EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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27 EW NEWS & OPINION November 2014 Contact information Parekh: parag2020@gmail.com Radcliffe: drradcliffe@gmail.com disease that went undetected on gonioscopy. And that may mean a change in disease management or when to initiate treatment. But for now, "that's all conjecture," he said. "With microincisional glauco- ma surgery, we're placing devices in the eye that work for some patients and not for others, and it's unclear why," Dr. Parekh said. "For example, the iStent [Glaukos, Laguna Hills, Calif.] may work better if you place it adjacent to a collector channel. But those channels are difficult to see. Wouldn't it be great if these new imaging devices could find the col- lector channels? Then we'd be able to plan iStent implantation more effectively." Importance of gonioscopy Simply put, "there are things that OCT or UBM can't do that gonios- copy can, like tell you how much pigment there is on the trabecu- lar meshwork," Dr. Radcliffe said. "Furthermore, OCT doesn't provide as much dynamic information as gonioscopy." Dr. Parekh added that for pa- tients with phacomorphic glaucoma, "we're still going to perform cataract surgery on them to open up space in the angle regardless of how the diagnosis was made—gonioscopy or UBM or OCT." "Gonioscopy works. It's cheap. It's simple, and reimbursement is there," Dr. Parekh said. "Every in- surer accepts it. I'm not sure having those other devices changes my management in the patients I see." Dr. Radcliffe uses UBM to image behind the iris and sclera, but notes it tends to be reserved for "rare and challenging cases." The University of Iowa Health Care Ophthalmology and Visual Sciences hosts a website, gonioscopy.org, that is "dedicated to teaching gonioscopy through the use of videography," and includes video examples of most glaucoma- related diseases, according to the site. Dr. Radcliffe recommends that website to learn more about gonioscopy or to refresh skills. "New treatment options as well as the continuing need for comprehensive evaluation of the drainage angle are the reasons why gonioscopy is going to make a comeback," he said. "We can view these videos and start incorporat- ing gonioscopy more into our daily patient evaluations." EW Editors' note: Dr. Parekh has no financial interests related to his comments. Dr. Radcliffe has financial interests with Carl Zeiss Meditec (Jena, Germany) and Reichert (Depew, N.Y.). Meibomian Gland Dysfunction is treatable. Eliminate the guesswork of dry eye. Identify, diagnose and treat MGD with confidence. Ask us about our new LipiView ® II with DMI and learn more about the TearScience ® Solution for MGD. Give MGD a Second Glance structural change (severe gland atrophy and drop out) normal meibomian gland structure structural change (duct dilation, gland atrophy and drop out) tearscience.com 919-459-4880 sales@tearscience.com