As we launch into 2024, and in realizing that being a balanced, objective decision-maker is a core skill related to diagnosing and managing glaucoma, let’s choose to be more decisive in our care of this disease. To achieve this, I invite you to consider the OODA Loop1 as shown below. (The OODA Loop — observe, orient, decide, act — was developed by Col. John Boyd of the United States Air Force to help pilots make quick, life-saving decisions under pressure.)
Based on our clinical observations, what are our concerns? More specifically, what are the clinical findings, and do they correlate? Are additional ancillary tests reliable, and do they suggest glaucomatous development or progression?
To maximize these observation opportunities, we must gather reliable, correlating, and sufficient data. Because good decisions come from good data, this foundational step is a dynamic process in the decision process:
“Mr. Jones, to help increase certainty in your diagnosis, and to ensure these tests are providing the reliable information needed in the context of your optic nerve evaluation today, let’s recheck your visual field in a few weeks…”
Based on our observations and what we know, what do the clinical findings mean for the patient? Good data, collected from careful testing, gives us clinical context regarding both the stage and the stability of the patient’s glaucoma:
“Mr. Jones, by repeating the visual field test, I can use the additional reliable information to confirm that your suspected disease progression correlates with our optic nerve evaluation and suggests that your IOP levels may not be at a safe target range…”
Now, we are prepared and primed to make an evidence-based, mutualistic decision with the patient. This provider-patient partnership enhances adherence to any future appointments and treatments, though must be done clearly and without hesitation; all with the goal of preventing functional vision loss and preserving quality of life:
“Mr. Jones, to help prevent further progression and related irreversible loss of vision, we need to lower your IOP levels a few more points. To do this, there are some options that would be good to consider… Which of these do you think would be best for you?”
Next, let’s act selflessly and sufficiently. This means recommending the treatment that is sufficient to prevent further functional vision loss. Actionable data and clinical context, integrated with individual patient preferences, supports timely action.
“Mr. Jones, based on your past testing and today’s results, I think ______ is an excellent way to further prevent your glaucoma from progressing. Let’s talk a little more about it and what to expect…”
Stay in the loop in 2024
If our goal is to prevent functional vision loss from glaucoma while preserving quality of life, we must strive to make good daily decisions based on careful, contextual clinical observations, and then execute them selflessly and sufficiently. Happy New Year! OM
- Binda Zane E. Effective decision-making : How to make better decisions under uncertainty and pressure. 2016.
DR. LIFFERTH is clinical editor of Optometric Management. He practices at Center for Sight, is a member of the Optometric Glaucoma Society, and a Glaucoma Diplomate of the American Academy of Optometry. For additional glaucoma cases, you can also follow Dr. Lifferth on his Instagram account: glaucomaqd. Email him at email@example.com.