Perceptions of training in gonioscopy
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As a complicated disease, glaucoma should be effectively treated based on correct diagnosis and classification. Gonioscopy reflects the situation of anterior chamber angle which is a key structure for glaucoma. This article conducted a detailed discussion on the common errors, appropriate use and things worthy of note about gonioscopy. In addition, the purpose of gonioscopy in the clinical diagnosis and treatment of glaucoma, and how to overcome the deficiencies of gonioscopy have been discussed.
Gonioscopy
Anterior chamber angle
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Purpose. To analyze the literature reflecting the main modern methods of visualizing the angle of the anterior chamber of the eye, which are used in patients with glaucoma. Material and methods. To perform the review, a search was carried out for literature sources on the Pubmed, Scopus and Elibrary reference databases for the period up to 2022 inclusive using the following keywords: anterior camera angle, gonioscopy, electronic gonioscopy, optical coherence tomography, ultrasound biomicroscopy and the same phrases in Russian. Results. The variety of clinical and morphological forms of glaucoma, the wide prevalence, frequency of occurrence and steady growth of this disease require timely diagnostics, as well as dynamic monitoring of the results of conservative and surgical treatment in patients with glaucoma. Despite the importance of such a diagnostic method as gonioscopy, ophtalmologists still do not use it sufficiently, the frequency of its application during the first visit to the doctor for glaucoma varies from 17.96 to 45.9%. There are also additional instrumental methods of examination of patients with glaucoma that allow an objective assessment of the structures of the eye anterior segment: automated gonioscopy, optical coherence tomography of the eye anterior segment and ultrasound biomicroscopy. These methods can be used both for the primary diagnosis of glaucoma and its dynamic observation, as well as for choosing surgical treatment tactics and monitoring its results thanks to high-precision visualisation and image documentation. Each of them has its own characteristics, advantages and disadvantages, depending on the specifics of the disease and the presence of concomitant ocular pathology, which are described in this article. Conclusion. Taking into account the variety of clinical forms of glaucoma and the insufficient equipment of medical institutions, especially primary care, it can be concluded that it is necessary to improve diagnostic algorithms. Methods such as electronic gonioscopy, optical coherence tomography of the eye anterior segment and ultrasound biomicroscopy will make the diagnostic process more accurate and informative, help to correctly diagnose and determine treatment tactics for both primary care physicians and surgeons. The possibility of documenting the results obtained and creating a system for their analysis can contribute to the founding of a generalized database, which will greatly simplify and accelerate the process of providing care to patients with glaucoma. Key words: glaucoma, anterior chamber angle, gonioscopy, electronic gonioscopy, optical coherence tomography, ultrasound biomicroscopy
Gonioscopy
Ultrasound biomicroscopy
Glaucoma surgery
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Data collected during a population-based general ophthalmic prevalence survey among Alaska's northwestern Eskimos were analyzed to determine the prevalence of glaucoma. Of the 1686 Eskimos examined, 11 cases (0.65%) of glaucoma were found, including ten cases of angle closure glaucoma (both chronic and acute forms) and a single case of open angle glaucoma. This indicates the rarity of open angle glaucoma in Eskimo eyes and a reversal of the typical pattern found in the general US population. Narrow angle glaucoma occurred at a rate of 2.65% in Eskimos older than 40 years of age, the prevalence increasing with age in both sexes. Women were afflicted almost four times as often as men, and the sex difference persisted across all age groups. Anterior chamber angles appeared clinically narrower with age and among women. Seventeen percent of all Eskimos older than 50 years had occludable angles by gonioscopy. These findings target older Eskimo women as a group particularly at risk for angle closure glaucoma.
Gonioscopy
Age groups
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Purpose To report the various types of glaucoma among West African patients presenting to an eye clinic in Ghana. Methods A complete evaluation was performed in 198 consecutive Ghanaian glaucoma patients. Main outcome measures included intraocular pressure, visual acuity, gonioscopy findings, visual field, and total number of glaucoma medications. Results The most common form of glaucoma was primary open-angle glaucoma (44.2%). Open-angle glaucoma suspects also comprised a large percentage of the group (30.5%). Chronic angle-closure glaucoma was diagnosed in 6.6% of the patients. Conclusions Primary open-angle glaucoma is the most common form of glaucoma being treated in this outpatient eye clinic in Ghana. Chronic angle-closure glaucoma was the second most common form of glaucoma in this series and was usually undiagnosed due to a lack of gonioscopic evaluation. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in this region. Pseudoexfoliation and pseudoexfoliation-associated glaucoma were not seen in this population.
