When Glaucoma Specialists Meet
Chat Highlights
April 7, 2004

Norma Devine, Editor

On Wednesday, April 7, 2004, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "When Glaucoma Specialists Meet."

Moderator:  Tonight's topic is "When Glaucoma Specialists Meet." 

P:  How important is it to attend meetings like the AGS (American Glaucoma Society)? 

Dr. Rick Wilson:  I'm biased, but I think such meetings are indispensable for the exchange of information about new research, new techniques, tips on surgical procedures that are learned in lectures, or just chatting in the hall about patients' problems. 

P:  Do the AGS meetings attract doctors from around the world?

Dr. Rick Wilson:  Since AGS is the American Glaucoma Society,  we mainly have ophthalmologists from the U.S. and Canada.  We also have doctors trained in the U.S., so some come from Australia, New Zealand, Europe, and South America.  This is not in relation to your question, but I do think glaucoma specialists are a breed apart.  Your glaucoma beats you down, but it also beats us down and keeps us humble.

Moderator:  What do you talk about when you get together?

Dr. Rick Wilson:  We usually talk about complications and problem patients, the ones that make us lose sleep at night.

Moderator:  How do you think that differs from what other eye surgeons talk about?

Dr. Rick Wilson:  When cataract surgeons get together they talk about the last 2,000 cataracts they did in 12 minutes without complications.  Retina doctors talk about how they can take a piece of retina from here and put it over here and get it to stay flat.  They don't mention that the patient can only count fingers at six inches. 

P:  Do sales representatives from drug companies and industry attend the meetings?  

Dr. Rick Wilson:  We do have representatives from industry attend the meetings and exhibit their latest medications, testing machines, etc.  They are not usually allowed in the academic meeting, unless they are research scientists.

P:  On AGS website, I saw the terms "abstracts" and "posters."  Would you explain what they are?

Dr. Rick Wilson:  Abstracts are summaries of the talks.  Posters are brief papers that are illustrated on a poster board.  The author is often present to explain the study to interested passersby.

P:  Are there groups that meet for subspecialties in glaucoma? 

Dr. Rick Wilson:  Yes.  Those interested in perimetry, circulation, or a particular multi-center study will often get together.

P:  Do abstracts have to be published in order to be presented?

Dr. Rick Wilson:  No.  The papers must be selected to be presented at the meeting.  They cannot be published before the meeting; no one would want to listen to old news.

P:  Is attendance compulsory for members to maintain standing in the Association?

Dr. Rick Wilson:  If my memory serves, members must attend one out of three years.  

P:  How many glaucoma specialists attend the AGS meeting?  Is the AGS meeting the "big" one?

Dr. Rick Wilson:  It is the big one for us.  Often as many as 400 glaucoma specialists attend.  More would attend the American Academy of Ophthalmology meeting as it is the main meeting in the world for academic ophthalmologists, as well as general ophthalmologists.

P:  I think these meetings are very important.  I don't know where I would be if my glaucoma specialist wasn't so up on things.

Dr. Rick Wilson:  There is an increasing pressure on doctors to attend continuing medical education courses and to be recertified with a test.  I am "grandfathered" in, but will volunteer to take the test next year.  It is difficult because I don't practice general ophthalmology, only glaucoma, and tend to forget some things like crossed eyes.  I have made no attempt to remember how much to move an eye muscle to get the eye to straighten out, since it didn't interest me and I haven't performed such an operation since 1978.  But now I need to know enough to pass this general test.

P:  My ophthalmologist is not a glaucoma specialist.  Is he missing out on a lot of important information about glaucoma,  or can he catch up with you specialists by reading journals?

Dr. Rick Wilson:  I have a stack of glaucoma literature 18 inches high that I need to get to.  If I have trouble keeping on top of the glaucoma literature, a general ophthalmologist who has to keep up with everything will have to short the glaucoma.

P:  What are "clinical pearls" in reference to these meetings?

Dr. Rick Wilson:  Tricks or techniques to get lower pressures with surgery and avoid complications.

P:  Glaucoma patients often say that no two glaucoma specialists seem to agree about much.  Is there justification for that statement?  

Dr. Rick Wilson:  Yes.  Unless there is one clearly superior way to treat a particular problem or disease, then there is more than one way to skin the cat.  Several approaches may be equally satisfactory.  Each glaucoma specialist uses the approach that seems to work the best for her or him.

P:  Do doctors wait for meetings to release the results of their studies or research?

Dr. Rick Wilson:  Usually we rush to get things prepared in time for a meeting, and then publish it.  We may publish other studies in between meetings.

P:  How do you define a glaucoma specialist? Do you know any  glaucoma specialist(s) in Romania?

Dr. Rick Wilson:  A glaucoma specialist is a doctor who concentrates on the treatment of glaucoma.  He or she usually has had a glaucoma fellowship in glaucoma of a year or two after ophthalmology residency.  I don't know a glaucoma specialist in Romania, but I can look on the Internet to see who is listed. 

P:  The American Glaucoma Society maintains a web page that lists glaucoma specialist members of the AGS in the United States and a few other countries.  Is there an international glaucoma society?

Dr. Rick Wilson:  There is an international glaucoma meeting, but not really an international glaucoma society. There is a nascent Association of International Glaucoma Societies that I hope will morph into an international glaucoma society.

P:  Do these meetings (like the AGS) offer education credits for doctors?

Dr. Rick Wilson:  Yes.

P:  What, besides an examination with the slit lamp, tonometer, and visual field test, could confirm or rule out the presence of early open-angle glaucoma?  

Dr. Rick Wilson:  An excellent doctor with a good view of the optic nerve is still the best way to diagnose open-angle glaucoma.  The HRT (Heidelberg Retinal Tomograph), OCT (Optical Coherence Tomography) and GDx (Nerve Fiber Analyzer) are getting better, but are really suited for following the nerve and nerve fiber layer for change (progression), rather than for diagnosing glaucoma.

P:  Why aren't all American glaucoma specialists listed on the AGS website?

Dr. Rick Wilson:  At present, a doctor must be out of fellowship for four years, must have published three papers,  and more than 50% of his or her practice must consist of treating glaucoma patients.  Not all glaucoma specialists meet those requirements.

P:  That might explain why my specialist isn't listed yet.

P:  Does the AAO meeting give general ophthalmologists the opportunity to see and hear specialists?  I would imagine it would help them to learn about the latest findings.

Dr. Rick Wilson:  Yes, it does, although it is like a 15-ring circus with lectures, videos, and courses going on all over the place at the same time.

P:  What's the difference between an academic ophthalmologist and a general ophthalmologist?

Dr. Rick Wilson:  Academic ophthalmologists teach residents, often do research, and are usually sent the most difficult problems.  Most of the time, academic ophthalmologists are specialists, not generalists.

Dr. Rick Wilson:  Everyone have a great week.  Will see you next Wednesday.  Same time.  Same place.

End of highlights for April 7, 2004.

On April 14, Dr. Wilson discussed "Post-cataract Surgery Issues for Glaucoma Patients" in the Chat room. Click here for highlights of that meeting.

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