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Second Edition: 2018

Poorly taught and often forgotten, gonioscopy remains within the core of the ophthalmologic examination of any patient who has glaucoma or is suspected of having it. Cost-effective and often diagnostic, gonioscopy can provide crucial information for diagnosis and management. Even though newer technology is attractive because it can provide objective and accurate data about the angle structures, such information cannot replace yet an examination by a clinician who is well trained and experienced with standard gonioscopy.

Gonioscopy is the gold standard for diagnosis and evaluation of all forms of glaucoma. It allows the examiner to actually see any obstruction to the aqueous drainage in the anterior chamber angle by direct visualization of the trabecular meshwork and its adjacent structures. A number of congenital and acquired diseases affecting the eye can be picked up by performing a detailed gonioscopic evaluation and the primary diagnostic use of gonioscopy is to distinguish open angle versus closed angle mechanisms for glaucoma. Other critical uses of gonioscopy are picking up neovascularization of the angle in eyes with posterior segment ischemia, detection of abnormal pigmentation and anomalies associated with closed globe injuries. In addition to the diagnostic utility of gonioscopy, with recent advances in glaucoma surgery, a number of microsurgical techniques now require intraoperative gonioscopy to be used for inserting glaucoma implants into the Schlemm's canal or supraciliary space. The current text and atlas on gonioscopy is a comprehensive compilation of our experience and documentation of glaucoma patients over the last two decades. It includes the principle, indications and types of gonioscopy, the techniques for dynamic gonioscopy, classification systems, evaluation of normal anterior chamber angles and clinical findings in various forms of congenital and acquired glaucomas. Additionally, conditions such as ocular tumors, foreign bodies, post-surgical complications, systemic disorders with angle anomalies, etc. have been incorporated. There is a special section on RetCam gonioscopy, intraoperative gonioscopy and gonioscopy after glaucoma surgery including minimally invasive glaucoma surgery. The atlas has over 600 photographs and gives the readers a clear visual understanding of the disease process. We hope that this text and atlas will help in imparting the trainees an in-depth knowledge of gonioscopy, and help in the correct diagnosis and treatment of glaucoma.

Gonioscopy is the current “Gold Standard” for viewing and imaging the anterior chamber angle. It is a simple technique of vital importance for the correct diagnosis of various forms of glaucoma.

I would like to thank Professor Atul Kumar, Chief, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, for his precious guidance and constant encouragement. Words are not enough to thank Dr Talvir Sidhu, an exceptional and dedicated Senior Resident with an unmatched compassion for patients. This project has only been possible because of her sincere efforts. I wish to thank my dear friends and international collaborators—Keith Barton, Mermoud André, Michael Coote and Shamira Perera for contributing excellent goniophotographs. I would like to thank the faculty of the glaucoma services at Dr Rajendra Prasad Centre for Ophthalmic Sciences, Professor Ramanjit Sihota, Professor Viney Gupta, Dr Sunil Choudhary, Dr Shikha Gupta, Dr Dewang Angmo, and our optometry staff who run the Glaucoma Clinical Research Lab, Mr Ajay Sharma, Mrs Amisha Gupta and Mr Suresh Yadav. This work has been possible due to the time and effort put in by several residents of Dr Rajendra Prasad Centre for Ophthalmic Sciences, and I wish to express my humble gratitude for Dr Neha Midha, Dr Neha Kamble, Dr Rohit Agrawal, Dr Tarun Arora, Dr Abdul Shamir, Dr Ankit Singh Tomar, Dr Srikanta Padhy, Dr Yogita Gupta, Dr Mritika Sen and Dr Nimi Raj. I would like to especially thank two junior residents— Dr Pooja Shah and Dr Saurabh Verma, who have put in a lot of effort in the collection of goniophotographs and helping in the written text.