Gonioscopy
Iridectomy
Outpatient clinic
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Abstract Background/Objectives: Glaucoma is the second leading cause of blindness worldwide. In Africa, glaucoma is an established public health problem, and primary angle-closure glaucoma (PACG) is not commonly discussed. Recognizing it is important because of its negative impact on visual morbidity, and also because its treatment is different from primary open angle glaucoma (POAG). In response to the observation of many PACG cases at the Northern Community Eye Hospital in Tamale, Ghana, we investigated the proportion of those attending with a first diagnosis of glaucoma who had PACG. Subjects/Methods: Using the electronic records, we identified 976 patients who attended with a first diagnosis of glaucoma between January 2021 and October 2022. Of these, 588 met the inclusion criterion of a clear glaucoma subtype diagnosis. Results: Of these 316 (53.7%) had POAG, 210 (35.7%) PACG, and 62 (10.5%) secondary glaucoma. Thus, over a third of presenting glaucomas had PACG. Conclusion: This highlights that PACG is present in a large proportion of our African population. Our study demonstrates the importance of a clear diagnostic pathway including gonioscopy in the assessment of glaucoma patients and the consideration of wider training on angle closure glaucoma diagnosis and management.
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Anatomy, physiology and pathophysiology. Concept of Classification. The intraocular pressure in glaucoma. Anterior chamber angle examination: Gonioscopy and ultrasound biomicroscopy. Optic nerve and retinal nerve fiber layer. Visual field and other functional tests in glaucoma. Chronic or primary open angle glaucoma. Primary angle closure glaucoma. Secondary glaucomas. Pediatric glaucoma & glaucoma associated with developmental disorders. Medical therapy. Glaucoma laser procedures. Glaucoma surgical procedures. Non-penetrating glaucoma surgery. Treatment overview.
Gonioscopy
Ultrasound biomicroscopy
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To determine the performance of different tests in screening for glaucoma.The results from a glaucoma prevalence study of 479 Chinese elderly Singaporeans were analysed. Glaucoma screening tests evaluated in this study included Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), optic disc assessment, screening Humphrey visual field and gonioscopy. The sensitivity, specificity and positive predictive values of the various screening tests in detecting glaucoma were calculated.The sensitivity of GAT and NCT at a specificity of at least 90% was 26% and 30% respectively with a low positive predictive value (PPV) of 0.13. Optic disc assessment with a vertical cup-disc ratio cut-off of more than 0.7 had a sensitivity of 100% and a specificity of 94% and a PPV of 0.46. The sensitivity of visual fields was 100% with a specificity of 76% and a PPV of 0.17. Gonioscopy had a sensitivity of 100% and specificity of 93% and a PPV of 0.14 in detecting primary angle closure glaucoma.Optic nerve assessment performed better than other glaucoma screening tests. There are, however, many other considerations that need to be taken into account in determining the ideal test for population screening.
Gonioscopy
Optic disc
Applanation tonometry
Screening test
Chinese population
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Purpose: To evaluate the diagnostic outcomes of patients suspicious for glaucoma referred from the company health screening. Methods: In this prospective study, 147 (87 male, 60 female) patients for glaucoma suspicious referred from the company health screening were enrolled. They underwent slit-lamp examination, Goldmann applanation tonometry, gonioscopy, optic disc examination, visual field examination and peripapillary retinal nerve fiber layer (RNFL) thickness measurement using optical coherence tomography (StratusOCT) and scanning laser polarimetry (GDx VCC). We analyzed their diagnostic outcomes. Results: The mean age of patients was 43.8±9.6 years. Reasons for glaucoma suspicion and the number of referred patients were 111 (75.5%) high cup/disc ratio, 23 (15.6%) high intraocular pressure and 13 (8.8%) both of these. The diagnostic outcome was as follows: glaucoma, 26 (17.7%); glaucoma suspect, 4 (2.7%); ocular hypertension (OHT), 14 (9.5%); no glaucoma and no ocular hypertension, 89 (60.5%); and normal, 18 (12.2%). Conclusions: Glaucoma, glaucoma suspect and ocular hypertension were confirmed in 27.2% of patients suspicious for glaucoma referred from the company health screening. Thus, the company health screening appears to be relatively sensitive to detecting glaucoma patients.
Gonioscopy
Scanning laser polarimetry
Optic disc
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Gonioscopy
Ultrasound biomicroscopy
Quadrant (abdomen)
Anterior chamber angle
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Gonioscopy
Modalities
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