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    Glaucoma experiences transformative growth as a subspecialty

    Renaissance features innovative diagnostic and therapeutic tools to improve disease management


    Reviewing compliance issues

    Dr. Singh also addressed areas where further work was needed to improve the care of glaucoma patients, including medication compliance as well as compliance with appointments–the latter being a surrogate for disease surveillance.

    Patients getting their eyes checked regularly is as important as continuing to take their  medications, according to data presented by Dr. Singh and colleagues, including Shan Lin, MD, at San Francisco General Hospital.

    “Only 25% to 50% of people in the United States who have glaucoma know that they have it,” Dr. Singh said. “Many who are under care are noncompliant.”

    While only a small percentage of affected individuals go blind from glaucoma, it is not possible to prospectively separate those who will do well from those who will do poorly. IOP is clearly a risk factor and lowering IOP helps, but there are patients with high IOP who do better than expected and others with low IOP who go blind from glaucomatous disease.

    Regular follow-up is critical to distinguish the few who are destined to do poorly and need aggressive therapy from many others who are at lower risk of vision loss.

    “There is a lot of ‘glaucoma light’ in the offices of ‘suburban’ practitioners, particularly in Caucasian populations,” Dr. Singh said. “Tertiary glaucoma providers, if not careful, can end up living in a bubble where they believe everyone with glaucoma needs very low IOP.”

    Dr. Singh concluded by pointing out that many patients have a false sense of security about taking glaucoma medications if they think that good compliance means they don’t need to see an ophthalmologist on a regular basis.

    “The data from San Francisco General suggests that showing up regularly for appointments is at least equally important,” Dr. Singh said. “Even patients who never miss their medications may continue to show disease progression and need more aggressive intervention, such as laser or surgical therapy. You can’t perform a trabeculectomy for a patient who needs it if they don’t show up.”

    Kuldev Singh, MD, MPH

    e. [email protected]

    This article was adapted from Dr. Singh’s American Glaucoma Society Subspecialty Day Lecture that he delivered during the Glaucoma Subspecialty Day, held prior to the 2017 American Academy of Ophthalmology meeting. Dr. Singh is a consultant for Aerie Pharmaceuticals, Alcon Laboratories, Glaukos, Ivantis, and other pharmaceutical companies.

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