Assess narrow angle glaucoma with AS-OCT

Utilize anterior segment OCT images to confirm and help explain diagnoses.

By James S. Lewis, MD

Anterior segment OCT (AS-OCT) plays a significant role in angle-closure glaucoma management as it provides an effective method of viewing the anterior chamber angle.

Here are some of the benefits of AS-OCT when diagnosing and managing glaucoma patients.

Image averaging shows another at-risk angle.

Asymptomatic angle-closure glaucoma.

PHYSICIAN-PATIENT INTERACTION

Improving communication

Explaining to patients my reasoning for performing peripheral iridectomy for narrow-angle glaucoma is one of the most difficult tasks I face. When patients present feeling asymptomatic, the last thing they want to or expect to hear is, “I have to put a little opening in your iris with a laser. It’s not going to feel very good, you’re going to need drops for a few days, and it’s not going to improve your vision.” They are often less than thrilled.

While diagrams are great, imaging the patient’s anterior chamber angle and showing them your concern of potential angle closure is made much simpler by AS-OCT images. Utilizing AS-OCT images bolsters the patient’s understanding and acceptance of peripheral iridectomy.

High-resolution imaging of angle at risk for angle closure.

Sectoral closure of angle following surgical intervention to exchange phakic IOL.

CONFIRMING DIAGNOSIS

Supplementing gonioscopy

AS-OCT is not required to diagnose the vast majority of narrow angle glaucoma cases. However, there’s nothing more reassuring to confirm your diagnosis than qualitative and quantitative assessment of the anterior segment with AS-OCT.

Hypotony after glaucoma procedure with anterior displacement of posterior chamber IOL (PCIOL) and complete closure of angle.

Iridocorneal endothelial syndrome identified following clinical assessment of iris thinning.

Angle structures are normal according to AS-OCT. Opacification and scarring of cornea prevented traditional assessment.

Pupillary block with resultant angle closure immediately following combined cataract, PCIOL and DSEK. Attack broken in office with laser peripheral iridotomy.

Determining the anterior chamber angle status with gonioscopy alone leaves open a level of interpretation. If I am uncertain about proceeding with glaucoma surgery after performing gonioscopy (especially after inadequate visualization, analyzing AS-OCT images helps me to make a final decision. OM

About the Author
	James S. Lewis, MD, of Elkins Park, Pa., is a board-certified ophthalmologist with specialty fellowship training in cornea, external disease and anterior segment surgery. Disclosures: Dr. Lewis is a consultant for Nidek.