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    5 things about glaucoma care that frustrate me

    The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

    When I was an optometry student, I couldn’t wait to treat glaucoma. Refractions were cool, but saving people from the biggest “thief of sight” there was—now that was sexy!

    Like the old saying goes, “Be careful what you wish for.”

    Nearly three decades later, 40 percent of my schedule consists of glaucoma or glaucoma suspect patients. Each week, more patients hop onboard the train, jostling for position in the “q3mo FU line” like rush-hour commuters.

    My subspecialist consultants and I have captured and held a lot of ground on the glaucoma battlefront, winning far more often than losing.

    Winning, of course, being defined as “some light at the end of the tunnel up until the day they die.”

    Previously from Dr. Brown: A tale of two state boards

    Still, there are some aspects of glaucoma care that continue to bedevil and frustrate me.  Here are five:

    1. Lowering intraocular pressure (IOP) remains the mainstay of treatment

    For the majority of patients, adequate IOP reduction will halt, or at least slow down, the progression of the disease. Thanks to advances in both medical and surgical treatments, lowering IOP is easier today than it’s ever been.

    But what do you do if a patient is maxed out on meds and/or surgery, and the disease continues to progress?

    We haven’t advanced as far as we’d hoped on the conceptual disease front, and glaucoma remains an optic neuropathy whose precise multifactorial causes continue to elude us.

    Adding more weapons to our treatment belt, like neuroprotection or increased optic nerve perfusion, would be nice. But so far, we don’t have much to show for our efforts at figuring out exactly what this disease is and what to do about it.

    2. We have better topical medications, but compliance remains a problem

    I’m glad it’s not like “the good old days” when the only decent options we had were timolol and pilcocarpine.

    Prostaglandin analogs were a revolutionary development in glaucoma care that saved the sight of millions. From what I read and hear, some new topical meds in the pipeline might be even better.

    Related: Using the extra eyes within your exam room

    But still, drops are only as good as the patient’s willingness and ability to comply.

    And we all know how that one goes.

    It’s a tough sell convincing patients to submit to the ball and chain of daily medication when they’re symptomless—or at least were until they started using the drops that you prescribed that made their eyes turn red and sting like fire.

    Which leads me to my next point…

    Michael Brown, OD, MHS-CL, FAAO
    Dr. Brown has practiced medical optometry in a comanagement center and with the U.S. Department of Veterans Affairs Outpatient Clinic in ...


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