Maximum Iris Angular Fluctuations

Discussion in 'Optometry Archives' started by Dong, Dec 27, 2008.

  1. Dong

    Dong Guest

    Hi,

    I went to see an opthalmologist who said my angle was narrow, in
    fact she said she couldn't see the drainage or the trabecular
    meshwork. I then visited 2 other opthalmologists (one of them a
    glaucoma expert) who both said my angle is open and they can see
    the meshwork. Is it possible for the angle to shift to such a huge
    extend that on one day it is very narrow and in another day it
    is very open?? But the iris is attached near the ciliary body and
    the angle is supposed to be dictated by the structure and
    shouldn't have moved so much. Could it be because the 1st
    opthalmoligist just want to laser me to earn more money? The
    2 other opthalmologists said there is absolutely no need for
    laser because it is normally and fully open and I have no narrow
    angle glaucoma risk.

    Thanks.

    Dong
     
    Dong, Dec 27, 2008
    #1
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  2. The ophthalmologist who said the angle was narrow may have had a financial
    incentive.

    A more likely reason is the typoe of gonioscopy lens used. That person may
    have used a convention large lens that surrounds the cornea, and can
    compress the periphery of the cornea, making the anlee appear to be narrow.
    The preferred examination lens is the central, smaller lens, frequently
    referred to as a Zeiss 4-mirror lens, (although not all are make
    specifically by Zeiss). This presses only in the center of the cornea, and
    does not therefore risk compressing the periphery. In fact, if too much
    pressure is applied with the Seiss lens, it can do the opposite, making the
    angple appear larger than it is due to compressing the fluid in the chamber
    and forcing the angle open. One has to check with a delicate touch. The
    indentation technique is used if the angle appears to be closed - pushing in
    a bit to see if the angle opens up tells you if it is just narrow, or if it
    is sealed closed.

    David Robins, MD
    Board certified Ophthalmologist
    Pediatric ophthalmology and adult strabismus subspecialty
     
    David Robins, MD, Jan 4, 2009
    #2
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