Early Detection of Glaucoma with Objective Pupil Testing

[Joe DiGiorgio O.D.]

The new glaucoma procedures require surgical gonio lenses. If only we could put our patients under a local before doing gonio EVERYONE could get their $12.

So let's say we lease a $12,000 Konan Auto Goniometer. What would be the break even point.

 

[h.c. jang]

Now an automated gonioscope would pique my interest.

My shaky hands suck at gonioscopy. Damn hypoglycemia.

Gonioscope GS-1

https://www.nidek-intl.com/product/ophthaloptom/diagnostic/dia_retina/gs-1.html

International market only.

 

[Joe DiGiorgio O.D.]

Gonioscope GS-1

https://www.nidek-intl.com/product/ophthaloptom/diagnostic/dia_retina/gs-1.html

International market only.

We can probably do that now with our AS-OCT. So if Konan can bring that to the US market for say $9,995, it could be a real winner.

Just like auto refractor/keratometer. Everyone knows how to do retinoscopy (for about $299), but who has not invested in an AR/K?

 

[h.c. jang]

We can probably do that now with our AS-OCT. So if Konan can bring that to the US market for say $9,995, it could be a real winner.

Just like auto refractor/keratometer. Everyone knows how to do retinoscopy (for about $299), but who has not invested in an AR/K?

I don’t think your can truly see the angle with an OCT. That device actually takes a picture or video of the angle and its structures and stitches. You have to remember that it actually is gonio and it contacts the cornea.

And as far as these devices go. They should perform whatever you want to replace or delegate by making it easier, quicker and/or more accurate. The AR/AK clearly is easier and quicker and in many cases more accurate. With gonio I’d settle for easier. The EyeKinetix is clearly more accurate.

 

[Laurence Craig Thomas]

This is an updated entry on the third patient in my webinar (the non-glaucoma patient).

If you recall, this patient had a history of seizures and an abnormal RAPDx score of (0.69) in the right eye -- but no other measurable functional vision abnormalities.

Her only structural abnormality was a mild loss of the ganglion cell complex in each eye (i.e., partial optic atrophy).

I have not figured out what is wrong with her but I believe something is wrong with her.

I ordered imaging which was normal.

We had a follow-up visit to discuss the imaging results and scheduled a visit for six months to repeat all of the diagnostic tests.

The ganglion cell findings and the imaging results are presented below...

 

[Frederick Frost]

This is an updated entry on the third patient in my webinar (the non-glaucoma patient).

If you recall, this patient had a history of seizures and an abnormal RAPDx score of (0.69) in the right eye -- but no other measurable functional vision abnormalities.

Her only structural abnormality was a mild loss of the ganglion cell complex in each eye (i.e., partial optic atrophy).

I have not figured out what is wrong with her but I believe something is wrong with her.

I ordered imaging which was normal.

We had a follow-up visit to discuss the imaging results and scheduled a visit for six months to repeat all of the diagnostic tests.

The ganglion cell findings and the imaging results are presented below...

View attachment 24282

View attachment 24283

Craig,

I noticed on the MRI there was a history of migraine headaches. Migraines cause hypo perfusion of the optic nerve and can lead to abnormal pupillary reflexes and retinal ganglion cell loss.

 

[Laurence Craig Thomas]

Fred, didn’t know that. What’s my next move?

 

[Frederick Frost]

Fred, didn’t know that. What’s my next move?

This is where it gets totally theoretical because I’ve never really found how we can track migraine preventative therapy properly. I posted a while back maybe even more than a year ago the OCT thinned on migraine patients. No one seem to know if we could use an OCT to monitor the effectiveness of migraine preventative therapy.

Since migraine is a diagnosis of exclusion, we would have to eliminate any other causes and I would start with the case history to see if your patient’s migraines seem to originate on the side that has the pupillary abnormality and the thinning on the OCT.

We could then try a topical beta blocker to see if it would help with the headaches, or magnesium supplement, or any other migraine preventative therapy and then track and see how the pupillary response and OCT do over time.

It would be nice to hear from Dr. Stewart if the pupillary device is sensitive enough to track progressing changes in the pupillary response over time.

 

[Ed Makler]

This is where it gets totally theoretical because I’ve never really found how we can track migraine preventative therapy properly. I posted a while back maybe even more than a year ago the OCT thinned on migraine patients. No one seem to know if we could use an OCT to monitor the effectiveness of migraine preventative therapy.

