Performing diagnostic testing in any health care practice can be anxiety-provoking for patients, especially when the purpose of the test has not been adequately explained to them. The lack of education provided by the doctor (or staff) can lead to an unpleasant patient experience, which can prompt them to seek their eye care elsewhere. An apprehensive patient may cause inaccurate information to be collected, resulting in the doctor making less effective patient management decisions. A recent study shows significant elevations in IOP due to psychological stress.1
The good news: Optometrists can decrease this patient anxiety, while simultaneously increasing the likelihood of treatment buy-in by educating their glaucoma patients on the purpose of every diagnostic device patients encounter in their practice.
This article provides the patient scripts I have found effective in explaining the purpose of each diagnostic device for glaucoma. (See “Explaining glaucoma first,” below.) Regardless of device type, my experience has taught me that using language that is simple, clear, and reassuring is most effective. If allied health staff perform glaucoma diagnostic testing in your office, they should feel free to amend these scripts to their liking.
Explaining glaucoma first
None of the patient education on the purposes of the individual glaucoma diagnostic devices will be understood, unless the OD first educates on glaucoma itself.
My explanation of glaucoma goes something like this: “Your eyes each have a nerve at the back of them called the optic nerve. It delivers vision from your eye to your brain for your interpretation. The part of the optic nerve that I see looks like a doughnut. My job is to judge how healthy the tissue — the dough of the doughnut— is for each optic nerve. Usually both nerves look identical. If I detect a difference between the nerves or the tissue in one area of the nerve is too thin, my suspicion is raised for a condition called glaucoma. Glaucoma occurs when the optic nerve loses more tissue than is expected with normal aging. It is progressive and often develops without noticeable symptoms, affecting side vision first. Early detection can prevent irreversible vision loss and allow for timely intervention.”
Fundus Camera
“This camera is used to acquire photos of your optic nerve head, which is where visual information exits the eye and travels to the brain for your interpretation. Acquiring photos of the optic nerve head over time aids in detecting any changes to the optic nerve, such as thinning, that could indicate glaucoma.”
Gonioscopy Lens
“This lens allows for the examination of your eye’s internal drainage system. Your eye is always producing fluid to maintain its normal structure. The system that drains the fluid sits right behind where the white part of your eye meets the colored portion. Using mirrors in this lens allows me to see whether that drainage system is open, closed or has any abnormalities, such as narrowing or blockage, that could cause glaucoma.”
Ocular Response Analyzer
“This device measures the elasticity of your cornea, which is the clear surface at the front of your eye. The device uses a gentle puff of air to assess how your eye responds to the force of the air without needing to touch your eye. It is believed the reading predicts how well your entire eye handles pressure, including your optic nerve.”
Optical Coherence Tomographer
“This device is similar to an ultrasound, though it uses light waves instead of sound to provide high-resolution cross-sectional images of your optic nerve, which delivers vision from your eye to your brain for your interpretation, in real time. These cross-sectional images reveal measurements of each area of the optic nerve: top, bottom, left, right, and then the device compares the thickness of your nerve to others your age who do not have glaucoma. As a result, the device aids in detecting tiny changes in optic nerve thickness not visible during a regular eye exam, so glaucoma can be identified and treated early.”
Pachymeter
“This is an instrument that measures the thickness of your cornea, which is the clear surface at the front of your eye. The pachymeter we use employs ultrasound, which bounces back to the device to aid in calculating the thickness of your cornea. This thickness measurement is important because if your cornea is thinner than average, it may increase your risk of developing glaucoma and, thus, require further diagnostic tests for glaucoma.” (NOTE: This patient script can be amended for an optical pachymeter, which employs a highly targeted laser beam to measure corneal thickness.)
Perimeter (Visual Field Test)
“Glaucoma typically affects our peripheral or side vision first, making it difficult to detect any loss until significant. Perimetry, also referred to as a visual field test, aids in detecting early signs of vision loss. If we notice on your visual field printout a cluster of missed points, rather than random ones, it could indicate early changes from glaucoma.”
Tonometer
“This allows me to measure the pressure that is inside your eye. Just like a tire, your eye is inflated, though with fluid, instead of air. When the pressure from this fluid gets too high, it puts you at risk for developing glaucoma.”
Visual Electrophysiology
“Electrophysiology is a non-invasive test that measures how well your optic nerves are working by recording the electrical responses of your retina, the thin layer of tissue at the back of your eye. Electrodes will be placed on the front and back of the head with gel. Once the electrodes are positioned correctly, you will be asked to look at a screen that contains flashing lights or patterns. That’s it. No need to answer any questions or push any buttons.”
Home Monitoring Device
Another avenue to consider in your glaucoma patients are home-monitoring IOP devices, which can be a great tool to measure IOP between visits. We explain that such devices “measure your eye pressure with a soft, disposable probe that lightly touches your eye without using a numbing drop. You might feel a slight tickle or light touch but that is it. The probe measures your eye pressure by determining how quickly it bounces back off your cornea.”
Other Learning Styles
Not all patients comprehend well with auditory information. Therefore, supplementing these scripts with different learning styles (i.e., visual, reading, writing) could be advantageous for patients. For example, a patient who says they learn best through reading/writing would benefit from access to the scripts on the practice website, including them in the new patient packet, or in handouts that detail the purpose of each diagnostic device for glaucoma. Regardless of whether patient scripts are used exclusively or supported by tools related to the other learning styles, it’s imperative patients are educated on the individual diagnostic devices for glaucoma. Doing so quiets their anxiety. Anxiety can lead to inaccurate data gathering for the diagnosis and treatment of glaucoma. OM
Reference
- Ferreira NS, Costa VP, Miranda JF, et al. Psychological Stress and Intraocular Pressure in Glaucoma: A Randomized Controlled Trial. Ophthalmol Glaucoma. 2024;7(6):518-530. doi:10.1016/j.ogla.2024.07.004
