Gonioscopy remains underused in charting glaucoma progression

PHILADELPHIA — Becoming more comfortable with gonioscopy is crucial in the fight to prevent blindness, according to a surgeon here who advocates better training with this diagnostic tool.

Ronald L. Fellman, MD, quoted a survey finding that only 46% of initial ophthalmic patient visits include gonioscopy, while optic disc evaluations are performed in 94% of new patient visits.

"Let’s face it; gonioscopy is simple, [and it] should be painless," he told attendees at a meeting here celebrating the 40th anniversary of the Wills Eye Hospital fellowship program. "But we’re not really teaching that like we should."

Dr. Fellman added that it is not enough for surgeons to know if an angle is "open" or "narrow," but that clinicians must have the know-how to grade angles alphanumerically, using the Schaefer and Scheie systems.

"It takes a while to learn it, but it allows me to communicate with anyone in the world," he said about the systems, adding that more accomplished gonioscopists are needed to teach students how to use the tool.

He noted that gonioscopy can, for starters, reveal ethnic variabilities in glaucoma progression, provide better understanding of the natural history of the disease and explain the mysteries behind why some angles continue to close or fail to deepen.

"All this information stays within these walls and doesn’t get out. We need to do better at that," he said.