Van Herick Angle Assessment

When it activates

Scribeable activates a calculator from the encounter. The Van Herick Angle Assessment can activate when the transcript or pasted chart context documents any of these:

• Anterior chamber angle assessment
• Narrow angle screening
• Angle closure risk evaluation
• Pre-dilation angle assessment
• Glaucoma angle evaluation

Inputs the note needs

1 input. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

Grade 0: Closed angle (iridocorneal contact). Grade 1: <1:4 ratio of anterior chamber depth to corneal thickness (very narrow, high closure risk). Grade 2: 1:4 ratio (narrow, moderate closure risk). Grade 3: 1:4 to 1:2 ratio (open angle, low risk). Grade 4: >=1:1 ratio (wide open, no closure risk).

Interpretation

Grade 0: Closed angle — do NOT dilate; urgent referral for angle-closure management. Grade 1: Very narrow — high risk for angle closure; gonioscopy required before dilation, consider prophylactic laser peripheral iridotomy. Grade 2: Narrow — gonioscopy recommended, caution with dilation. Grade 3: Open — safe to dilate, standard risk. Grade 4: Wide open — no angle-closure risk. Van Herick is a screening estimate; gonioscopy is the gold standard for definitive angle assessment.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Van Herick 1969.

• Van Herick W et al. Estimation of width of angle of anterior chamber: incidence and significance of the narrow angleVan Herick (Anterior Chamber Angle) 1969 · 1969 · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the Van Herick Angle Assessment (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. A stated Van Herick Angle Assessment value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.

Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.

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Can activate in: Ophthalmology, Optometry.