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Educate patients on glaucoma’s role in quality of life
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What is it we really want for our patients with glaucoma? Intraocular pressures within target range? Stable visual field and optical coherence tomography? A well perfused optic nerve? While all are obviously important, what we really want is patient gratification: A sense – on our patient’s behalf – that we are providing them with a lifetime of clear, comfortable vision.
Unfortunately, for many, winning the glaucoma battle seems anything but gratifying. In short, the daily grind of managing glaucoma simply lacks an immediate, tangible benefit. Maybe it is because treating glaucoma does not result in a detectable improvement in vision. Maybe it is because the eye drops we use are a bit of a hassle, can exacerbate ocular surface disease and often cost a small fortune. Whatever the reason, it is safe to say that while the successfully managed glaucoma patient is relieved, they are also a bit underwhelmed. It is no wonder long-term glaucoma compliance is such a challenge.
When you think about it, optometry is fortunate in that much of what we do results in immediate patient gratification that validates us in the minds of our patients. Whether we are dispensing a child his first pair of eyeglasses, removing an eye patch the day after cataract surgery or placing a bandage lens over a corneal abrasion, patients usually experience a tangible benefit. Immediately. So, it is quite understandable why most associate a visit with the optometrist with gratification. We make them see better, feel better or both.
The challenge in managing glaucoma is that our patients simply lack that immediate gratification. Sure, we can share IOP trends and review disc photos, OCTs and visual fields, but, for many, these are abstract constructs. And they are certainly not the sort of things that translate into clearer, more comfortable vision at the conclusion of their visit. So, in the absence of any immediate benefit, what is the motivation for our patients? What is the one thing we can leverage to ensure patients remain engaged and compliant in their lifelong war against glaucoma? The answer might well lie in quality of life.
Of course, compliance, to varying degrees, is an issue in all chronic disease states. Some conditions, however, ensure compliance. Skip your hypertension, hypothyroid or diabetes medicine long enough and you will probably feel pretty lousy. Other conditions, such as elevated cholesterol and glaucoma are not quite the same. If you skip these medications for a week or two, you are not likely to perceive a difference. This is precisely why patient education and quality of life metrics are a critical part of our treatment strategy.
While our glaucoma patients’ greatest fear is blindness, many realize that well controlled glaucoma rarely results in total blindness. What they do not understand is the impact glaucoma can have on quality of life. That even mild glaucoma can be associated with some degree of visual disability and negatively impact quality of life. That glaucoma can impact everything from night driving to the degree with which we remain physically active to our quality of sleep.
In this month’s Primary Care Optometry News, our feature article, “Clinicians agree quality of life is a vital part of comprehensive glaucoma care”, offers insight into just how glaucoma impacts quality of life – which life skills are affected, how they are measured and why it is so important to share this information with our patients. With a better understanding of glaucoma’s far-reaching implications, patients are likely to take a more active role in its management. In the final analysis, while today’s eye drop is not going to immediately improve vision, it is certainly going to enhance tomorrow’s quality of life.