A respected voice in the eye care industry, ophthalmologist Dr. Larry Berstein, has found that combining gonioscopy with a UBM Plus unit provides the most nuanced clinical data and is the preferred choice of his patients.
While both gonioscopy and UBM Plus units are tools that clinicians call upon to examine patients' anterior chamber, Dr. Berstein and others have found that combining these two approaches provides the richest data and best patient experience.
There are some patients for whom - in Dr. Berstein's experience - gonioscopy is contraindicated and frankly some of his older patients find gonioscopy "unkind" because of the need to blink, discomfort of the special lens or allergic reactions to the numbing agent used in gonioscopy.
Fortunately, UBM technology makes obtaining a numerical value for the angle change and delivering a more patient-friendly overall experience possible for Dr. Berstein and thousands of other ophthalmologists.
UBM Plus Units: The Preferred Clinical Choice
Ophthalmologists including Dr. Bertstein know when the time's right for an anterior segment evaluation - namely, when the patient displays an anatomically narrow angle.
High-frequency ultrasound biomicroscopy (UBM) gives clinicians the clearest images of patients' anterior chamber, sulcus-to-sulcus, and filtration angle.
UBM for Crystal Clear Images
UBM can also provide crystal clear images of otherwise hidden structures of the anterior segment and corroborate clinical findings from gonioscopy, especially as these relate to pathogenic angle-closure related issues.
The technology informing today's high-definition UBM imaging has actually revolutionized the detection and treatment of glaucoma - in addition to other anterior segment pathologies.
Improved axial resolutions and better transducers means that both pre-surgery and post-surgery changes can be pinpointed more precisely, thus improving patient outcomes.
UBM technology has, in fact, advanced so much that ophthalmologists can make instantaneous morphological evaluations of the anterior chamber angle and assess aqueous drainage passageways (e.g., through Schlemm's canal).
Some ophthalmologists have found that UBMs provide better data and more reliable insight into angle changes while simultaneously being easier to work with than gonioscopies.
UBM is a type of ultrasound that can provide a highly precise view into patients' cornea, ciliary body, and iris. UBMs are entirely open-lid examinations, and the numbing drop that patients receive prior to UBM means that there's no discomfort.
In fact, in Dr. Berstein's experience patients more often than not actually request UBM over gonioscopy because of the former's non-invasiveness.
Gonioscopy Still Clinically Relevant
Ophthalmologist Dr. Larry Berstein has found that patients actually prefer UBM Plus evaluations to the initial gonioscopy. That said, gonioscopy continues to be used by Dr. Berstein to evaluate anterior segment issues, chamber angle and to develop a foundation upon which later UBM readings can be matched against.
Although Dr. Berstein continues to use both in clinical practice, he and other ophthalmologists find that patients sometimes prefer to forgo gonioscopy on subsequent visits because of discomfort.
Gonioscopies continue to be an invaluable tool for clinicians to track the front anterior chamber of the eyestill, some older patients can find gonioscopy uncomfortable - in Dr. Bertstein's experience - because of the gonio lens and light sensitivity of the patient activated by the slit lamp light
Clinical Corroboration with UBM Plus
That's not necessarily unwelcome news for Dr. Berstein since he finds that on subsequent visits the data gleaned from UBM Plus readings proves richer and helps to corroborate any drainage and angle changes between visits.
Dr. Berstein goes onto say that: "There is a subjective element of interpretation even to a gonioscopic evaluation. Even though we all measure them and have our grades and apply our anatomical features to get a good sense [of the angle], I have found that for confirmation and sometimes for further evaluation the UBM is an invaluable tool."
Anterior segment issues are the first thing that Dr. Berstein looks for prior to a gonioscopic evaluation and corroborating his findings with a UBM Plus unit.
Being able to "track and monitor the progress with a numerical value for how much the angle has changed" has been an absolute game changer in Dr. Berstein's practice, which is why he continue to enthusiastically recommend UBM Plus units to other clinicians.