Glaucoma, Angle Closure, Chronic Workup

  • Author: Clement Chee-yung Tham, MA, BM, BCh, FRCS(Glasg); Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 24, 2012
 

Other Tests

  • Intraocular pressure (IOP)
    • Goldmann applanation tonometry remains the criterion standard.
    • The accuracy of the measurement may be affected by the central corneal thickness, so the measurement of the corneal thickness (usually by ultrasound pachymetry) is important.
  • Static and dynamic (indentation) gonioscopy is used to evaluate and document the extent, the nature (appositional versus synechial), and the cause of the angle closure.
  • Optic nerve head (ONH) and retinal nerve fiber layer (RNFL) assessments
    • Qualitative
      • Slit lamp biomicroscopy examination using noncontact lenses (eg, 90-D lens) or contact lenses (eg, central lens in Goldmann 3-mirror lens). Green filter (red-free light) may aid in the identification of RNFL thinning.
      • Fundus photography for documentation (stereoscopic or nonstereoscopic)
    • Quantitative
      • GDx VCC nerve fiber analyzer
      • Heidelberg retinal tomography (HRT)
      • Optical coherence tomography (OCT)
  • Visual fields[22]
    • Threshold testing by automated perimetry
    • Special programs, such as SWAP, may help identify early visual field losses.
  • Further investigations to delineate the mechanism of angle closure
    • Ultrasound biomicroscopy (UBM) examination[23, 24]
    • Anterior segment OCT (AS-OCT)
Next

Histologic Findings

PAS across chamber angle

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Staging

There is no formal staging for chronic angle-closure glaucoma (CACG), but grading systems (eg, Shaffer, Spaeth) exist to allow a more objective documentation of the openness of the drainage angle.

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Clement Chee-yung Tham, MA, BM, BCh, FRCS(Glasg)  Professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Coordinator of Glaucoma Service, Hong Kong Eye Hospital; Editor-in-Chief, Hong Kong Journal of Ophthalmology; Editor, Hong Kong Medical Journal

Disclosure: Alcon Grant/research funds Drug research; Alcon Honoraria Consulting; Pfizer Honoraria Consulting; Allergan Honoraria Speaking and teaching; Alcon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Allergan Consulting; Aeon Astron Corporation Grant/research funds Other; Alcon Consulting fee None; Merck & Co., Inc. Honoraria Consulting

Coauthor(s)

Robert Ritch, MD  Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, Chief of Glaucoma Service, Surgeon Director, Professor, Department of Ophthalmology, New York Eye and Ear Infirmary, New York Medical College

Robert Ritch, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew I Rabinowitz, MD  Consulting Staff, Department of Ophthalmology, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, and American Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Martin B Wax, MD  Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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