Since migraine is a diagnosis of exclusion, we would have to eliminate any other causes and I would start with the case history to see if your patient’s migraines seem to originate on the side that has the pupillary abnormality and the thinning on the OCT.

We could then try a topical beta blocker to see if it would help with the headaches, or magnesium supplement, or any other migraine preventative therapy and then track and see how the pupillary response and OCT do over time.

It would be nice to hear from Dr. Stewart if the pupillary device is sensitive enough to track progressing changes in the pupillary response over time.

Discussion like the one above is going to MOGA “Make Optometry Great Again”


The advanced instruments, including AI, will make us better clinicians and be able to help people live better lives

On ODwire, there are many ODs who,really believe in the progression of our profession and to become MODERN OPTOMETRISTS.

just to mention a few, don’t feel bad if I left you off

Mike Ware
Allan Panzer
Scott Caughgill
Craig Thomas
Charlie
Fred Frost
Joe DiGiorgio
Naz
Larry G

There are many more that are looking to press the limits of our profession and this is a good thing

I would like to include myself on this list but without Craig Thomas constantly pushing me to buy upgraded instruments, I will still have a tangent screen. Do you see it now, now, now

 

[h.c. jang]

Dr. Stewart,

Is the face cup / faceplate replaceable? And are they available or will be available in the future? I can tell from using the Optos that will need replacement in a few years and my EyeKinetix user manual says the are no user serviceable parts. This is of concern to me. I would highly recommend replaceable faceplates if you have not considered it because with repeated cleaning and patient facial oils and makeup it will need replacement.

Also is the face cup / faceplate made of latex? I would be concerned about patients with latex sensitivities if that is the case.

I've been informed yes replaceable faceplate and has zero latex.

 

[Joe DiGiorgio O.D.]

Discussion like the one above is going to MOGA “Make Optometry Great Again”

Sweet Ed. Wow those would be great hats. MOGA.

BTW--I like your new Avatar.

 

[h.c. jang]

Sweet Ed. Wow those would be great hats. MOGA.

BTW--I like your new Avatar.

How great was it before? Maybe MOG.

 

[Mike Ware OD]

Discussion like the one above is going to MOGA “Make Optometry Great Again”


The advanced instruments, including AI, will make us better clinicians and be able to help people live better lives

On ODwire, there are many ODs who,really believe in the progression of our profession and to become MODERN OPTOMETRISTS.

just to mention a few, don’t feel bad if I left you off

Mike Ware
Allan Panzer
Scott Caughgill
Craig Thomas
Charlie
Fred Frost
Joe DiGiorgio
Naz
Larry G

There are many more that are looking to press the limits of our profession and this is a good thing

I would like to include myself on this list but without Craig Thomas constantly pushing me to buy upgraded instruments, I will still have a tangent screen. Do you see it now, now, now

Thanks Ed but I don't belong with that esteemed group. If optometry needs me to make it great again then we are F****D worse than I thought.

 

[Laurence Craig Thomas]

Dr. Jang - optometry is an open-ended profession where YOU can make it as great or as lame as you want to.

I went to dinner last month with a 40-year-old optometrist who netted $925,000 last year!

I know dozens of optometrists who are millionaires.

I know optometrists that use $100 bills for toilet tissue!

Keep Optometry Great... Always

 

[h.c. jang]

Dr. Jang - optometry is an open-ended profession where YOU can make it as great or as lame as you want to. I went to dinner last month with a 40-year-old optometrist who netted $925,000 last year! I know dozens of optometrists who are millionaires. I know optometrists that use $100 bills for toilet tissue! Keep Optometry Great... Always

That's awesome. I only meant that weren't great and then we sucked. We can take out the AGAIN. But I like KEEP too. KOG.

 

[Ed Makler]

Hey everyone, the archive of the webinar is up, in the first post of the thread.

Thanks again for everyone who turned out, it was great (and congrats to Nancy Davis, who won the Apple Watch!!)

-- ad

I received my EYEKINETIX today.

Not even close! I'm prepping for the NEXT webinar which is next week, and preparing the archives of two prior ones as well.

In terms of the discounts, watch the archive of last night's show, we go over the discounts in the program (with Konan's contact info too.)

thanks
ad

I received mine last week. Yes, Craig is a great salesman!

