Media type: Website

Synopsis: This website provides a fantastic visual learning tool to better understand and improve every provider’s gonioscopy skills. Beginning with learning the technique of gonioscopy and being able to grade and see exquisite examples of both normal and pathological angles through the glaucoma specialist to having a resource to identify unusual angle findings, this site is an invaluable resource. The quality of the images allows everyone to gain knowledge that is often difficult to visualize, in a single site. Dr Alward and his team have developed a resource that should be a requirement for all learners and most practitioners.

Target Audience: Medical students, ophthalmology residents and fellows, practicing ophthalmologists

Review: Dr Lee Alward and his team have developed the technique of video gonioscopy and shared that knowledge with everyone through this fabulous website. Gonioscopy is a difficult technique and the view of the angle is often suboptimal. Particularly for those learning gonioscopy, the Atlas of Gonioscopy provides an invaluable resource to facilitate and ease the learning curve. The site demonstrates proper basic gonioscopy technique both with 4-mirror and Goldmann-type lenses. There is also information on more advanced gonioscopy techniques such as dynamic or compression gonioscopy, a vital tool for diagnosis and therapy. Grading systems, particularly the Spaeth system, are described providing the basis for recording as to what is seen gonioscopically. Dr Alward also provides a delightful history of gonioscopy, including links to many wonderful illustrations by E. Lee Allen.

By far the most impressive part of this site is the fantastic views of the angle with clarity and magnification that have never before been available. There is great variability in the normal angle; only by seeing many can this be appreciated. This site provides a wealth of videos demonstrating the spectrum of the normal angle. The wide range of pathology demonstrated provides a resource to identify the abnormal. This includes common diseases such as pigment dispersion and pseudoexfoliation that are seen frequently and gonioscopy plays a key role in the diagnosis and therapy. There are also examples of diseases that are rarely if ever seen, such as epithelial down-growth and anterior segment tumors, where gonioscopy plays a key role in identifying these potentially devastating diseases.

Likely, the most important outcome from this site is that there are no more excuses as to why gonioscopy should not be done routinely in appropriate patients. It is not an easy skill to learn and maintain competency. However, this site provides the necessary information to learn gonioscopy, record it, and comprehend what is seen in patients throughout your career.