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Glaucoma specialist offers tips on answering patients’ questions
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ANAHEIM, Calif. – George A. Cioffi, MD, said his list of questions that patients ask about glaucoma is constantly evolving and growing.
Cioffi, the Edward S. Harkness professor and chairman of the department of ophthalmology at Columbia University College of Physicians and Surgeons, ophthalmologist-in-chief at New York-Presbyterian Hospital/Columbia University Medical Center and editor-in-chief of Journal of Glaucoma, addressed attendees here at the Optometric Glaucoma Society meeting, held prior to the American Academy of Optometry meeting.
Cioffi said clinicians need to have an answer when patients ask if they will go blind.
Consider age, life expectancy, disease stage, progression rate and measurement technique, risk of progression, aggressiveness of therapy and definition of visual disability, he said.
“Every patient you see is thinking this, so why not bring it up?” Cioffi said.
The incidence of glaucoma-induced blindness is improving, but it is still not zero, he said.
“We know people can go bilaterally blind from glaucoma,” he continued. “As I’ve practiced longer I’ve become much less cavalier in saying we can take care of this, especially in young patients with bad disease at onset.”
Individual calculators to predict glaucoma risk have been slow to evolve, he said.
“When I started my practice it was a rarity to see patients in their 90s. Now a week doesn’t go by where I don’t see multiple people in their 90s. We look different as a population than we did years ago,” Cioffi added.
Patients will ask if they are getting worse, and the clinician has many ways to assess visual function, Cioffi said.
A series of visual fields can provide event analysis, he said, and can help the clinician determine if the patient is getting worse.
“You have to weigh for yourself – in the context of the patient – what else is going on and know that not all methods in the literature are the same and all are not done in the same fashion,” Cioffi added.
Patients will ask if they have to take drops forever.
Five years ago, Cioffi said he was asked to talk about drug adherence, and he told meeting attendees: “Just wait, because sustained-release medications are coming.”
His prediction was wrong, he said.
“They’ve really been slow to become available,” he said. “Issues of compliance still remain a huge issue for our patients to overcome, and I don’t see a solution coming soon. We don’t really have a great sustained mechanism on the market now, but there are some in trials.”
Cioffi recommended two practices to combat patient compliance. First, explain the importance of the disease and treatment to every patient. Second, reminder calls from a doctor are more effective than downloadable apps.
“If a patient trusts their doctor, they are more likely to be adherent,” he added. – by Abigail Sutton
Reference:
Cioffi GA. Questions glaucoma patients ask. Presented at: Optometric Glaucoma Society annual meeting. November 7-9, 2016. Anaheim, Calif.
Disclosure: Cioffi reported no relevant disclosures.