Addressing glaucoma conundrums
Medical care is often fraught with clinical conundrums, from the logistical of figuring out what to do with patients who refuse to take medicine, to tests or imaging that don't match diagnoses.
Las Vegas-Medical care is often fraught with clinical conundrums, from the logistical of figuring out what to do with patients who refuse to take medicine, to tests or imaging that don't match diagnoses. Caring for glaucoma patients is no different, as Joseph Sowka, OD, FAAO, can testify.
"The more glaucoma patients I see, the more conundrums I run into," Sowka says of his work at the Nova Southeastern University College of Optometry, where he sees glaucoma patients exclusively. "If you feel like you're struggling out there with some of these issues, understand that we all experience them."
Diagnostic testing
Of the biggest challenges clinicians face is whether a patient actually has glaucoma. While technology and testing has advanced over the years, there are still many instances when different tests-OCT, visual field, etc.-produce conflicting results. Conflicting results can lead to improper diagnosis and more harm than good, especially when optometrists start treatments based solely on problems identified in tests.
"You need to treat the real disease, not 'red' disease," Sowka says. He points out that often tests can be misleading, displaying "red" problem areas where there really are none. He recalls an example of one patient whose three digital retinal photographs showed clear glaucomatous progression. The problem was, those three images were done within 15 minutes of one another. "Clearly, more testing was needed as this wasn't showing the whole story."
Sowka recommends comparing multiple tests and recognizing that discrepancies often point to a problem other than glaucoma. From optic nerve anomalies to neurological diseases, along with a host of alternate “-omas,” each can present test results at one point in time that could be interpreted incorrectly.
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