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NCEES Credentials Evaluations

Objective

The objective is to visualize the angular structures (Schwalbe’s line, trabecular meshwork, scleral spur, ciliary body band) and to evaluate four key points:

A – amplitude of the angle
B – pigmentation
C – trabecular meshwork
D – iris insertion

There are several classifications for the angle aperture, such as the Shaffer system, which takes into account the angle formed by the inner portion of the trabecular meshwork and the anterior face of the iris. Thus, according to the number of structures visualized:

A:        Degree 0 – 0     – no visible structure = closed angle
                       1 – 10°   – only the Schwalbe’s line is seen = probable closure
                       2 – 20°   – trabecular meshwork seen = possible closure
                       3 – 25°-35º – scleral spur seen = improbable closure
                       4 – 35°-45º – ciliary body band seen = impossible closure

Nowadays, Spaeth’s gonioscopy is the most advised since it is more detailed, as it studies not only the angular aperture but also the insertion of the iris root (if it is anterior to the Schwalbe’s line, scleral spur or ciliary body band) and its peripheral configuration (convex, regular or concave) during compression of the dynamic gonioscopy.

B: Trabecular pigmentation is physiologically moderate, but may vary with age and race. It is increased in the Pigment Dispersion Syndrome (Fig. 3), Pseudoexfoliative Syndrome, and in inflammatory or tumour processes.