Perceptions of training in gonioscopy

Abstract

Purpose: To evaluate ophthalmology trainees' perception of their gonioscopy learning experience in the Ophthalmology Specialty Training programme. Materials and methods: A cross-sectional electronic survey was conducted amongst ophthalmology trainees across London Deaneries. The 10 questions survey collected parameters including training grade, previous level of gonioscopy training, confidence in performing the procedure, level of satisfaction with the training formats received, potential barriers and improvements to the training programme. The respondents were also invited to express any additional comments. Results: Fifty-seven complete responses were analysed. Respondents included 25 junior trainees (ST1-3) and 32 senior trainees (ST4-7 and fellow). One fifth of the respondents (11/57) were unconfident in performing gonioscopy, majority being junior trainees (9/11). Over a quarter of the respondents were dissatisfied with the quantity of the gonioscopy training received. Teaching formats such as consultant teaching (mean 8.0), self-directed learning (mean 8.0) and small-group tutorials (mean 7.6) were all well received. Overall, lack of clinical time was considered as the major barrier to gonioscopy training; however lack of training was considered as the major barrier in the low confidence group. Conclusion: This study highlighted ophthalmology trainees' dissatisfaction in the current gonioscopy training curriculum and a lack of confidence in performing the procedure. Appropriate modifications to the Ophthalmology Specialty Training programme could enhance trainees' gonioscopy learning experience.

Feasibility of Automated Gonioscopy Imaging in Clinical Practice

“…Community optometrists tend to use Van Herick’s technique to assess limbal chamber depth, and although this has a high sensitivity (84.9%) and high specificity (89.3%) for detecting occludable angles, it does not provide direct visualization of the ICA 14. Further potential advantages of automated compared with traditional gonioscopy include a role in teaching,5 and that the user can zoom in on any abnormalities, permitting a significantly higher magnification compared with that of slit lamp gonioscopy. Photographs also allow comparison over time, useful for longitudinal follow-up and are useful for postoperative documentation of microinvasive glaucoma surgical devices 3…”

“…4 Nevertheless, gonioscopy is underutilized, with a lack of time and lack of confidence in potential explanations. 5 Gonioscopy is also subject to intraobserver and interobserver variability, dependent on the level of experience of the user. 6,7 The Gonioscope GS-1 (Nidek Co.) is a desktop camera that acquires 360 degrees automated color photographs of the angle using a 16-mirror gonioprism (Fig.…”

“…Gonioscopy remains the gold standard as it provides a 360-degree view of the iris root, angle, and peripheral cornea, in addition to allowing assessment of trabecular meshwork pigmentation and detection of abnormalities such as peripheral anterior synechiae, neovascularization, or cyclodialysis clefts 4. Nevertheless, gonioscopy is underutilized, with a lack of time and lack of confidence in potential explanations 5. Gonioscopy is also subject to intraobserver and interobserver variability, dependent on the level of experience of the user 6,7…”

Ophthalmic exam and ophthalmology residents’ subspecialty preference

“…Quigley et al [5] also observed that residents performed gonioscopy on only 50% of open angle glaucoma patients. In another study aimed to evaluate residents' perception of gonioscopy, 20% of them stated they were not confident in performing the exam [6] . These findings are consistent with gonioscopy having received the lowest overall ranking in our cohort.…”

Moving beyond the Slit-Lamp Gonioscopy: Challenges and Future Opportunities

“…Since the introduction of gonioscopy in clinical practice, technology has evolved, offering more advanced methods to inspect the ACA that partially overcome shortcomings of slit-lamp gonioscopy [ 8 ]. In particular, slit-lamp gonioscopy is often limited by poor documentation of findings, steep learning curve, eye contact, partial agreement between examiners, impractical photography of the observed finding and limited grading or measurements [ 9 , 10 ]. This review critically discusses the clinical value of two of the most promising technologies for document the ACA, namely optical coherence tomography (OCT) and digital gonioscopy.…”