Common Mistakes Patients Make
Chat Highlights
Wednesday, February 21, 2007

On Wednesday, February 21, 2007, Dr. Michael James Pro a glaucoma specialist at Wills, and the glaucoma chat group discussed "Common Mistakes Patients Make."

Moderator:  Tonight's topic is about common mistakes patients make.  Which are the most common?

Dr. Pro:  I gave a talk about that recently.  I divided the mistakes into those before glaucoma diagnosis and those after.  The mistakes before are generally (1) most people do not understand their own risk for glaucoma, such as family history of glaucoma, (2) high myopia, (3) steroid use, and (4) race.

Moderator:  That means they don't get checked as often as they should, until it's too late?

Dr. Pro:  Right.  That is often tragic, because in some people the disease is advanced by the time they are diagnosed. Of course, glaucoma is usually asymptomatic, (that is, has no symptoms) and you don't lose vision until it is advanced.  That’s why it is important to know your risk factors.  An important one is being of African descent.  The incidence of glaucoma in people of African descent is about three times that of people of European descent.  I think patient education is essential.

Moderator:  What about after a diagnosis of glaucoma has been made?

Dr. Pro:  The biggest problem is compliance with drops and the treatment plan.  A few patients are "in denial".  They don't feel symptoms of glaucoma, and thus don't bother to take the drops. But for others, the drops are difficult to instill, or they forget to take the drops, or put them in the wrong eye.  Many patients don't really know what glaucoma is, confusing it with cataracts or other eye problems.  They don't really understand the reason for using the eyedrops as instructed.  After all, the drops don't immediately help the vision. In some patients, the drops are irritating, sting, and burn.

Moderator:  Alcon Inc. recently came out with a compliance monitor.  The dropper bottle is placed in the monitor and gives a warning when the next drop should be taken.  It also records whenever the lever to release a drop is squeezed. When the patient returns to the doctor, he or she brings the monitor along.  The doctor puts the monitor in a holder and downloads data to a computer about each time the patient took the medication.  That provides a complete record of the patient's compliance with instructions.

Dr. Pro:  Some patients in the Glaucoma Service use the Travatan dosing aid.  It is easier for some patients to use, because the holder is larger and makes instilling the drop easier.  Also, at each visit a read-out is generated, and the doctor knows if the patient is compliant with the drops and knows when the patient took the drops.

P:    How much do those medication monitors cost?

Dr. Pro:  I don't know.  Alcon gave out a few on a trial basis. I don't think I can prescribe them yet.

P:  Are the mistakes we baby boomers make different from those made by our parents?

Dr. Pro:  I think baby boomers, in general, are better informed about medical issues.  But, to my knowledge, there are no studies on compliance that compare one generation to another. All people are prone to forgetfulness when they have several medications and medical problems.

P:  According to a recent study commissioned by the U.S. Dept. of Health and Human  Services, many patients don't check the source and date of the medical advice they find online.  Do you recommend reliable sources of information online to patients?

Dr. Pro:  Good point.  For instance, if you “Google” "glaucoma," you are bound to get many different sites.  In general, it can be tough to know.  Patients should try to use government-sponsored sites and should even learn to use the scientific literature by getting familiar with PUBMED.gov.  Those are mostly peer-reviewed journals.  Of course, this chat room, where a glaucoma specialist answers patients’ questions, is a good source of information.

P:  If you "Google" glaucoma, you get 556,000 hits.

Dr. Pro:  Wow!

P:  So we can say that lack of education and awareness lead to patient mistakes, both before and after diagnosis, that non-compliance with treatment is a mistake, as is depending on unreliable information. Any others?

Dr. Pro:  Well, patients should know their own medical history.  For instance, if you once had laser surgery (SLT or ALT), or if you tried a specific drop in the past that didn't work, it's good to keep a brief journal and a log of the medications.

Moderator:  I'm always surprised when I hear people say they are taking medications, but have no idea what they are for.

Dr. Pro:  Right.

Moderator:  Many glaucoma patients, when first diagnosed, are hoping to be cured quickly. Can you comment on that?

Dr. Pro:  Glaucoma is a chronic condition.  It does not go away, but it can be controlled.  For example, a person with a narrow angle, but a healthy nerve, can have a laser iridotomy and may never need drops or develop glaucoma.  Some people with early glaucoma or ocular hypertension with a healthy nerve may get a laser trabeculoplasty (SLT or ALT) and remain drop-free for years.  The patients I care for are usually sent to me with moderate to advanced glaucoma.  They need to be treated for the rest of their lives.

P:  Many patients also assume that glaucoma treatment will improve their vision.  But that seldom occurs, does it?

Dr. Pro:  No, it doesn’t. I tell all my patients that my treatment will not improve the vision, especially before surgery.

P:  My doctor uses very simple language to talk to me and, I suppose, to his other patients, too. I sometimes wind up being confused.  For example, I don’t know what he meant by "window shade".  I want to tell him that it's okay to use the medical terms, but I'm afraid that he will be offended.  Any suggestions?

Dr. Pro:  I think you should ask him to use the medical term, and ask him to explain it if you don't understand.  I sometimes use simple terms to help patients understand, because many patients do not know the medical jargon and are afraid to ask questions for fear of sounding uninformed.

P:  I urge glaucoma patients anywhere in the world to ask their eye docs to check out the wealth of information on this Glaucoma Service Foundation Web site, including the archives of the doctor-moderated chats.  (Making you world famous, Dr. Pro.)

Dr. Pro:  No autographs, please.

Moderator:  Thank you, Dr. Pro. You are terrific.  We appreciate your taking the time tonight to share your knowledge with us again.

On March 7, Dr. Pro discussed "Cataracts and the Glaucoma Patient" in the Chat room. Click here for highlights of that meeting.

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