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Obtaining slit-lamp gonioscopic images requires much expertise and can be time-consuming. The images are typically limited to 4 quadrants with hardly standard resolution and lighting conditions. Our goal was to study the ability of the novel system in documenting the 360 degree of the anterior chamber angle in a standard manner under one minute.
The Nidek GS-1 (Nidek Inc, Japan) was utilized to perform semi-automated imaging of the iridocorneal angle on patients who presented to an academic glaucoma sub-specialty clinic under IRB-approved study. Images are obtained in a manner quite familiar to patients and analogous to getting applanation tonometry performed. Topical proparacaine is administered to the eye and then the 16-mirror gonioscopic lens (which is attached to the machine) is coupled with lubricating ophthalmic gel ointment and is brought in proximity to the corneal surface (time=30 seconds). The machine then achieves focus on the angle structures and takes 16 sequential high-resolution photos (time=less than 30 seconds).
In this pilot study, the full 360 degree of iridocorneal angles of 21 eyes from 13 patients with glaucoma were successfully imaged using Nidek GS-1 under 60 seconds. All eyes were able to be imaged in one sitting and we were able to image the full spectrum of angles from narrow/closed to fully open. The 360 degree view of the images were able to be displayed in 3 formats: 16 separate quadrants, a linear stitch, or a circular stitch. Successful imaging was also achieved of surgical devices and post-surgical conditions including CyPass, iStent, XEN, tube shunt, trabeculectomy, sclerostomy, peripheral iridectomy, as well as, angle recession, angle neovascularization, and pigment dispersion.
The utility to easily document baseline gonioscopic images and follow in a longitudinal manner with sequential images under an efficient and standard imaging environment may offer the ability to better assess for possible change or progression.