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No cookbook approach to glaucoma management
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![Michael D. DePaolis, OD, FAAO [photo]](/~/media/shared-images/michael-d-depaolis-od-faao.jpg)
I recently had the opportunity to coach my son’s Odyssey of the Mind team. Odyssey of the Mind is a national academic competition in which the team – comprising five to seven classmates – is presented with a problem to solve. The students must conceptualize a solution, which usually involves an engineering principle, an original story and a theatrical production. The team is allowed to spend up to $145 on materials, and their presentation must be no longer than 8 minutes in duration. Competitively, the team’s solution is judged on its creative, functional and artistic merits. Given the competition’s time and budgetary constraints, simplicity reigns supreme.
Striving for simplicity
No doubt, simplicity is a good thing. In every industry, companies strive to provide products that are simple to use. Given how busy our lives are these days, consumers crave simple solutions.
To a certain degree, as optometrists we enjoy simplicity in our professional lives as well. We develop office procedures and protocols to streamline and simplify patient flow. We select certain contact lenses to simplify our fitting efforts. We prescribe certain allergy medications to simplify our patients’ lives. Indeed, we strive for simplicity in every aspect of our professional lives – glaucoma included.
Undoubtedly, the past decade has brought significant advances in glaucoma detection and treatment. Prostaglandin analogs have simplified our lives with efficacious, once-daily dosing. Perimetry advances have resulted in more patient-friendly, reliable visual field testing. Optic nerve imaging technologies now provide us with the means by which to more closely monitor structural changes. Arguably, each of these technologies has contributed to simplifying glaucoma management. However, none of these advances has simplified glaucoma.
Glaucoma: a complex entity
Glaucoma remains a somewhat poorly understood, complex, multifaceted disease entity. While we better understand its pathophysiology, epidemiology, risk factors, diagnosis and treatment options, it is anything but a simple disease. As such, it’s imperative we appreciate its complexity.
In adopting new technologies we do so in the spirit of better understanding the disease to better care for our patients. We should never look at risk analysis (calculators), newer perimeters or optic nerve imaging technology as a singular means by which to definitively diagnose glaucoma. Nor should we consider a specific therapeutic agent as a “cookbook” approach to treatment. It’s just not that simple.
Like all clinical dilemmas, effective glaucoma management requires both technology and astute clinical acumen. Blending the latest technologies with a healthy dose of experience and professional judgment will always yield the best patient outcome. Trying to manage glaucoma with one – but not the other – will just not suffice. It’s that simple.