Page 26 - 21st Century Perspective - Glaucoma Supplement
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Preventing Vision Loss: Importance of Optometry
Optometry is a profession dedicated to preserving and enhancing vision. Therefore, there may be no
higher calling for optometrists than to prevent vision compromise or loss in people who are at risk
for, or who have glaucoma.
As reported in the November 2017 issue of Primary Care Optometry News, American Optometric
Association President Christopher J. Quinn, OD, addressed the Optometric Glaucoma Society
during its meeting held just before the 2017 American Academy of Optometry meeting in Chicago,
and made quite clear that “Glaucoma is a serious public health problem in this country. Optometry is
the solution … Glaucoma is a disease that this profession should own.”
Robert D. Fechtner, MD, concurred, stating “There’s no way to take care of this epidemic, except
through partnership. The optometric portion of care is the largest portion."
Although modulating IOP (no medications are available yet to “treat" glaucoma), is reasonably
straightforward, the greatest challenge is in making the diagnosis. This challenge includes not
missing glaucomatous optic neuropathy in patients presenting with IOPs in the normal range.
Historically, IOP has been the rudder steering further workup. This is a grossly inadequate
algorithmic approach, because a large subset of glaucoma or glaucoma suspect patients do not
present with elevated IOP. Medicolegal surveillance clearly shows that, by far, the most common
reason doctors of optometry are successfully sued is for failure to diagnose. Virtually 100% of such
cases could be avoided if greater attention is paid to the nuanced study of the optic nerve head.
Complicating this situation is the realization that many people experience their highest IOP outside
of traditional office hours. Therefore technology, such as the Icare HOME tonometer may facilitate
our ability to uncover missed ocular hypertension patients.
Rather than the IOP being the finding that causes us to pursue a comprehensive glaucoma
evaluation, our diagnostic approach needs to quickly shift to an attentive study of the optic nerve
head. This is best accomplished with a magnified stereoscopic evaluation of this tissue.
Therapeutic management of IOP
Considering that the only known approach to halting or slowing optic nerve atrophy is reducing IOP,
we want to focus on the issue of critical medical management. As is reasonably well understood, the
physiologic internal ocular plumbing is quite simple: aqueous humor is produced by the
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