Learning about the “silent thief of sight” in optometry school is much different than encountering your first glaucoma patient after graduation. With that said, and this issue’s theme, this month’s column focuses on what I feel the new graduate should keep in mind about glaucoma.

Anyone can develop it
The sight-stealing disease does not discriminate. In fact, although rare, we know that pediatric glaucoma exists.

A resource I recently learned about from a colleague is the Ocular Hypertension to Glaucoma Risk Calculator (https://oil.wilmer.jhu.edu/risk/). By entering information from our individual patient’s testing, the calculator estimates the five-year risk of an individual with ocular hypertension developing primary open-angle glaucoma, if the patient meets the demographic data of patients within the ocular hypertension treatment study.

Each patient is a puzzle
To properly diagnosis and manage our glaucoma patients, we must add up the results from the multiple testing options and put the results in the context of the optic nerve.

A 62-year-old white male I saw earlier this year presented to my office for an annual eye exam, “just needing new glasses.”
Upon pre-testing, his IOPs were 33 mmHg OD and 55 mmHg OS, with handheld tonometry, and
3 mmHg higher when confirmed with Goldman tonometry. His pachymetry was normal, and retinal nerve fiber layer (RNFL) and ganglion cell complex were also normal upon OCT testing. Visual field (VF) testing was also normal. His angles were quite narrow. I was concerned. He didn’t fit the typical angle-closure patient characteristics (no pain, eyes white and quiet, etc). Turns out, the patient has ocular hypertension. His IOPs returned to normal with medication.

One test does not fit all
Testing that works well and helps you diagnose one patient may not be the best strategy of testing that works on another patient. Some patients may require multiple tests and multiple follow-up appointments.

I had a patient recently who had a very concerning VF defect that did not correlate with RNFL defects. After repeating her VFs, we found the first one to be completely inaccurate.

Patient reliability can vary greatly and is, therefore, always something good to keep in mind.

Stay current on treatments
Gone are the days of treating patients with drop 1, drop 2, drop 3, and then surgery when the drop options have been depleted. Wonderful eye drop options exist, more are in development, and surgical options, such as selective laser trabeculoplasty and microinvasive glaucoma surgery, can be mixed and matched at different disease stages.

Read this magazine, peer-reviewed journals, newsletters, and attend eye care-related meetings to stay current on treatments to help each patient.

Find a glaucoma guru
The adage, “we don’t know what we don’t know,” easily applies to glaucoma. For this reason, enlist a glaucoma guru to whom you can bounce off cases and meet with periodically. Maybe this person is local and/or has diagnostic equipment you don’t. Or, perhaps you were impressed by one of their lectures at a recent eye care-related meeting. The point is to reach out and forge this friendship, as doing so will provide both professional and personal fulfilment. OM

DR. O’BRIEN is the owner and optometrist at Denver Eye Care & Eyewear Gallery, in Denver, N.C. She is heavily involved with student programming through private practice clubs and the Vision Source NEXT program, and works with iCare Advisors as a consultant to help others pursue their cold-start private practice dreams.