Confident communication makes patients partners in their care

Boston-Optometrists now have many new sophisticated tools at their disposable to use in the evaluation and management of patients with glaucoma, but good communication skills may be their most critical asset in determining patient outcome, said Elliot M. Kirstein, OD, FAAO, at the annual meeting of the American Academy of Optometry.

Relationships with patients are key

"Every day, each glaucoma patient must make a conscious decision to comply or not to comply with his or her prescribed therapy. This ongoing decision-making process must be based upon a sound and pragmatic understanding of their disease," Dr. Kirstein said.

"Getting the necessary messages across requires that patients view the optometrist as a knowledgeable, informed advocate. Getting patients to listen and understand their disease, its treatment, and what is at stake, optometrists talking about glaucoma need to be confident and convincing in their delivery. They need to show that they know what they are talking about and that they have a plan," he said.

The first point to consider is that many patients do not understand what glaucoma is. A few simple analogies can help to convey the concepts that damage to the optic nerve causes vision loss and that the functional consequence of the damage is irreversible.

Improving poor reception

Dr. Kirstein uses the example of a TV coaxial cable to describe how glaucomatous damage to the optic nerve leads to vision loss. He explains that the optic nerve is central nervous system tissue and can be thought of as a living coaxial cable. Just as the operation of a TV depends on coaxial cable integrity, so, too, does vision depend on an intact optic nerve. While a damaged coaxial cable can be replaced to restore the TV picture, the optic nerve cannot be repaired.

Discussing spinal cord injuries helps patients understand the permanent consequences of optic nerve damage, he said.

"Most patients are aware of what happened to Actor Christopher Reeve and understand that, while there might have been ways to prevent his injury, after his spinal cord was damaged, there was nothing that could be done to restore the functions he lost. With that analogy, patients can understand that they need to try to prevent optic nerve damage from glaucoma, because once it occurs and they begin losing vision, there is nothing that can be done to fix it," he explained.

Dr. Kirstein added, "I have found patients effectively latch onto these analogies, and their use helps motivate patient cooperation in continued care. Patients need to be able to relate to a tangible benefit from treating glaucoma because otherwise, their focus can be on the negatives relating to medication side effects, cost, and the inconveniences of treatment and follow-up care."