Keeping an Eye on Your Glaucoma
Chat Highlights – May 1, 2013 Guest Speaker
Dr. Anand Mantravadi
Lorraine Miller, Editor, Chat Topic Researcher
Moderator: Our topic is “Keeping an Eye on Your Glaucoma” with your host Dr. Anand Mantravadi from Wills Eye. Welcome, Doctor!
P: With a diagnosis of glaucoma, what can a patient do to better prepare for an office visit with their doctor?
Dr. Mantravadi: For a patient visiting their doctor for the first time, some helpful information to take to the appointment would be knowledge of prior medicines used, history of allergies to medicines, and knowledge of prior eye pressures. During follow-up visits, a record of what one is using and how they are using the drops would be helpful.
P: Optometrists, ophthalmologists and specialists all see glaucoma patients. How should a person with a glaucoma diagnosis decide which type of doctor they need?
Dr. Mantravadi: It depends on training and experience. Optometrists are not surgeons. They can handle medical glaucoma with variable levels of comfort and experience. Ophthalmologists are trained in medical and surgical management of eye disease. Many can perform glaucoma surgery and use lasers. A glaucoma specialist has spent additional training in surgical management and cases of all complexities.
P: What type of problem should a patient experience to constitute calling your office between visits?
Dr. Mantravadi: Patients call for many reasons from minor to serious issues.
P: Can you explain what RSVP stands for and whether this would warrant a call to the doctor?
Dr. Mantravadi: RSVP is short hand for “redness,” “sensitivity to light,” “decreased vision,” and “pain”. This is a quick way to remember the signs and symptoms of an infection, particularly a post-operative infection. We recommend patients notify their physician immediately if this occurs.
P: Is the level of care different with each type of professional? Can an optometrist order medications and tests? Can they follow more difficult glaucoma?
Dr. Mantravadi: Optometrists are afforded the ability to provide medical care of variable levels. Ophthalmologists are trained to provide medical and surgical care for eyes of variable levels. Glaucoma specialists can provide medical and surgical care of all complexities.
P: Apart from controlling intraocular pressure, exercising, maintaining a good lifestyle, and specialist visits, to what degree can you ensure that visual field loss from damage will not occur?
Dr. Mantravadi: The best that one can do is to understand the nature of their process, adhere to recommended regimens as best as possible, and take good care of yourself physically and mentally. Glaucoma can be slowed considerably and blindness can be prevented in many. However, it is the world’s most common cause of irreversible blindness for many reasons, with non-adherence with therapy being a major factor.
P: How do I know when I should get a second opinion?
Dr. Mantravadi: A second opinion can be important in complex cases where there may be more than one answer. It can be important if one is uncertain in the diagnosis, management and treatment options of their care.
P: Does nocturnal hypotension affect glaucoma?
Dr. Mantravadi: There is emerging data supporting the role of nocturnal dips in blood pressure in glaucoma. In particular, there is a growing body of evidence supporting the concept of perfusion pressure in the glaucomatous process. Insufficient blood flow to the optic nerve may potentially play a role in some forms of glaucoma.
P: Could you please explain the difference between ocular perfusion pressure (OPP) and intraocular pressure (IOP)?
Dr. Mantravadi: Intraocular pressure is the pressure within the eye. Perfusion pressure is the amount of blood flow getting to the eye, often calculated with a complex formula: mean ocular perfusion pressure =2/3 diastolic blood pressure + 1/3 (systolic BP-diastolic BP) – intraocular pressure.
P: Is there a specific test to determine insufficient blood flow to the optic nerve?
Dr. Mantravadi: All current tests have limitations. Fluorescein angiography, Doppler ultrasound studies, and others can all have some role.
P: How do you know when a patient can be compliant with three medications?
Dr. Mantravadi: Often we don’t know. Outside of a history from the patient, we don’t have any reliable way to estimate if a patient is taking all three medications or even any of them. We rely on the patient to provide us this information and an understanding of their ability to take more than one medication.
P: Doctor, do you feel that given the mind and body connection, patients with upbeat and positive attitudes fare better?
Dr. Mantravadi: Yes, patients with good attitudes are often active participants in their own care and will likely do better.
P: What situations with glaucoma frustrate a physician the most?
Dr. Mantravadi: The care of a glaucoma patient is a privilege and truly a rewarding experience. I feel meaningful longitudinal relationships based around caring for oneself can develop and be very rewarding. I feel there are many opportunities for great success in preventing blindness or slowing it down to a rate where one may outlive their glaucoma. In some cases as in many diseases, the disease can be aggressive and one may not fare as well as we all would like due to the nature of the process. This is frustrating but it does provide an opportunity to continue to strive for better and more effective alternatives.
P: Are the hand held pressure checkers as effective as the older types?
Dr. Mantravadi: Hand held tonometers can be variable in reliability.
P: Recently an elderly family friend overseas suddenly lost his vision and was rushed to the hospital. His IOP was high and he had a retina vein occlusion. His vision could return back after the pressure subsides. Can you please explain what a retina vein occlusion is?
Dr. Mantravadi: A vein occlusion is when the venous outflow is obstructed. Risk factors include hypertension, high cholesterol, arteriosclerosis, and smoking.
P: What do you think about ginkgo biloba for the eye?
Dr. Mantravadi: It has been shown in non-randomized trials to improve blood flow.
Moderator: We would like to thank Dr. Mantravadi for joining us this evening and sharing with us with his expertise.