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Benjamin P. Casella, OD, FAAO
Dr. Casella, a 2007 graduate of University of Alabama at Birmingham School of Optometry, practices in Augusta, GA, with his father in his grandfather's practice.
Rethinking prostaglandin analogs side effects
I recently came across a journal publication describing a patient with Crohn’s disease and open-angle glaucoma.1 Essentially, the patient’s treatment with topical latanoprost was associated with an exacerbation of her Crohn’s disease.
Is the ISNT rule helpful?
Are there any absolute laws for glaucoma other than the broad few that govern its definition? Well, maybe not. Think about it. The word “typically” precedes much of what we say when we describe glaucoma outside of its definition. An example would be the fact that visual field loss is typically nasal at first. However, a temporal wedge defect may, at times, be the first defect to become manifest.
The neurology of glaucoma
The next time I see a patient with diabetic retinopathy who seems to be nonchalant or blasé regarding his condition, I’m going to say something along the lines of this: “Mr._______, this leaking of your blood vessels is going on elsewhere in your body, but your eyes just happen to be the only place we can see it without being invasive.”
Maximum medical therapy in glaucoma
A few months ago, I began to see what may be a little more progression on her OCT studies. I’m fairly confident that we’re in a good place right now as far as compliance is concerned, and I’m entering a crossroads with her regarding possibly adding therapy vs. getting a consult for a laser procedure, such as selective laser trabeculoplasty (SLT), vs. getting a cataract consult.
ODs must be responsible for public misconception about optometry
I didn’t get up screaming. I didn’t hurl my computer across the room. I didn’t even let my inferiority complex show through the emotions I was feeling. Instead, I calmly and politely wrote a short letter to the news organization explaining what optometrists are, and that glaucoma was what I, as an optometrist, spent most of my days dealing with.
7 pearls to guide glaucoma treatment
In an effort to take the best care of my glaucoma patients that I can, I’ve made use of a few pearls that have helped me to keep calm in the face of the beast that is glaucoma.
Big optic cups
Cup-to-disc ratio is certainly important in evaluating a patient for glaucoma. However, it’s not the only clinical measurement to consider. Evaluate the overall size of optic discs. Optic disc hemorrhages may have corresponding retinal nerve fiber defects. Subtle areas of parapapillary atrophy are another indicator for the possible presence of glaucoma. Look beyond the optic disc cupping to gather additional information.
You are smarter than your OCT
Spectral domain optical coherence tomography (SD-OCT) is a landmark diagnostic technology. Clinicians should keep top of mind that SD-OCTs, as sophisticated as they are, do not think or interpret. That is solely the job of the clinician. In addition, visually assessing the retinal nerve fiber layer (RNFL) directly can yield more qualitative information than SD-OCT scans provide.


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