Ran it on every patient last three days. It's catching about one patient a day that I would have let sail through here and said "see you in a year".

Yesterday...my receptionist. 42 year old. No subjective concerns . 0.57 eyekinetix reading. 20/20 OU. No VF defects, perfect looking nerves and color testing is good. My OCT is down and I don't have RETeval, etc. Her husband works at the hospital so she is opting to just get an MRI done first instead of planning to take off work to travel to the nearest office that has all the diagnostic equipment I don't have (2 hrs)

Today...29 year old. First exam in 7 yrs, just wanting new glasses. Confrontation fields normal. Father has glaucoma. 0.35 eyekinetix reading OD. Ran VF and a superior defect OD noted and MD -1.6.. Nerves appear healthy. I wouldn't have suspected a thing with this guy

I'm sold. It's as amazing as Craig makes it seem.

Caveats...
I have ran myself on it a few times and the readings have varied from -0.31 to -0.01. If the readings are -0.30 I have my tech run another.

I have not done it yet, but I'm going to have the techs also run color testing right then if the eyekinetix score is abnormal.

It seems to me that dry eye patient readings have to be watched closely (blinking a lot affects the results I feel). Put an artificial tear in their eye before the testing.

I received and installed my EYEKINETICS today. This is an amazing instrument that has endless possibilities

Today was the first time in almost 48 years of practicing optometry that I felt confident in evaluating pupils

It even stores a video of the pupils reacting

MOFA. Make Optometry Fun Again

 

[Ed Makler]

In this ODwire.org webinar, Craig Thomas, OD will discuss how he uses the new EyeKinetix® as a screening tool to detect subclinical optic neuropathies, including normal tension glaucoma.

You will learn how to integrate this new technology in a busy practice, and review cases that illustrate the importance of accurately detecting subtle pupillary defects.

** KONAN is offering specials to people who watch the discount and contact them by December 15, 2019 -- watch the webinar for details. The savings are significant.

I sent out correspondence to MDs that refer their diabetic patients and patients that on are plaquenil to my office.

I explained that we have installed a new instrument that measures pupillary reflexes and sent them information on the instrument.

Yesterday I had five referrals from MD's asking me to run the test and send them the results . Two referrals today.

I told the MDs that this was not a covered service by insurance or Medicare. They sent the patients anyway. Two of the patients scheduled for full exams

I was not sure what to charge, but I did come up with a number. 1 million dollars(is this collusion)

If anyone is interested in my real number , pm me.

 

[Lloyd Pate]

I sent out correspondence to MDs that refer their diabetic patients and patients that on are plaquenil to my office.

I explained that we have installed a new instrument that measures pupillary reflexes and sent them information on the instrument.

Yesterday I had five referrals from MD's asking me to run the test and send them the results . Two referrals today.

I told the MDs that this was not a covered service by insurance or Medicare. They sent the patients anyway. Two of the patients scheduled for full exams

I was not sure what to charge, but I did come up with a number. 1 million dollars(is this collusion)

If anyone is interested in my real number , pm me.

And how can you tell them the test results are from diabetes or plaquenil and not another etiology? How does the extra expense to the patient enhance their care?

 

[Paul Farkas]

I sent out correspondence to MDs that refer their diabetic patients and patients that on are plaquenil to my office.

Congratulations on some creative thinking. A pleasure to read a post by an OD trying a new approach .

 

[Ed Makler]

And how can you tell them the test results are from diabetes and not another etiology? How does the extra expense to the patient enhance their care?

Lloyd,

They MDs did not send them for an evaluation for diabetes. I did not mention that this would help with glaucoma or diabetes. They only wanted pupil responses and the results from the test.

I don't know what these physicians are going to do with the results but they are asking for the test.

How is pupil testing going to affect their treatment of their patients???

What do I know? I am just a dumb OLD optometrist just trying to make a living.

 

[Lloyd Pate]

Lloyd,

They MDs did not send them for an evaluation for diabetes. I did not mention that this would help with glaucoma or diabetes. They only wanted pupil responses and the results from the test.

I don't know what these physicians are going to do with the results but they are asking for the test.

How is pupil testing going to affect their treatment of their patients???

What do I know? I am just a dumb OLD optometrist just trying to make a living.

What did you tell them the test would do? What is the exact correspondence?