Glaucoma

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Our patients have numerous choices regarding advanced technology and eye care. Advances range from how patients check in for an appointment to what tools a surgeon uses to dissect tissue. They all have their benefits, and all come at a cost.

Optometry Times Editorial Advisory Board member Leo P. Semes, OD, FAAO, sits down to talk about managing glaucoma, treatment recommendations, intraocular pressure, and new medications in treating glaucoma at Vision Expo West in Las Vegas, NV.

A poor ocular surface is a common condition in glaucoma patients due to the incidence of dry eye, age, and use of benzalkonium chloride (BAK). Poor compliance with glaucoma therapy can result. Use of point-of-care testing can help identify patients with a poor ocular surface and drive treatment decisions. Treatment options, including surgical, are discussed.

In the past decade, several significant advancements have been made in the arena of glaucoma diagnosis. Spectral domain optical coherence tomography (SD-OCT), newer algorithms in trend analysis of visual field studies, and combined visually evoked potential (VEP) and pattern electroretinography (ERG) studies have been the hallmarks of such recent advancements.

When I was a resident at the SUNY College of Optometry, I was asked a to conduct a few patient question and answer sessions regarding glaucoma. The sessions consisted of me sitting with a small group of patients, family members, or whoever wanted to know more about glaucoma.

Recently, I received a progress note from a glaucoma surgeon concerning a patient whom he and I share. The patient is a 58-year-old African-American female with a longstanding history of primary open-angle glaucoma.

Ben Gaddie, OD, FAAO, Optometry Times Editorial Advisory Board member, noted several specific areas that were advancing to give ODs better data and better control over patient health outcomes, including: • Corneal mechanics • 24-hour IOP monitoring • New glaucoma drugs and drug delivery systems • Advancements in OCT imaging

Glaucoma isn’t being treated aggressively enough, and eyecare practitioners are being too cautious when it comes to treating and diagnosing the disease-often at the patient’s expense.

Not long ago, a colleague asked me if I performed Goldmann tonometry on all of my glaucoma patients. Without hesitation I said, “No.” When asked why not, I simply answered that not all of my patients are physically able to have the test performed on them.

With the advent of electronic health records, it is now easier than ever to keep up with what medications a patient is actually taking, and (especially in the arena of glaucoma) the several classes of medications, such as steroids, beta blockers, and antihistamines, that can influence how patients’ eyes behave. With this in mind, I had a patient come in the other day with an interesting question regarding her intraocular pressure (IOP).

It’s been a busy week for ophthalmology research and news after both the Association for Research in Vision and Ophthalmology (ARVO) annual meeting in Seattle and the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting in New Orleans.