any advice on learning gonioscopy

[Free Radicle]

Just starting residency - I am having a difficult time discerning the structures. I am able to resolve a crystal clear image of the angle with my lens, but I do not think that I know what I am looking at. Somehow the cartoon representations of the angle do not translate well to me when looking through the slit lamp.

Does anybody know of any resourse that has real gonio pix, I think this might be a better way to learn.

Thanks

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[rubensan]

the AAO puts out a pretty good Atlas of gonioscopy. We got ours courtesy of a pharm rep. I worked with an attending that said as a "first year if you can tell whether the angle is open or closed you're doing pretty well." Like every other part of the ophthalmic exam, the more you do, the better you'll get. One of my past seniors recommended the following: no matter how busy clinic gets, gonio, do a depressed exam, use the direct ophthalmoscope and perform retinoscopy at least once daily.

Just starting residency - I am having a difficult time discerning the structures. I am able to resolve a crystal clear image of the angle with my lens, but I do not think that I know what I am looking at. Somehow the cartoon representations of the angle do not translate well to me when looking through the slit lamp.

Does anybody know of any resourse that has real gonio pix, I think this might be a better way to learn.

Thanks

 

[ckyuen]

also, try putting the three mirror on there, use the smallest mirror, it will get you used to looking at the anatomy of the angle. Then when you can consistently make out each structure, you'll feel much more confident with the posner.

 

[PDT4CNV]

I would agree with Rubensan that practice is the best way to get good.

Start with a lens that is easy to hold, stable on the eye, and gives a great view such as the Volk G-4 with the flange. This is one of the best gonio lenses. Once you are comfortable, start using a no fluid lens like a posner or sussman type lens.

 

[V05]

I suggest you learn to identify the scleral spur (the white band between the two darker bands).

On patients with open angles, once you have ID'd the SS, you should be able to ID the structure in front (pigmented TM) and behind (ciliary body band). Repeat this process on as many patients as you can.

The problem sometimes is that once we know the angle is open by identifying the SS we do not look at the other structures. On patients with abnormal angles where we cannot see SS, then we have difficulty arriving at the correct angle configuration. Looking at the normal structures as much as possible will help you identify abnormal/difficult angle configurations.

 

[Tux]

@op: do a google images search for gonioscopy or similar, there's a few nice pics that may help you along.

 

[orbitsurgMD]

Just starting residency - I am having a difficult time discerning the structures. I am able to resolve a crystal clear image of the angle with my lens, but I do not think that I know what I am looking at. Somehow the cartoon representations of the angle do not translate well to me when looking through the slit lamp.

Does anybody know of any resourse that has real gonio pix, I think this might be a better way to learn.

Thanks

You should get a decent non-contact goniolens--the Sussman with a large ring is a good choice--and do as many exams as you can. Examine both phakic and non-phakic patients, regardless of their findings. You will become more familiar with angle anatomy and pathology and you will get more laser cases.

 

[snowbank]

As others and our own Dr. Doan has posted elsewhere on this forum, try gonioscopy.org

 

[MstaKing10]

-for sure gonioscopy.com
-avoid sussman at first, use three mirror or one with flange so you bypass an additional barrier to visualization which is positioning of the lens
-play around with beam width
-lower light intensity for pt comfort
-practice,practice,practice...

 

[echinoderm]

what magnification is best?

 

[Visionary]

what magnification is best?

High mag on Haag-type SL. Some SL allow for super-high mag. That's likely overkill.

 

[vanelo]

gonioscopy.org check it out, great site

 

[azzarah]

Try a Goldmann lens to see all the angle structures first. Once you are comfortable seeing them with the Goldmann lens, you can try with your own gonio lens. Gonioscopy.org is great too. When I was a junior resident on call by myself, I always used the goldmann when I had to definitely look at the angle.

I can't See this $hit
Iris, CBB, SS, TM, Swalbe's line