What is a Glaucoma Specialist?
Chat Highlights
February 6, 2008

On Wednesday, February 6, 2008, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "What is a Glaucoma Specialist".

Moderator:  Welcome back to chat Dr. Pro.  Thank you for joining us.  Tonight our topic is “What is a Glaucoma Specialist?”  What makes a glaucoma specialist?  Is it education, training, experience?

P:  Some of us would answer the question "What is a glaucoma specialist?" with just one word -- a hero. :)

Dr. Pro:  In this field there are different ways to become a glaucoma specialist.  Today most of us take an extra year or two of training after residency.  But there are many ophthalmologists who did not take a fellowship yet specialize in glaucoma either because of personal interest or because they have a patient population with lots of glaucoma.

Moderator:  What does fellowship training consist of, and can you do it anywhere?

Dr. Pro:  The training takes place with preceptors who register themselves with a central registry.  These preceptors are glaucoma specialists who are usually academically affiliated, either as a member of an academic center, or affiliated with one.  These practices see mostly patients with glaucoma and are fairly high volume.

Moderator:  Like Wills Glaucoma Service?

Dr. Pro:  Yes!

P:  What is residency?  Are there residencies in just glaucoma or is it rotation?

Dr. Pro:  Great question!

Residencies take place after medical school.  Medical students pick a speciality at the end of the third year or beginning of forth year of school.  Some residencies are more difficult to obtain than others, but all students get matched to a specific residency, either in internal medicine, psychiatry, surgery, or even ophthalmology.

The different residencies are of different lengths of time.  Some are three years, some five or more.  Ophthalmology is a total of four years.  The first year is an internship, usually in internal medicine or surgery, the next three years are ophthalmology training.

Every residency is organized differently.  Larger programs like Wills typically have rotations, so residents work on the Glaucoma Service at times in their training; smaller programs usually work the glaucoma patients into their clinic, so they may always be managing glaucoma.

P:  What’s a normal day in the life of a glaucoma specialist like?  Is it long and full of surprises?

Dr. Pro:  Well I can speak about my usual day.  I usually start seeing patients from 7:30 to 8:00.  Many of my patients are individuals with moderate to severe glaucoma that I see regularly.  A percentage are those that had surgery.  They need to be seen more frequently after surgery and sometimes there are surprises.  Post-op care can be tough.  The pressure can be too high or too low. I need to be prepared to remove sutures or even reform anterior chambers.

Sometimes the most interesting patients are those that are sent to me for consultation.  Those patients are fun to see because I feel a bit like a detective; I am trying to discover the patient's problem.  Is it an unusual type of glaucoma?

Some patients don't have glaucoma.  It is very satisfying for me to examine a patient and find that they don't have glaucoma.  Maybe they were sent to me for a second opinion; maybe someone started drops years ago and the patient never had glaucoma to begin with.

P:  Do fellowship applicants apply to several centers or just one?

Dr. Pro:  There is a whole process; it's called the match.  Applicants apply to multiple programs.  The programs sort through the applications and invite a number of applicants in interview.  After the interview the programs ranks the applicants and the applicants rank the programs.  A central computer then fits the applicant to the program based on the rankings of the two parties.

P:  Are training and standards similar for glaucoma specialists the world over?

Dr. Pro:  In some respects the specialists are the same.  We all deal with the same problems and read the same literature.  Training is different.  By and large most other countries do not have the organized programs and match process like us.  The extra training that ophthalmologists in other countries take is often more informal.  So the training quality may vary, but there are fantastic glaucoma specialists in other countries.

P:  How does a glaucoma specialist keep up with the newest procedure, knowledge and technology for glaucoma treatment?

Dr. Pro:  Well I try to read the latest studies in journals that impact glaucoma care or surgery.  We also attend various meetings, such as the annual American Academy of Ophthalmology.  There is also an annual glaucoma specialist meeting.  And finally, the Internet has changed things; there is a glaucoma specialist Internet group sponsored by the American Glaucoma Society.  We send each other questions on tough cases and members answer back.

New membership to the American Glaucoma Society is mostly limited to individuals who graduated from fellowship programs.

P:  If a doctor hasn't received specialist training, but has an interest in treating glaucoma patients, in what ways can he learn about treating glaucoma?

Dr. Pro:  Like I mentioned above, all residents see glaucoma patients during residency.  Also all residents are trained in glaucoma surgery.  There is no reason that a doctor with particular interest in glaucoma could not hone his or her skills by keeping abreast of the literature and attending conferences and skills courses (which are offered at meetings).

P:  How can I as a patient assess the surgical skill of a glaucoma specialist?

Dr. Pro:  You can learn how many glaucoma procedures that the doctor performs.  Just like any skill surgeons usually improve with repetition.  Sometimes this information can be obtained from your insurance company.

P:  From an emailer- What would you consider a proper amount of shunt operations a glaucoma specialist should do yearly to qualify as ‘experienced’ or even ‘safe’? (How many do you do each year, if I may ask?)

Dr. Pro:  Well I do at least three a week. I do more trabeculectomies as that is usually the first procedure that I do.  I don't know what a "safe" number would be, but it is probably best to visit surgeons who perform them frequently.

P:  How significant is the number of articles a surgeon has published?

Dr. Pro:  Publications in no way reflect surgical skill. It does indicate whether a doctor has an academic interest.

Moderator:  Dr. Pro, thank you for chatting with us.  See you two weeks!

Dr. Pro:  Goodnight and thank you moderators and all the chat members.

On February 20, Dr. Pro discussed "Glaucoma, What's New?" in the Chat room. Click here for highlights of that meeting.

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