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    Why aren’t ODs referring to each other?

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

    A 55-year-old male patient presents to your office. The patient has a family history of glaucoma. Both his father and grandfather had glaucoma.

    The patient is not taking any medications and doesn’t have any known allergies. He is a low myope OU and presbyopic. He has a slight asymmetry in his cup-to-disc ratio with 0.4 OD and 0.6 OS.

    There are no signs of neural rim thinning. There are no signs of Krukenburg spindles or pseudoexfoliation syndrome. Angle estimation is open with Van Herrick Angle Depth Estimation. The patient’s’ intraocular pressures (IOP) are OD 23 mm Hg and OS 25 mm Hg at 9:30am.

    All other ocular findings were unremarkable.

    What is the next step?

    Previously from Dr. Brujic and Dr. Kading: Optimize patients’ CL experience by avoiding 3 bad habits

    Using the right technology

    If you are in an office that is equipped with the appropriate diagnostic technologies, you would then educate the patient on the findings and help the patient better understand glaucoma. A conversation would ideally occur in which the patient’s questions and concerns would be answered followed by appropriate diagnostic testing.

    This would typically include gonioscopy to assess the angles in all four quadrants, an optical coherence tomography (OCT) assessment of the optic nerve including nerve fiber layer thickness, and a measurement of ganglion cell complex thickness. OCT angle measurements may provide additional diagnostic value.

    Since the Ocular Hypertensive Treatment Study,1 central corneal thickness measurements have become the standard of care. This is due to the increased risk patients with thinner corneas who are also ocular hypertensive have in developing glaucoma over a five-year time period.

    Mile Brujic, OD, FAAO
    Dr. Mile Brujic practices in Bowling Green, OH. He also owns Optometric Insights, a service providing career coaching to optometrists.
    David Kading, OD, FAAO, FCLSA
    Dr. Kading owns a two-location, three-doctor practice in Seattle. He specializes in dry eye and contact lenses with an emphasis on ...

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