Eyeworld

MAR 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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March 2012 Seeing the future of angle- closure glaucoma diagnosis by Vanessa Caceres EyeWorld Contributing Editor Maybe It's Time To Examine Your Optical Dispensary Partners In Vision has been providing full service optical management nationwide since 1999, in offices just like yours. Partners In Vision has been proviiding full service optical ma i anagement nationwi in offices just like yo Our comple Prog m I In omp t t t t t t rogram Iogram ncludes: 4UB Gm de since 1999, ours. mplete T Turn-KKeey Dispensarry y 4UBGmOH "TTJTUBODF GmOH "TTJTUBOD F .BOBHFE $BSF 1PTJUJPOJOH *OUFHSBUJPO 0Gm 0QUJDBM #FODINBSLJOH $PNQSFIFOTJWF 0QUJDBM .BOBHFNFOU 4PGUPGUXBSF Call now free pers dispensa 18 1 88 $PNQSFIFOTJWF 0QUJDBM.BOBHFNFOU GU XBSF Call now to schedule your free personalized optical dispensary assessment. ee pers sonalized op to schedule your sonalized optical ary assessment. 1-888-PIV-1112 www.partnersinvision.com A normal gonioscopy Source: Ricardo Amin, M.D. PARTNERS IN VISION Optical Management Specialists pivinfo@partnersinvision.com 0GmDF SBJOJOH 4VQQP U &EVDBUJPO *OUFSOBM .BSL*OUFSOBM.BSLFUJOH "TTJTUBODF 1SPHSB N 0QUJDBM #FODINBSLJOH .BOBHFE $BSF 1PTJUJPOJO H *OUFHSBUJP O GmDF5SBJOJO H 4VQQPS U &EVDBUJPO FUJOH "TTJTUBODF SPHSBN New technology has some advantages, but gonioscopy still receives highest praise D espite technological advances in imaging, a number of glaucoma spe- cialists are sticking to the tried-and-true method when diagnosing angle-closure glau- coma. "My go-to is still gonioscopy," said Leon W. Herndon, M.D., asso- ciate professor of ophthalmology, Duke Eye Center, Duke University, Durham, N.C. "Gonioscopy is low tech and low cost," said Douglas J. Rhee, M.D., assistant professor, Massachu- setts Eye and Ear Infirmary, Harvard Medical School, Boston. "It requires contact with the eye but still is the gold standard." The ease with which these physicians can perform gonioscopy is the main reason why they stick with it over new imaging tech- niques, such as ultrasound biomi- croscopy (UBM) and anterior segment ocular coherence tomogra- phy (OCT). Gonioscopy has also been around longer, making results inter- pretation easier, Dr. Herndon said. "It's not that I don't trust the new modalities, but this is what I've been doing for 15 years, and I know what I'm looking for. The first time with the new modalities, I may have more questions than answers, al- though I know that's the case with any new technology," Dr. Herndon said. UBM and OCT are not as widely available as a gonioscopy lens since the technology is more expensive. Although Dr. Rhee said that some cite the technology as being easier to use for physicians outside of the United States who are not well trained in gonioscopy, he questions the advantage when the technology can also be costly. Even though gonioscopy is easy to perform, it does require some practice. "I like to use the Zeiss four- mirror lens (Carl Zeiss Meditec, Dublin, Calif.) so that I can perform dynamic indentation gonioscopy. I think this is the best way to defini- tively identify landmarks," said Robert J. Noecker, M.D., former vice chair, University of Pittsburgh Medical Center Eye Center, and cur- rently in private practice. "I also like to look at the angle under bright and dim lighting, as the configura- tion in at-risk eyes can vary a lot de- pending on the lighting."

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