Page 23 - 21st Century Perspective - Glaucoma Supplement

Then, there is the reverse monocular discontinuation trial. Americans are on the move — mostly
from colder to warmer climates. As such, we see an increase of patients who have been previously
treated for glaucoma by other eye doctors whose level of expertise is unknown to us. Depending on
the patients’ abilities to describe their medical history, evaluation and care, and most importantly, the
anatomic status of the optic nerves, presenting IOP and current eye drops, we normally ask them to

discontinue their eye drops and allow us to recheck their IOP in 3 to 4 weeks. We also ask patients
to sign a records release form so that we can obtain their previous medical records and thereby
more comprehensively ascertain what has and has not been done in the past. We often find a need
to restart the drops, but now we have a better idea of the patient’s untreated baseline IOP. However,
in about 25% of these patients, we find no need to continue the drop(s), as either the drop(s) were
not working, or the patient was simply being treated for disease they did not have.

Glaucoma is a disease for which optimum management is predicated upon great attention to detail;
critical, dynamic thought is always in play.

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