Clinical Report: Gonioscopy Still Matters

Overview

Gonioscopy remains a critical examination technique in glaucoma care, providing direct visualization of the iridocorneal angle, which newer imaging technologies cannot replicate. Despite its importance, gonioscopy is underutilized, with significant gaps in documentation and performance among clinicians.

Background

The role of gonioscopy in glaucoma management is essential, as it allows for direct assessment of angle structures crucial for diagnosis and treatment planning. While advanced imaging technologies like anterior-segment OCT and ultrasound biomicroscopy have emerged, they do not replace the need for gonioscopy. Understanding the limitations and complementary nature of these technologies is vital for optimal patient care.

Data Highlights

Only 49% of Medicare patients had documented gonioscopy prior to glaucoma surgery. More than 70% of patients lack documented gonioscopy within the first 6 months of evaluation.

Key Findings

Clinical Implications

Clinicians should prioritize gonioscopy in glaucoma evaluations to ensure comprehensive assessment of the anterior chamber angle. Training and documentation practices must improve to enhance the consistency of gonioscopy performance in clinical settings.

Conclusion

Gonioscopy continues to play a vital role in glaucoma management, and its integration with advanced imaging technologies can enhance patient outcomes. A renewed focus on this technique is essential for effective glaucoma care.

References

1. Jim Gallagher, Glaucoma Physician, 2026 -- Gonioscopy Still Matters
2. Jill Gottehrer, Optometric Management, 2025 -- Getting Back to Gonioscopy
3. European Glaucoma Society, British Journal of Ophthalmology -- Terminology and guidelines for glaucoma, 6th Edition
4. Comparison of Swept-Source Anterior Segment Ocular Coherence Tomography and Gonioscopy in Detecting Anterior Chamber Angle Closure - PMC
5. Optometric Management — Getting Back to Gonioscopy
6. glaucoma physician — Pearls for Using Different Gonioscopy Viewing Systems
7. European Glaucoma Society – Terminology and guidelines for glaucoma, 6th Edition | British Journal of Ophthalmology
8. Comparison of Swept-Source Anterior Segment Ocular Coherence Tomography and Gonioscopy in Detecting Anterior Chamber Angle Closure - PMC
9. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial - ScienceDirect