Visiting a Glaucoma Specialist
Chat Highlights
August 19, 2009

On Wednesday, August 19, 2009, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Visiting a Glaucoma Specialist".

Moderator: Tonight our topic is “Visiting a Glaucoma Specialist.” Doctor, what is the difference between an optometrist, ophthalmologist and a glaucoma specialist? Is there a difference in the care I would receive from each?

Dr. Pro: Yes. There is a difference in training.

An optometrist undergoes professional training to become an eye care provider after college. Optometry schools are four years long. They are trained in the relevant sciences and anatomical courses and also in eye care, including training in refraction, contact lens fitting. An optometrist does not have to undergo any kind of residency to practice and can start practicing right out of optometry school.

An ophthalmologist is a graduate of medical school who undergoes a residency in ophthalmology. So an ophthalmologist graduates from college, and then has four years of medical school (with a wide range of courses taught about all fields of medicine). After graduation from medical school a one year internship (usually in internal medicine) is undertaken, and after that three years of ophthalmology training, which includes learning to operate on the eye in the whole range of sub-specialties.

After residency, an ophthalmologist can practice or take a one to two year fellowship in a sub-specialty. Glaucoma is usually a one-year fellowship where more in-depth care of a glaucoma patient is learned and the glaucoma surgical disciplines are mastered.

P: When would you suggest a person see a glaucoma specialist?

Dr. Pro: Most people do not need to see a glaucoma specialist. So someone needing a check-up for glasses should see an optometrist or a general ophthalmologist.

A patient usually sees me for two reasons: usually he or she is sent from the referring optometrist or ophthalmologist due to a concern that the person may need treatment for glaucoma or that the glaucoma is not well controlled; and, some people come to me one their own because they may have a strong family history of glaucoma and they want an evaluation, or they may want a second opinion about the care that they have been receiving from their doctor.

Dr. Pro: Not yet. Optometrists cannot prescribe drops in all states (I do not know about Canada).

In those cases the optometrist would act as more of a screener and refer any questionable cases. Where I practice (PA and NJ), optometrists can dispense drops and do treat glaucoma. I might add that many do a terrific job.

P: I do not know about optometrists prescribing in Canada either-- mine sent me to a glaucoma specialist.

P: How can a person find a glaucoma specialist?

Moderator: Some online resources are http://www.GlaucomaWeb.org
American Glaucoma Society, or http://www.wehsocietey.org
the Wills Eye Alumni Website (search for glaucoma specialists).

Dr. Pro: Thanks.

Dr. Pro: Well, there are two groups again. Those that are referred should ask the referring doctor if he or she should bring along any copies of tests or notes from prior visits. I cannot tell you how many times the patient says that the notes were supposedly mailed, faxed, or whatever. It can help save time and may prevent repeating some tests.

Those that come without a real history of glaucoma or eye care may not have much to bring, but can still find out if other members of the family have glaucoma, and so should learn the family history.

Bring a list of medications you are taking and more importantly, bring the drops that you are taking. This is important because patients often remember the drop by the bottle cap color, but are easily confused about the names. If you bring the drop and tell the technician how you use it or others, it is a big help.

P: Is it helpful to bring another person to take notes and ask questions?

Dr. Pro: Sure, many patients are nervous. I have found many times that I explain a treatment course or options and when I see the patient for a follow-up visit they do not remember a thing I said! Especially when I discuss surgery, which is understandable.

P: What will a glaucoma specialist do during the initial visit?

Dr. Pro: We do a comprehensive exam. We pay close attention to the angle and the nerve in particular, areas in which other eye care providers have less expertise. We often perform tests such as corneal thickness, visual fields, or some kind of optic nerve imaging.

What we are trying to do is get an understanding of this particular individual and his or her risk to either develop glaucoma or have the glaucoma worsen. We then try to lessen that risk with a treatment course. The easy cases are when you are sent a patient with an IOP of 45. The tough cases are the ones where the IOP is controlled and there are mixed signals on testing (i.e. the visual field looks stable but the nerve scans may be getting worse).

P: Which exams should a glaucoma specialist perform during the first visit?

Dr. Pro: Well, like I said we look at the angle and nerve. We check the IOP and usually perform a dilated exam. Maybe the most important test is the visual field. The type of disc imaging depends on the patient. In some situations the OCT is valuable, but in others a color disc photo is very useful.

P: I see my glaucoma specialist every six months. Is it necessary to also see a general ophthalmologist, or will the glaucoma specialist spot other, non-glaucoma problems?

Dr. Pro: Well, we can usually spot other problems, but not all glaucoma specialists are the same. Some are comfortable treating or monitoring a wide variety of problems, and others are more narrowly focused. If in doubt, just ask your glaucoma specialist if you should also be seeing a comprehensive ophthalmologist. Many of my patients maintain an optometrist or comprehensive ophthalmologist for glasses or see a specialist for other conditions like treating macular disease.

Moderator: Thank you Dr Pro, that is all the time we have.

Dr. Pro: You are welcome! Good night.

On September 2, Dr. Pro discussed "Inflammation and Glaucoma" in the Chat room. Click here for highlights of that meeting.

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