VIDEO: Individualized approach key to monitoring glaucoma progression

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When I'm seeing a patient in my office, there's no one way to determine if the patient's disease is progressing. And I think when I first started, you know, I was under this notion that we would use our visual field machine, our OCT technology to just pick off the progressors one at a time. Now, for me, it's just much more nuanced than that. It's definitely individualized. It has a lot to do with getting to know the patient themselves, understanding how they perform on different tests, understanding their follow-up patterns, their compliance. And so I would say sometimes we escalate treatment because we have proof of progression.

And that might come from OCT or a visual field and a great visual field taker, fairly rare. And sometimes it comes from a risk evaluation. Just knowing that a patient with advanced glaucoma probably can't tolerate a pressure of 21 is a reason to intervene. And, you know, if you wait for progression by the book on visual field for some of these patients, you'll end up intervening too late and it'll cost you. Most of the progression that happens in my practice is a patient who disappears for a year and comes back and their disease is just obviously worse.

And in some of those cases, I wish I had, you know, had to foresight to just intervene when my gut was telling me, you know, their current plan of attack with their glaucoma and compliance and follow up wasn't going to work. And so, you know, the more and more I do this, there's no simple formula. Certainly don't wanna wait for the technology to tell you they're progressing. I think it's okay to look at the patient as a whole, talk to them, understand who they are, you know, what they can tolerate, how committed they are to their topical therapy.

And sometimes you have to intervene ahead of time.Maybe, maybe most of the time we should, because waiting for people to lose vision and then intervening leads to frustration from a patient who's stuck in a place of poor vision.