Moving beyond the Slit-Lamp Gonioscopy: Challenges and Future Opportunities

After almost a century from its introduction in clinical practice, slit-lamp gonioscopy is still considered the reference standard for evaluating the anterior chamber angle (ACA). Gonioscopy is essential for diagnosing angle closure disease, and ACA features are included in glaucoma's diagnostics and treatments algorithms. However, shortcomings of slit-lamp gonioscopy include a steep learning curve, lack of agreement between examiners and poor documentation. Thanks to advances in miniaturization and computing, new instruments for digital gonioscopy have been developed and marketed. This narrative review focuses on the Gonioscope GS-1, which permits semi-automated circumferential documentation of the ACA in real-colour photographs. Advantages and disadvantages of GS-1 compared with slit-lamp gonioscopy and other ACA imaging technologies such as optical coherence tomography are discussed. Finally, potential opportunities offered by this device for telemedicine, virtual clinics, and automatic classification with deep learning are presented.

Automated summary

Slit-lamp gonioscopy, introduced almost a century ago, remains the reference standard for evaluating the anterior chamber angle, despite drawbacks such as steep learning curve and lack of agreement between examiners. The Gonioscope GS-1 offers semi-automated documentation of the ACA in real-colour photographs, presenting advantages and disadvantages compared to traditional methods and other imaging technologies. Potential opportunities for telemedicine, virtual clinics, and automatic classification with deep learning are discussed.