Glaucoma in the Trenches

on September 23rd, 2007 | Filed under Optoblog

I was listening to an ophthalmology update podcast number 7:

# Program Title: Deciding when to treat glaucoma, and what to tell patients.
Description: A conversation with George L. Spaeth, MD, Professor of Ophthalmology and Chief of Glaucoma Service at Wills Eye Hospital in Philadelphia. He has a special interest in the quality of life of patients with glaucoma, and insight on deciding when to treat.
Speaker: George L. Spaeth, MD

Dr. Spaeth’s premise is that when you tell someone that they have glaucoma, you lower their quality of life. At one point in the conversation he states that even if someone has visual field loss, you still may opt not to treat, again citing quality of life concerns.

Okay, let’s step back. The mere fact that you are running all these extra tests like visual fields, fundus photography, HRT2/OCT/GDx, and checking their IOP every 3-4 months is going to cause some worry. Am I going to look them in the face and say, “No, you don’t have glaucoma even though, as I just showed you on your visual field printout, you have some areas of decrease vision. And disregard these big, red X’s on the HRT2 printout.”

So, I’m not going to treat someone because I don’t want to hurt their feelings? I suppose that would go over really well in a malpractice suit.

What if I simply said something like, “Yes, you have glaucoma, but odds are you won’t go blind if we start these drops as soon as possible and make sure you take them everyday and see us back for regular follow-up to maintain our target eye pressure goal.” Would that approach be enough to soften the blow to their quality of life?

And while we’re on the subject of glaucoma, I think it’s preposterous that the American Academy of Ophthalmology stopped admitting optometrists to their annual convention with CE. The public health is at stake. Already someone over in the UK did a study and smeared optometrists by saying that optometrists were more likely to miss glaucoma than ophthalmologists (listen to As Seen From Here podcast episode #48, start listening around minute 26:00).

This whole glaucoma topic just makes me shiver when I think that there is such thing as a glaucoma specialist. I know I’ve already gone over this before, but ALL eye doctors must be glaucoma specialists for the sake of our patients. I foresee in the future that maybe every complete exam will include stereo photos given to the patient in case they switch doctors, HRT2/OCT/GDx testing, and using one of those new fangled ways of testing eye pressure thingies that I don’t quite understand yet because I can’t afford yet another expensive instrument in my practice.

Yes, the expense will be enormous to implement these tactics. Maybe those who don’t include such things in every exam should just call their routine eye exam an eye screening. But doing that is one step away from having the ophthalmology establishment legislate out of existence the optometry profession since we would be ignoring the public health by only providing eye screenings and not full eye care.

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