Subspecialty receives ‘deserved’ attention with Glaucoma Day

The World Cornea Congress met for the first time in conjunction with ASCRS.

Issue: May 15, 2005

ByMary E. Archer, ELS

Bradford J. Shingleton, MD [photo]
Bradford J. Shingleton

WASHINGTON – The American Society of Cataract and Refractive Surgery held its first Glaucoma Day here, with presentations and information devoted exclusively to the diagnosis and medical and surgical treatment of glaucoma.

“This is truly a special event, on this our first Glaucoma Day,” said Bradford J. Shingleton, MD, one of the program directors for the meeting. “We hope this program will whet your appetite for the other glaucoma programs we’ll see during the ASCRS meeting.”

The annual ASCRS meeting has included glaucoma sessions in recent years, but this is the first time the organization has devoted an entire day to the subject, speakers noted.

Presenter Reay H. Brown, MD, said, “I just want to say how incredible it is that there is a Glaucoma Day at ASCRS. I have been a member of the ASCRS Glaucoma Clinical Committee for 9 years, and I never thought something like this would happen. I congratulate ASCRS for giving glaucoma the attention it deserves.”

Communication aids compliance

Good communication between physician and patient is important in improving compliance, according to Stephen A. Obstbaum, MD.

“Physicians need to ensure that patients have an understanding of the disease, and they need to provide clear direction to their patients about taking their medications and coming to their office visits,” Dr. Obstbaum said.

He suggested that physicians work with patients regarding setting treatment goals and that they counsel patients about making and keeping scheduled appointments. Additionally, he said, physicians must stress to patients that if there are barriers to reaching treatment goals, such as the cost of medications, then the patient must address these problems. Similarly, patients’ physical limitations that might interfere with keeping their appointments must be identified and dealt with.

Dr. Obstbaum added that physicians should empower patients “to take an active role in managing their condition.”

Early diagnosis vital

The earlier a patient is diagnosed and treated for glaucoma, the better, according to one clinician.

“The advantages of early diagnosis are that the patient can be treated sooner, which offers improved odds of preventing functional vision loss,” said Kuldev Singh, MD. “The benefits of IOP-lowering therapy have been quantified.”

Dr. Singh said that although early diagnosis does not always mean early treatment, early diagnosis means that the patient’s awareness of the disease will be improved.

“There will be less harm to the patient if progression happens early on in the disease, rather than later,” Dr. Singh said.

He added, however, that there can be potential pitfalls of early diagnosis.

“Patients can be anxious when they learn they have glaucoma. But you need to assure them that if they are diagnosed and treated early then they shouldn’t be anxious,” he said.

When to say “when”

It often takes more than one pressure-lowering drug for patients with glaucoma to achieve their target IOPs, but physicians should be cautious about the number of agents they prescribe, Dr. Singh said in a separate presentation.

“When patients are on many medications, it’s hard to tell which ones are working,” Dr. Singh said.

He noted that there are cost and compliance factors when prescribing multiple drugs.

“After we try a couple of drugs, then we do trabecular surgery, and we don’t want to do filtration surgery because it’s not a great procedure. So you have to try to find what drugs work best,” Dr. Singh said.

Beta-blockers not obsolete

Ophthalmic beta-blockers can still be a cost-effective option for medical treatment of glaucoma in some patients, but other more recently introduced drugs should now be considered as first-line glaucoma therapies, according to one clinician. He said perhaps it is time to “retire” beta-blockers as initial monotherapy.

“Compared with prostaglandin analogues, [ophthalmic beta-blockers] have reduced IOP-lowering efficacy, reduced nocturnal IOP control and reduced efficacy,” said David S. Greenfield, MD.

Dr. Greenfield said there are many good points to beta-blockers, including their “excellent tolerability, their availability without preservatives, their good stability at room temperature, and the fact that they are highly cost effective.” He added that patients who have recently had intraocular surgery or who have had complications from cataract surgery might be good candidates for beta-blockers.

But he suggested that beta-blockers should be “retired” as initial monotherapy. He said that they can cause adverse effects, and the side effects, including respiratory dysfunction, sexual dysfunction and bradycardia, are not readily predictable. Additionally, studies have found that the drugs have inferior nocturnal IOP control, he said.