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Navigating the Angle: Gonioscopy

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Navigating the Angle: Gonioscopy 4/13/17 Navigating the Angle: Gonioscopy Justin Schweitzer, OD, FAAO Cataract, Cornea, Refractive and Glaucoma Surgery Specialist Vance Thompson Vision Sioux Falls, South DaKota To Participate in Live Polling: • Download “Poll Everywhere” App from your mobile app store • Log on & choose “I’m Participating” • Join PollEv.com/ Or to participate via mobile device without the app, text Cornea to 22333 to join Allergan GlauKos Bausch and Lomb Bio-Tissue Alcon BioTissue Reichert 1 4/13/17 2 4/13/17 How do we view the angle? Direct Lens – use a contact lens with specific anterior curvature that will overcome critical angle Indirect – use a mirror to overcome the critical angle Direct Gonioscopy Koeppe Lens Indirect Gonioscopy Goldmann Three Mirror Zeiss four-mirror lens 3 4/13/17 Gonioscopy The gold standard for assessing the drainage apparatus of the eye CPT code 92020 Gonioscopy Important in distinguishing between different types of glaucoma Open vs Closed angle glaucoma Types of Goniolenses 4 4/13/17 6 mirror lens?!?! 5 4/13/17 SlitS -Lamp Setup 6 4/13/17 Set-up Tips Position mirror at 12:00 Keep gonio lens oriented straight, not tilted Put light on mirror before you go to the oculars Consider resting hand on the patient’s head and using elbow rest if needed Start with Low Mag and Observe Iris Conformation Optical Corneal Wedge 7 4/13/17 How Do We Do It? Angle Anatomy Angle Anatomy Posterior Iris Insertion Ciliary Body (Band) Scleral Spur Trabecular MeshworK Anterior Schwalbe’s Line 8 4/13/17 Ciliary Body (Band) Visibility - Wide Pigmentation Scleral Spur Tr ab ec u l ar Mesh w o r K 9 4/13/17 Schwalbe’s Line Review – Identifying Angle Structures – Two Basic Techniques Posterior Anterior Anterior (Optical Wedge) to Posterior Angle Presentations 10 4/13/17 What Are You Seeing? 11 4/13/17 What Are You Seeing? What Are You Seeing? 12 4/13/17 Recording Your Findings St. Andrew’s Cross Most Posterior Anatomical SS Angle Seen 1+ pig CB CB 1+ pig Rating of Angle “Openness 1+ pig SS Other Significant Findings 2+ pig Iris flat 360 degrees Shaffer Classification 13 4/13/17 Spaeth’s Classification Insertion of iris root – Spaeth Classification Width of angle recess – Spaeth Classification 14 4/13/17 Peripheral Iris – Spaeth Classification Pigmentation – Spaeth Classification Spaeth Grading B15b 2+ ptm Schwlbe’s line visible (B) 15 degree angle Describes open but somewhat narrow Angle with mild pigmentation and a Anterior bowing of iris (b) Bowed iris 2+ pigment in tm (2+ptm) 15 4/13/17 Scheie’s Grading of Angle Classification Wide Open – all structures visible Grade I – hard to see over iris root into recess Grade II – Ciliary body band obscured Grade III – posterior trabeculum obscured Grade IV – Only Schwalbe’s line visible Angle Presentations 16 4/13/17 What Are You Seeing? Plateau Iris Syndrome Development of residual angle closure after patent Laser Peripheral Iridotomy (LPI) Flat iris plane Deep anterior chamber Narrow angle due to anterior insertion of iris root 17 4/13/17 What Are You Seeing? Angle Recession #1 RisK Factor is Trauma 18 4/13/17 What Are You Seeing? 19 4/13/17 ThanK You [email protected] gonioscopy.org 20.
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