Treating and Managing Your Glaucoma Patients

Dr David Anderson Jan 2014By Dr. David Anderson – We have all heard the statistics about undiagnosed glaucoma, the aging population, and the opportunity that exists in our practices because optometrists provide nearly 75 percent of all primary care eye exams to our communities. I agree that we will have the biggest impact in diagnosing glaucoma, but also in the treatment of glaucoma.

Many optometrists have been treating glaucoma for years; we all are well trained in the diagnosing skills for glaucoma, and most of us have amazing technology to help us find the disease many years prior to any vision damage. We also know that the treatment options that are available are highly effective. But what percent of our patients are compliant? What does compliance mean to our patients? Does following our instructions most of the time mean compliance? More than 50 percent of patients are non-compliant in all of health care, so what do we do with this? How do we treat a painless, asymptomatic disease in a non-compliant world?

This leads to the reason I love treating and managing patients with glaucoma. Our treatments have varying degrees of success, carry side effects and are not fully understood by our patients. And in glaucoma care, treatment is rarely black and white. Most often we are managing patients who may have several options for the next step in care. In fact, it is rare that 100 percent of doctors would choose the same follow-up care, diagnostic test frequency and medication for first and second line treatment.

We all have different ideas for each patient encounter. What I love about glaucoma is not the gray area, but that the gray area gives us an opportunity to discuss the condition with the patient and involve them in the care plan while discussing the various options. Following Woody Hayes’ comments about passing the football, I tell every patient there are four things that happen when I prescribe a medication for a long-term condition, and three are bad:

1. We provide a vision benefit.

2. We introduce potential side effects.

3. We change a patient’s lifestyle and routine.

4. We add to their health care costs.

Those negatives are potential barriers to compliance and, therefore, successful treatment and vision preservation. So for each glaucoma patient, when considering a medication, I always discuss surgical options, especially SLT.

During the last 10 years, SLT has been shown to be as effective as all of our first and second line medications.  SLT shows similar pressure-reducing effects with minimal side effects, while drastically reducing compliance issues for most patients. The way I have incorporated SLT in to my practice is much the same way we have all incorporated cataract care into our practices. A few years ago, I spoke with my favorite cataract surgeon about SLT. I asked him how many he has done, what his success rate was, and what type of follow up he usually does. I also asked if he was willing to co-manage SLT surgery for my glaucoma patients, and how best to coordinate this. Over time, we have developed the best set of record sharing and follow-up strategies for my patients, much like we did for cataract surgery patients.

In the few years that I have done this, I have learned a few things about SLT co-management, including the best patients for the procedure, and the things my surgeon does on each patient before, during and after the procedure.

The best candidates are ocular hypertensives who have other risk factors like family history or thin corneas but little to no visual field loss. Another great candidate is a patient on multiple medications who may have suspect compliance or admits to frustration with using drops or their side effects. The last patient that tends to do well with SLT is someone who is currently progressing. I offer it to this last group primarily to buy some time until better medications are available or more research could give us different perspective. With SLT having up to five years of pressure control, time can be a huge asset for many of our patients.

Of course, many optometrists may wonder, why would an ophthalmologist want to co-manage a disease patient?  The answer is two-fold and very simple: they have worked with our cataract patients for years and have seen the quality of care we provide to our patients, and they are surgeons and would rather do surgery than check pressures and discuss field loss with a patient every few months.

Reach out to your ophthalmologist and present them with an opportunity to do more for your patients. Most would love to partner with you to provide the best care for your glaucoma patients.

Realeyes Starts Off Strong in 2014

Realeyes Westside Academy Jan 2014Realeyes staff and volunteer eye doctors have presented to more than 4,300 students in 38 Ohio schools so far in 2014.

In January, during presentations to pre-kindergarten, first, third and sixth grade classes at Edon Northwest Elementary School (Williams County), a third-grade student claimed the presentation was “better than recess!”

