Which of the following assessments is recommended for evaluating acute angle-closure glaucoma?

• A. Gonio with compression
• B. Anterior segment OCT
• C. IOP measurement
• D. Gonio with compression, anterior segment OCT, and IOP

Answer: (D)

Evaluating acute angle-closure glaucoma requires a complete view of the angle, the anatomy, and the pressure inside the eye. Gonioscopy with compression directly visualizes the angle and helps determine whether the posterior trabecular meshwork is obscured and how tightly the angle is closed, with compression aiding visualization when corneal edema or a shallow chamber makes viewing difficult. Anterior segment OCT provides an objective image of the anterior chamber angle and iris configuration, helping document the extent of angle closure and monitor changes over time. Measuring intraocular pressure tells you how high the pressure is and helps guide urgent treatment and track response.

Using all three together gives the most accurate and practical assessment: you confirm angle closure, document the anatomy, and know how elevated the pressure is, which is essential for management. Relying on just one modality could miss important information—IOP alone doesn’t reveal angle status; imaging alone doesn’t quantify pressure; and gonioscopy without compression can be limited by acute edema.