Fig. 11 Grade the angle. A. The intraocular pressure (IOP) is 28 mm Hg and routine gonioscopy revealed this angle. Gonioscopy in the fellow eye reveals a C40f configuration. At first glance the angle is graded in the following manner: Grading at position of yellow arrow reveals: Scheie grade wide open 4+ pigment; Shaffer grade, 4, 4+ pigment 40 degrees closure impossible; Spaeth, E40f. Grading at position of red arrow reveals: Scheie grade, wide open 4+ pigment; Shaffer grade 4, 4+ pigment, 40 degrees closure impossible; Spaeth C40f. The Spaeth system allows a differentiation of the “open” angle where recession is noted at the E40f area and normal angle designated by C40f. This is classic angle recession. A system that forces the examiner to look at specific points will help differentiate normal from abnormal. B. Grade the angle. Scheie grade wide open trace pigment; Shaffer grade 4 trace pigment 40 degrees, closure impossible; Spaeth D40f trace pigment. The iris inserts into ciliary body band, which is a pale gray, angular approach is 40 degrees, and the peripheral configuration of the iris is flat. The scleral spur can barely be appreciated. C. Grade the angle Scheie grade wide open, PAS trace pigment; Shaffer grade 4 trace pigment, peripheral anterior synechiae (PAS) 40 degrees, closure impossible; Spaeth C40f trace pigment, PAS. The iris inserts high onto the inner wall of the eye, directly into scleral spur increasing the likelihood of chronic angle closure glaucoma. The angular approach is wide open and the peripheral configuration is flat. The point is according to the Shaffer system the angle would not be capable of closure, but there are PAS and the eye required a peripheral iridectomy. Thus the angular approach does not have to be steep to have angle closure disease. Clearly, more than one descriptor is necessary for many angles.