Hosted by Prof. Dan Lindfield, this first 2026 episode features Ms. Nishani Amerasinghe and Dr. Carolina Medina Martin in an expert-led discussion on improving Angle Visualisation, focusing on practical strategies to enhance angle assessment during glaucoma evaluations and MIGS procedures. The speakers share actionable tips, techniques, and equipment considerations that can be easily applied in daily practice. Common challenges encountered by clinicians at different experience levels are explored, along with pragmatic solutions to help overcome them.
The Interventional Glaucoma Podcast
Episode 20: Simple Tips to Improve Angle Visualisation
Key Takeaways
- Gonioscopy underpins all glaucoma and MIGS work
A solid understanding of angle anatomy is essential. Clinicians must be confident identifying normal and abnormal angles before attempting any angle-based intervention. - Clinic and intraoperative gonioscopy are different skills
Slit-lamp gonioscopy relies on the corneal wedge, while intraoperative gonioscopy requires spatial awareness of Schlemm’s canal without this landmark. Both skills must be practiced independently. - Visualisation can be enhanced with simple techniques
Blood reflux into Schlemm’s canal and the use of dyes such as Trypan Blue or Vision Blue can significantly improve identification of target structures during MIGS. - Blood reflux is reassuring, not a complication
Intraoperative heme reflux indicates correct positioning within Schlemm’s canal. It can be managed easily with viscoelastic and should not deter the surgeon. - Phaco-first vs MIGS-first: no single correct approach
Both strategies are valid. The choice should be adapted to the patient, indication, surgeon experience, and training context. Flexibility is key. - Lens choice should prioritize surgeon comfort and control
Handheld gonio lenses allow dynamic fine-tuning using the non-dominant hand. Hands-free lenses may be useful but require precise patient and microscope positioning. - Aim high to compensate for parallax
Due to viewing angle and incision geometry, surgeons should aim slightly anteriorly/higher on the trabecular meshwork to accurately access Schlemm’s canal. - Not every angle is suitable for full treatment
In the presence of PAS or abnormal anatomy, treatment should be selective—or avoided altogether. MIGS works best in open-angle glaucoma. - Training starts with repetition, not devices
Extensive gonioscopy practice (hundreds of exams) is essential. Surgeons should become comfortable simply viewing the angle intraoperatively before introducing MIGS devices. - Confidence comes from preparation and ergonomics
Proper patient positioning, adequate viscoelastic, light handling of the gonio lens, and a calm, stepwise approach are critical to successful angle surgery.
Guests
Prof. Dan Lindfield
Prof. Dan Lindfield is a consultant ophthalmologist and cataract surgeon in Guildford and Farnham who specialises in cataracts and glaucoma surgery, including laser therapies for glaucoma, such as SLT, trabeculectomy, and minimally-invasive glaucoma surgery (MIGS). He has an extensive portfolio of research and academic work which is published in leading peer-reviewed journals.
Ms. Nishani Amerasinghe
Ms. Amerasinghe is a full-time Consultant Ophthalmic Surgeon based at the University Hospital Southampton NHS Foundation Trust, specializing in Glaucoma and Cataract Surgery. She is one of the leading experts in Glaucoma in the UK employing the latest medical and surgical techniques including lasers (SLT), conventional glaucoma surgery (tube and trabeculectomy) and minimally invasive glaucoma surgery (MIGS). She is an expert complex cataract surgeon using the latest innovative techniques. She is past president of UKEGS.
Dr. Carolina Medina Martin
Dr. Medina is a specialist in glaucoma and cataract surgery. She is the author and co-author of several publications in scientific journals and has also published surgical videos with the American Academy of Ophthalmology. Dr. Medina has pursued advanced training at renowned international institutions such as Moorfields Eye Hospital in London and King Khaled Eye Specialist Hospital in Riyadh. She participates in international clinical trials on glaucoma and collaborates in the development of new techniques and implants for modulating scarring in the surgical treatment of this condition. Additionally, she has collaborated in pioneering initiatives such as #InfraestructurasCovid.
Additional Resources
Follow Prof. Dan Lindfield on Social:
Prof. Dan Lindfield | LinkedIn
Follow Mrs Nishani Amerasinghe on Social:
Ms Nishani Amerasinghe | LinkedIn
Follow Dr Carolina Medina Martin on Social:
Dr Carolina Medina Martin | Linkedin
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