Today, eyecare teams are strained by heavily loaded schedules and stacks of diagnostic images to review. We sometimes forget the compassion we have for patients with ocular disease when we deliver the news.
It is not realistic for patients to be prepared to respond when they are given news of a disease or disorder. Many times, patients are caught off guard at the mention of disease and assume a blank stare as their minds wonder in fear. What questions are they supposed to ask?
Instead of sending these patients home to worry and surf the tidal wave of disaster—the Internet—doctors and staff should be first-line educators. We should be prepared to provide information before patients ask.
If a patient has just been given the diagnosis of glaucoma or currently has glaucoma, stay proactive by providing answers to the questions she might ask.
1. What is glaucoma?
Glaucoma is a group of ocular diseases with various causes that ultimately are associated with progressive optic neuropathy leading to loss of visual function.1
This definition is comprehensive because there are a multitude of causes for glaucoma, not just high intraocular pressure (IOP) and the disease must be progressive in nature, not simply a one-time loss of neural tissue, like in the case of a stroke. High IOP is one of the strongest risk factors for disease;2 therefore, it is a variable that should always monitored.
One of my professors described IOP and glaucoma as water draining through a sink. The eye produces water (aqueous) and escapes from the eye through a drain. A sink works with water flowing from a faucet and draining. If no one turns off the faucet, water builds up in the sink. If there is a problem with the drain, water builds up in the sink. This buildup of water increases pressure just like in a closed system, i.e., the eye.
2. What are the signs and symptoms of glaucoma?
The disease may manifest without any pain or noticeable vision loss. This is why glaucoma has been called the silent thief. In fact, most patients will never experience significant signs or symptoms of glaucoma.
In severe cases of ocular hypertension or when IOP is elevated up to 40 mm Hg or even 60 mm Hg, patients my experience ocular pain, light sensitivity, redness, and headache. One patient with an IOP of 74 mm Hg said, “Doc, please get this rat out of my head.” He was describing the severe head pain that is associated with high IOP.
Angle closure glaucoma may cause blurred vision or vision loss; this may be temporary or permanent. Refer back to the sink analogy. If the drain becomes clogged or closed, the IOP can rise rapidly and cause symptomatic nerve damage.
3. Will I go blind from glaucoma?
To tackle this question, we must first define blindness. The Centers for Disease Control and Prevention (CDC) defines legal blindness as central visual acuity of 20/200 or less in the better eye with the best possible correction and/or a visual field of 20 degrees or less.3 Most studies which look to answer the aforementioned question use the legal blindness criterion.
Based on legal blindness criterion alone, we look to two major studies.4,5 They reported that 12.4 percent and 22 percent, respectively, of patients with glaucoma will go blind in both eyes. Each study looked at a subset of patients from the 1980s and earlier.
Another study looked at patients diagnosed between 1981 and 2000 compared with patients diagnosed between 1965 and 1980 in the same geographic location.6 According to this study, the probability of glaucoma-related blindness in at least one eye at 20 years decreased from 25.8 percent for subjects diagnosed between 1965 and 1980 to 13.5 percent for subjects diagnosed between 1981 and 2000. Better diagnostic equipment and improved medical and surgical treatments have dramatically improved patient outcomes.
What legal blindness does not address is patients’ ability to perform vision-related activities or patients’ quality of life (QoL). A clinician’s ultimate goal is to address patients’ concerns, which usually are centered on improving or at least maintaining their ability to function. Several studies have been developed to better assess these concerns. One investigator found patients with good visual acuity can report unfavorable vision due to decreased visual field and poor contrast sensitivity. This informs us that there are more important factors to people being able to “see” vs. being able to function.7,8