A week later, at multiple presentations at Westside Academy, Columbus (Franklin County), kindergarten students sang the tunes of “Sammy Safe-Eyes,” first-grade students participated in the penlight activity portion of “The Adventures of Rhet & Tina,” and third-grade students helped solve “The Case of Vinny Vision.”

Realeyes teaches students about the importance of vision health and eye safety and is presented at no charge by doctors in the community to pre-school through eighth-grade classes. Realeyes is funded by a grant from the Ohio Department of Health’s Save Our Sight Fund. Contact the Ohio Optometric Association for additional information at 800-874-9111; email:

Optometrists Should Educate Patients About Glaucoma

muckley 3By Elizabeth Muckley, OD – January is National Glaucoma Awareness Month and the Ohio Optometric Association and the American Optometric Association are urging people of all ages to take control of their eye health through early detection to help minimize the risk of developing glaucoma. As primary eye care providers, optometrists are at the forefront in detecting this silent disease.

More than 2.7 million Americans and more than 60 million people worldwide have glaucoma. Experts estimate that half of them don’t know they have it. Combined with our aging population, we can see an epidemic of blindness looming if we don’t raise awareness about the importance of regular eye examinations to preserve vision.

The World Health Organization estimates that 4.5 million people worldwide are blind due to glaucoma. And according to data from the American Optometric Association’s 2013 American Eye-Q® consumer survey, Americans do not fully understand glaucoma:

  • 72 percent think glaucoma has early warning signs. It does not; only a comprehensive eye exam administered by an eye doctor can detect the disease.
  • 86 percent don’t know what part of vision glaucoma affects – progressive deterioration to peripheral vision, making it hard for the patient to see.
  • 47 percent think glaucoma is preventable. It is not preventable, but it may be treated and progression can be slowed if it is detected and treated early.

Americans are also unaware if they are at risk for developing glaucoma; only 13 percent of Americans know that a person’s race could place them at a higher risk of developing glaucoma. According to the Glaucoma Research Foundation, those at higher risk include people of African, Asian, and Hispanic descent. Other high-risk groups include people over age 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted. As much as 40 percent of vision can be lost without a person noticing it.

Educate your patients about their risk of developing glaucoma and the importance of a yearly, comprehensive exam to detect this silent thief before unnecessary, irreversible vision loss occurs. As optometrists, we have a tremendous opportunity to change the course of this disease with timely detection and treatment.

Annual OSU Optometry Student Night a Success

IMG_2419 It was another terrific turnout at the annual Ohio State Student Night event held January 8 in the Ohio Union, hosted by the Ohio Optometric Association. In addition to the 120 students in attendance, Dean Melvin Shipp, Dr. Karla Zadnik, Dr. Mike Earley and other faculty members attended.

The evening began with a reception during which students met our member optometrists. The guests were then welcomed by OOA Board President Dr. Lee Favede, AOA Trustee Dr. Robert Layman and OOA Executive Director Rick Cornett. They encouraged the students to pursue their careers with a passion for helping patients. Students were also urged to join and become active members in the AOA and the OOA because the professional organizations represented the interests of optometrists across the country.

During and after the dinner, students moved to the different tables to hear the doctors share their experiences working with patients and to ask questions about the profession. It was a great way for students to network with doctors and learn what it’s like to practice optometry in a variety of specialties and settings.

Special thanks to our Board members and other doctors who volunteered to share their experiences and provide lots of advice to these future optometrists: Dr. Lee Favede, OOA President; Dr. Terri Gossard, President-Elect; Dr. Jason Miller, Treasurer; Dr. Brenda Montecalvo, Past President; Board Trustees: Dr. Dave Anderson, Dr. Beckie Brown, Dr. Diana Gilbert, Dr. Drusilla Grant, and Dr. Beth Muckley; as well as Dr. Maria Fragoulis, Dr. Russell Maringer, Dr. Greg Hopkins and AOA Board Trustee Dr. Robert Layman.

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