Angle grading: a decimal scale for accuracy

Viewing the fundus with the aid of mydriatic agents is becoming more and more standard in optometric practice. The 2006 updated GOS contract in Scotland ensured fundal exam with mydriasis became standard practice for all patients over 60. A dilated fundal view brings benefits to both the patient and examiner but this increased use of mydriatic agents raises some challenges. The risk of angle closure is ever present but how great a risk is it, and how effective are we in mitigating that risk?

Various studies have looked at the prevalence of narrow angles and the risk of an angle occlusion following pharmacologic mydriasis. Primary angle closure glaucoma (PACG) affects 0.4 per cent of the European population over 40. The prevalence increases with each decade peaking at 0.94 per cent for patients aged over 70. In addition to this a 19 per cent increase is expected in the UK over the next decade.1 When we consider that one in 100 of over 70-year-old patients potentially has PACG we see how important it is to evaluate the angle width as part of a thorough eye examination, whether we are dilating the pupils or not.