Glaucoma is a progressive optic neuropathy that can lead to blindness if left uncontrolled. Given its numerous forms, the disease can occur in anyone, although there are certain groups of people known to be at higher risk, including African Americans, those with a family history and the middle-aged and elderly populations. Glaucoma is expected to affect 80 million people by 2020.
Here, I explain why glaucoma is in our wheelhouse and how you can manage the condition in a cost-efficient manner.
As optometrists, we are often the first line of defense for the general public’s ocular health. It is, therefore, incumbent on us to both detect suspicious glaucomatous signs, as well as secondary causes of glaucoma in our patients. Once we have diagnosed a patient with glaucoma, we then play a crucial role in staving off vision loss by periodically collecting both structural and functional data to monitor progression and formulate an appropriate treatment plan to allow for the most favorable prognosis possible. This became possible in 1978 after West Virginia passed the first therapeutic enhancement to optometric scope of practice, leading the way for the current 49 states where optometrists can provide glaucoma treatment.
Glaucoma should also be a focus for optometrists because practicing to the highest level of our optometric license maximizes efficiency in eye care delivery and continuous disc area surveillance and management. This, in turn, affords us the opportunity to establish strong doctor-patient relationships in the management of this chronic disease. Given the about 40,000 optometrists practicing in the U.S. with about 1,350 new optometric graduates every year, this is an opportunity to build a reputable practice and contribute to the growing need of glaucoma management.
Finally, glaucoma care enables us to create symbiotic relationships with other eye care providers through co-management, allowing for the highest quality of patient-care. As an example, the glaucoma clinic at Columbia University Medical Center has several specialists who regularly co-manage glaucoma with optometrists around the east coast. Patients who are referred for narrow angles, confirmation of glaucoma diagnosis or a second opinion about management are most often returned to the referring provider (optometrist or ophthalmologist) with a detailed report of what transpired during the consultation with recommendations of management. The patients are then followed regularly by the original optometrist or ophthalmologist, only returning to the specialist every few years, or as needed, for follow-up. The comfort level of each practitioner in managing glaucoma and the decision of when referral is necessary varies among optometrists, depending on their training and expertise.
Whenever considering immersing oneself in the management of any ocular disease, practice efficiency is top of mind. Efficient glaucoma management is indeed possible. Standardization of required work-up for initial evaluations and follow-up examinations fosters efficiency among the support staff, visit expectations in patients and an easy-to-follow protocol for the physician to standardize and simplify treatment decisions. Utilizing a methodical approach allows for exponential growth of your practice, increasing access to care for patients who have glaucoma.
After determining a management strategy of when your patient should return, formulate a plan of how you can follow your patients, getting the most valuable information possible at each visit in a way that characterizes both good clinical practice and cost efficiency.
For example, it is unwise to create a protocol of OCT and fundus photography always being done on the same day, since both tests will not be reimbursed. Obtaining a VF and OCT on the same day, however, is time-efficient, clinically pertinent in gathering valuable structural and functional information and reimbursable.
In summary, glaucoma management is an important and unique opportunity for optometrists to help the growing glaucoma population, build symbiotic relationships with nearby glaucoma specialists and build a large productive practice.
In this, the first of four “Practicing Medical Optometry” special editorial sections on ocular disease, my fellow optometrists, Leslie O’Dell, Danica Marrelli and Scot Morris will be providing you with a blueprint on practice management, diagnostics and therapies, respectively, related to glaucoma. OM