheral iris and trabecular meshwork is often hindered by the artificial widening of the angle when the pupil is unavoidably illuminated in routine gonioscopy. Therefore, this infrared slit lamp system provides a unique tool that helps to differentiate eyes with high risk of angle closure by more detailed descriptions on the existence and extension of appositional closure. However, it needs to be considered that this system may sacrifice the contrast of gonioscopic view, and therefore, may not able to identify other gonioscopic characteristics at the same standard as what can be achieved in routine gonioscopy, i.e., degree of angle width, profile of peripheral iris, and pigmentation on trabecular meshwork.

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