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    Using glaucoma diagnostic imaging

    Leverage these technologies to provide a comprehensive picture of the disease

    Over the last decade, there has been rapid growth in the management of glaucoma. Innovative imaging technologies that aid in the diagnosis of this vision-threatening disease have also been on the rise. Instead of relying on a single diagnostic tool, clinicians may consider leveraging the benefits of several modalities available today. Ultrasound biomicroscopy (UBM), optical coherence tomography (OCT), and gonioscopy are three imaging technologies I use to diagnose glaucoma and assess its progression, and ultimately, to make treatment decisions.

    Ultrasound biomicroscopy

    The first effective advantage of UBM is it offers a real-time, accurate assessment of the anatomy of the anterior chamber angle. And because of the rapidly changing demographics of North America, a substantial portion of patients are potentially narrow-angle glaucoma suspects or glaucoma patients and mixed mechanism patients who have a combination of open-angle, elevated intraocular pressure (IOP), and phacomorphic lens-induced angle narrowing.1

    The second advantage of UBM is its ability to assess structures posterior to the iris. There are no commercially available OCT units that can image behind the iris plane because OCTs cannot penetrate the tissue. For conditions in which the patient’s intraocular lens may be imparting a clinical symptomatology or if there’s an iris cyst, those factors need to be differentiated.

    UBM enhances ophthalmic imaging applications

    Finally, UBM is easy to use, and that is a major reason why I have incorporated it into my practice. In the past, UBM was conducted by sending a patient to a laboratory where an ophthalmic water bath system was utilized, and an ultrasonic probe was lowered into the setup to increase image sensitivity and penetration. The entire procedure took 30 to 40 minutes. Now, I need to only apply topical anesthetic and artificial tears to the patient’s eye and prep the tip of the probe. Ease of use has made the UBM a more useful and productive instrument for the busy primary-care practice. The best way to produce high-quality imaging with UBM is to use a tear supplement to create contact between the surface of the tip and the patient’s cornea. A tear supplement typically amplifies the quality and distinctiveness of the image, and the anatomy is more clearly defined. My UBM features a video loop that records imaging, so I can assess the vertical, nasal, horizontal, and inferior position of the angle. I can stop and review a loop at any time in order to examine the anatomy in detail or explore an area of concern.

    J. James Thimons, OD, FAAO, ABO
    Dr. Thimons is adjunct clinical professor at the Pennsylvania College of Optometry at Salus University. He serves as a consultant for ...


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    Optometry Times A/V