Therapeutics

Caution Ahead: Successfully Navigating the Glaucoma Treatment Journey

By David D. Richardson, MD

How many times have you driven to or from work and had no memory of the drive once you’ve arrived? It’s hard to avoid. In fact, it’s natural to stop paying attention to the details of anything that we do again and again. The predictability of habitual behavior allows our minds to essentially click into auto-pilot while our thoughts play like movies in our heads. The problem is that inattentive driving can result in accidents (sometimes fatal).

Inattention to the treatment of patients with glaucoma can also result in “accidental” visual loss. This article will focus on those things we should be mindful of with each of our glaucoma patients. By doing so we can avoid the many preventable mishaps common to glaucoma treatment.

Education Reduces Fear

Remember the first time you drove along a hairpin mountain road with nothing but three feet of gravel between you and a precipitous fall? Scary, wasn’t it? How about the next time…or the 10th…or the 20th time you traveled that road? Still scary? Probably not so much. Familiarity breeds trust and reduces fear.

Such is also the case with glaucoma treatment. When a patient is first diagnosed with glaucoma she may be fearful of going blind. With modern treatments, you may not even think of glaucoma as a blinding condition, but that is because you have “driven this road” so often. It is critical that patients’ fears be addressed as soon as the diagnosis is made. Don’t assume that a quiet patient has no questions. She may simply be too afraid to ask. Fortunately, there are many wonderful educational videos and booklets that can be shown to patients to effectively educate them about glaucoma and its treatment.

Of course, just as with the mountain road, it is important to maintain respect for the condition. Fear may not be of benefit, but a proper balance of attention to the road (or disease) is necessary for survival (or protection from vision loss).

Chart Out the Course

When we drive, it is often with a clear intent to get somewhere. With glaucoma treatment, we, as members of an eye care team, may know the destination: protection from loss of vision. But, does the patient? Before I routinely discussed this with my patients I would occasionally hear the following from them about their drop treatment: “Well, my vision didn’t get better so I stopped them.”

Patients who are not educated about glaucoma treatment don’t realize the goal is preservation of vision and they are prone to misunderstandings. Let me be clear about this:When a patient stops her drops for this reason it is not her fault, it is ours for not clearly communicating the goal of treatment. Just as you would not start driving your friends without telling them where you are going, do not expect your glaucoma patients to just “go along for the ride” without informing them of the purpose of the trip.

“But, I Don’t Want To Go!”

These words could come from either a six-year-old child who is tethered to his video game or your newly diagnosed glaucoma patient. Both are perfectly content the way they are. Why would they want to go on this trip? After all, glaucoma is commonly diagnosed before symptoms set in. The doctor is suggesting treatment that is costly, inconvenient, and may have side effects.

Lack of “buy in” from the patient is one of the common reasons for poor compliance with medical treatment of glaucoma. “I’m fine. My vision’s fine. I don’t need this treatment,” patients may say. These are all reasonable thoughts that might pass through a newly diagnosed glaucoma patient’s mind. It is up to the eye-care team to educate the patient as to why the inconvenience and expense are worth the cost in order to prevent permanent vision loss down the line.

Unlike a child that you can simply pick up and buckle into the car seat, don’t think you can just force a patient to take this journey with you. Effective education is not about telling them what they have to do. It’s about convincing them that this is worth doing.

“How Fast Are You Going?”

No road trip would be complete without a backseat driver. Once patients understand that the way to protect vision is by reducing IOP, it’s common for them to get fixated on “the number.” It’s important for them to know this metric is only one of many important factors their doctor attends to in order to manage their glaucoma. Whether (or how) you inform patients of “the number” will depend upon the preference of the doctor caring for them.

“Are We There Yet?”

Anyone who has ever spent more than half an hour in a car with a child knows how frustrating this question can be. At least on road trips the family eventually arrives at the destination. Such is not the case with glaucoma. Since the goal is continued protection of the optic nerve the road trip never ends.

Patients who do not clearly understand this may return to the office stating, “Well, the bottle ran out so I stopped taking the drops.” Again, this results from an error of communication. Patients need to know up-front that glaucoma treatment is similar to treatment of high blood pressure or diabetes – it is most commonly for life.

Focus on the Journey, Not the Destination

Road trips may be taken even without a destination. Whether they are enjoyable or disastrous depends largely on the preparation done as well as the expectations of the travelers. Glaucoma is essentially a never-ending road trip. As such, it makes sense to prepare your patients for this trip. Doing so will minimize discomfort, frustration, and anxiety. It may not be fun, but with your efforts to educate your patients, glaucoma treatment can result in a lifetime of enjoying good vision. And, isn’t the scenery one of the highlights of most road trips? OP

David D. Richardson, MD Dr. Richardson is an ophthalmologist practicing in Southern California. He is an adamant believer that successful treatment depends on a strong foundation of patient education. As such, he has authored a book www.Cataract-Book.com and blog www.About-Eyes.com about cataract surgery, as well as a website about glaucoma treatment www.New-Glaucoma-Treatments.com.