By George A. Cioffi MD
Issues on glaucoma comprise the epidemiologic points; hereditary and genetic elements; intraocular strain and aqueous humor dynamics; and medical evaluate, scientific administration and surgical treatment. includes various photographs illustrating ailment entities and surgical thoughts. final significant revision 2008 2009.
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Additional resources for 2011-2012 Basic and Clinical Science Course, Section 10: Glaucoma (Basic & Clinical Science Course)
Figures 3-1 and 3-2 give schematic and clinical views of the angle as seen with gonioscopy. Gonioscopy is required to visualize the chamber angle because under normal conditions light reflected from the angle structures undergoes total internal reflection at the tear-air interface. At the tear-air interface, the critical angle (approximately 46°) is reached and light is totally reflected back into the corneal stroma. This prevents direct visualization of the angle structures. CHAPTER 3: Clinical Evaluation.
Indirect gonioscopy also eliminates the total internal reflection at the surface ofthe cornea. Light reflected from the chamber angle passes into the indirect gonioscopy lens and is reflected by a mirror within the lens. Indirect gonioscopy may be used with the patient in an upright position, with illumination and magnification provided by a slit lamp. A goniolens, which contains a mirror or mirrors, yields an inverted and slightly foreshortened image of the opposite angle. Although the image is inverted with an indirect goniolens, the right- left orientation of a horizontal mirror and the up-down orientation of a vertical mirror remain unchanged.
However, because the relationship of measured lOP and CCT is not li near, it is important to remember that such correction factors as this are only estimates at best. In addition, the biomechanical properties of an individual cornea may va ry, resulting in changes of the relative stiffness or rigidity of the cornea and altering the measurement. The Goldmann tonometer, Perkins tonometer, pneumatonometer, noncontact tonometer, and Tono- Pen are all affected by CCT. Currently, there is no validated correction factor for the effect of CCT on applanation tonometers; therefore, clinical application of any of the proposed correction methods should be avoided.