Article

CLINICAL: Glaucoma

Right the Past’s Wrong Approach

Don’t be a scrooge with testing

A Christmas Carol, by Charles Dickens, is the classic story of Ebenezer Scrooge, a miser, visited by the Ghosts of Christmas Past, Christmas Present and Christmas Yet to Come. From these surprise encounters, the miser becomes a kinder and giving person. What if we were visited by “Clinics Past”? What would these encounters teach us that could help us in our “Clinics Present” and our “Clinics Yet to Come”? The American Optometric Association Clinical Practice Guidelines for Primary Open Angle Glaucoma and Glaucoma Suspects (www.aoa.org/documents/optometrists/CPG-9.pdf ) can be an enlightening guide in these encounters to help us.

Here, I provide a brief overview of these guidelines, along with an eye-opening related action step.

PATIENT DILATED OPTIC NERVE/RNFL EVALUATION PACHYMETRY GONIOSCOPY OPTIC NERVE PHOTOS/IMAGING PERIMETRY
1 × ×
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4 ×
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6 × ×
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8 ×
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BRIEF OVERVIEW

The guidelines state that all new glaucoma patients or suspect patients should undergo pachymetry, gonioscopy, tonometry, dilated optic nerve/retinal nerve fiber layer assessment, optic nerve imaging as well as perimetry, as part of the initial workup over the first few months, depending on the patient’s risk for disease progression.

ACTION STEP

Here (left) is my personal chart review of 10 random glaucoma suspects or glaucoma patients from my “Clinics Past” in 2019. Do they follow the guidelines in terms of regular evaluations, appropriate testing and personalized glaucoma treatment? Unfortunately, and as you can see, there are some gaps. From this enlightening information, I can now make a concerted effort to rectify this in the coming year.

GIFTS THAT KEEP ON GIVING

Perhaps the greatest gifts we, as optometrists, can give our glaucoma and glaucoma suspect patients in our “Clinics Yet to Come” are individualized care with sufficient awareness of the stage of their diseases and associated, patient-centric sufficient testing and sufficient treatment.

Happy Holidays to all, and may all of our glaucoma evaluations in the coming year be filled with unchanging optic nerve evaluations, stable/reliable VF testing, low IOP and, or course, happiness and peace! OM