Wills Glaucoma Service Foundation Lighthouse

AN UPSTATE MEDICAL PRACTICE

Lorenzo Pecora, MD

1. Objective

" To comment on what is unique in my setting” and “how that has caused problems as well as created opportunities”.

Good communication, an important tool in the management of patients with glaucoma.

2. Description of my practice

- advantages:

Our practice retains a family atmosphere

Patients are very cooperative

The possibility to help people with severe visual disabilities

A place in the community to express my feelings and ideas.

Lot of work to do: create a glaucoma support group, teaching students, etc.

Good interaction with other specialists

- difficulties:

Resistance (from my partners) to modified the way to work

Management of the office. Find people with the will to work

Dealing with the advertising campaign of others doctors

3. Special considerations in patients with glaucoma

Glaucoma is a chronic disease, as such requires long treatment and follow up. I think it is important we must get to know our patients, and understand their lifestyle and goals, and try not to modify their lives in such a way that it is no longer pleasurable to live.
Merely giving a patient a diagnosis of glaucoma obviously affects his quality of life, as more than 80% of patients reported feelings like anxiety, depression or fear of going blind when being told about their disease (1).
Most doctors focus the “success of treatment” in lower IOP levels and avoid progression of visual field defects.

4. Why good communication is crucial

a) Communication plays an important role in helping glaucoma patients understand their disease and learn how to manage it over their lifetime.

b) Important factor in compliance with treatment and follow up visits:

In the study of Taylor et al, “Causes of non-compliance with drug regimens in glaucoma patients”, patients manifested that they would like their physicians to teach them how to instill their eye drops, tell them about new/alternate medications and procedures as they become available, and offer new ways to make their regimen easier (2).
The most common reasons patients gave for not keeping follow-up visits were the perception that their eye problem was "not serious enough," the cost of examinations, and that the doctor did not tell them to come back (3).

c) In a study about the impact of glaucoma on the quality of life of patients. Odberg et al states that patients preferred to receive their information personally and orally. Nearly all the patients preferred to be informed by their eye specialist (1). We are not only technicians taking measurements. We are persons treating persons, feelings and experiences. Feelings and experiences concerning visual tasks, treatment, information and care should be considered.

5. Conclusion

There is a whole universe in each patient. We should open our mind and heart to receive what they offer us every day.

6. References

1. Odberg T, Jakobsen JE, Hultgren SJ, Halseide R. The impact of glaucoma on the quality of life of patients in Norway. I Results from a self-administered questionnaire. Acta Ophthalmol. Scand. 2001: 79: 116–120.

2. Taylor SA, Galbraith SM, Mills RP. Causes of non-compliance with drug regimens in glaucoma patients: a qualitative study. J Ocul Pharmacol Ther. 2002 Oct;18(5):401-9.

3. Kosoko O, Quigley HA, Vitale S, Enger C, Kerrigan L, Tielsch JM. Risk factors for noncompliance with glaucoma follow-up visits in a residents' eye clinic. Ophthalmology. 1998;105(11):2105-11.

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