Narrow angles

[Smileyy]

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In training, for our patients with narrow angles s/p LPI (with appropriate improvement in angle anatomy) and no evidence of glaucomatous damage to nerves, we still tended to get yearly HVF/OCT nerves.

I was curious what the logical reason for this was. I understand the need to get maybe one HVF + OCT nerve to see if there was damage while the patient was narrow, indicating intermittent attacks, but once you have one normal HVF and OCT nerve (after LPI treatment), why the need for repeated yearly tests?

If you treated the narrow angle with your LPI and the angle opens up, shouldn't their risk be essentially the same as everyone else with a normal angle anatomy?

Thanks!

 

[taco bell]

Patient can have mixed mechanism glaucoma, just because the narrow angle is treated with patent LPI and improvment on gonioscopy, does not mean they cannot develop an open angle glaucoma with subsequent progression on OCT and visual field, am i correct?

 

[dantt]

Patient can have mixed mechanism glaucoma, just because the narrow angle is treated with patent LPI and improvment on gonioscopy, does not mean they cannot develop an open angle glaucoma with subsequent progression on OCT and visual field, am i correct?

True but we don't do yearly exams on essentially normal people to look for development of glaucoma.

 

[airplanes]

My experience is that patients with narrow angles and no other pathology (such as evidence of POAG or ocular hypertension) are sent back to their referring providers without any further follow up.

 

[DrZeke]

In training, for our patients with narrow angles s/p LPI (with appropriate improvement in angle anatomy) and no evidence of glaucomatous damage to nerves, we still tended to get yearly HVF/OCT nerves.

I was curious what the logical reason for this was. I understand the need to get maybe one HVF + OCT nerve to see if there was damage while the patient was narrow, indicating intermittent attacks, but once you have one normal HVF and OCT nerve (after LPI treatment), why the need for repeated yearly tests?

If you treated the narrow angle with your LPI and the angle opens up, shouldn't their risk be essentially the same as everyone else with a normal angle anatomy?

Thanks!

First of all... Was this person ever in angle closure or closed at different spots? Did they undergo LPI because they were are risk for angle closure?

When people actually have glaucoma the guidelines are pretty clear cut. Some issues I noticed in glaucoma through attending meetings and observing at a few different places:

1) many people can't even decide what a glaucoma suspect or person at risk is or when to call one.

2) people don't necessarily keep up on literature or remember which types of patients with which risk factors are more likely to undergo progression.

3) people don't know when and when not to use HVF/OCT for these patients

4) a pt who has had LPI with narrow angles and undergone 2-3 HVF that are reliable and full can probably just be watched with yearly exams looking at cup to disc and monitoring visual

 

[taehong81]

In training, for our patients with narrow angles s/p LPI (with appropriate improvement in angle anatomy) and no evidence of glaucomatous damage to nerves, we still tended to get yearly HVF/OCT nerves.

I was curious what the logical reason for this was. I understand the need to get maybe one HVF + OCT nerve to see if there was damage while the patient was narrow, indicating intermittent attacks, but once you have one normal HVF and OCT nerve (after LPI treatment), why the need for repeated yearly tests?

If you treated the narrow angle with your LPI and the angle opens up, shouldn't their risk be essentially the same as everyone else with a normal angle anatomy?

Thanks!

The simple reason is $$$. I agree with you if a patient only abnormality is anatomatically narrow angle (normal iop normal disks normal hvf/oct neg fan hx, etc) and narrow angle improved by LPI then I would not get yearly hvf/oct. Would follow with annul exam with repeating gonio. Would get glaucoma testing only if there are changes to optic nerve exam or elevated iop.