Recently, I received a progress note from a glaucoma surgeon concerning a patient whom he and I share. The patient is a 58-year-old African-American female with a longstanding history of primary open-angle glaucoma.
With the advent of electronic health records, it is now easier than ever to keep up with what medications a patient is actually taking, and (especially in the arena of glaucoma) the several classes of medications, such as steroids, beta blockers, and antihistamines, that can influence how patients’ eyes behave. With this in mind, I had a patient come in the other day with an interesting question regarding her intraocular pressure (IOP).
Congenital anomalies, angle closure, and juvenile open-angle glaucoma aside, it can be generally agreed upon that glaucoma tends to be a disease of relatively older persons. This rings especially true in the arena of normal-tension glaucoma in which intraocular pressure (IOP) may play less of a causative role compared to vascular and hemodynamic dysfunction.
At the completion of the examination, I was getting ready to walk her up to the front when she stopped me and said she had a very serious question. We both sat down, and she asked me how long she had before she went blind because her mother went blind from glaucoma before seeking ophthalmic care.
Not very long ago, a 55-year-old African-American female presented with complaints of redness in her right eye for one week’s duration with mild discomfort. Medical history was significant for arterial hypertension, which was reportedly controlled with an oral beta blocker.
With that in mind, there are several aspects of my own EHR software that I really appreciate over paper charts. Besides the fact that I can actually read what I wrote (or typed), one thing that I particularly enjoy is the fact that I am able to consistently look at a new patient’s optic nerves without knowing his or her intraocular pressure (IOP) values beforehand.
For years now, there has been considerable evidence indicating that glaucoma should be considered a neurological disease and not an entity isolated to the eyes alone. Perhaps the most compelling evidence for such a characterization is the fact that the retinal ganglion cells affected by glaucoma do not synapse until they arrive at the midbrain (specifically, the lateral geniculate nucleus).