Drops and Dry Eye: QOL Considerations for the Glaucoma Patient

Aug 5, 2022
7 min read
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Drops and Dry Eye- QOL Considerations for the Glaucoma Patient_Fahmy_Schweitzer_EOG_2022_YT Thumbnail copy.jpg

On June 10-11, eyecare practitioners from all over the world gathered online for Eyes On Glaucoma 2022, a two-day educational event all about glaucoma disease diagnosis, treatment, and management.

With so much fantastic education happening at once, we knew that people had to choose which sessions to attend. So over the next few months, we'll be releasing much of the excellent content from Eyes On Glaucoma for you to watch at your leisure—whether for the first time or to review important learnings!

Scroll down to unlock this recording of Dr. Ahmad Fahmy and Dr. Justin Schweitzer's lecture on quality of life and establishing an effective ocular surface disease (OSD) treatment algorithm in patients with glaucoma , and don't forget to check out our list of future events!

Please note that these videos are provided for review only.

When treating comorbid glaucoma and ocular surface disease, quality of life considerations often fly under the radar. However, best practices for managing these conditions will take into account health-related quality of life (HRQOL) considerations in order to achieve the best possible disease outcomes, improve functional vision, and allow our patients to live full and happy lives.

This talk from Eyes On Glaucoma 2022 will include clinical pearls, discussions of topics such as alternatives to preserved medications, an effective ocular surface disease (OSD) treatment algorithm in patients with glaucoma, plus a discussion of how to manage severe OSD patients who may go on to develop glaucoma as a result of surgery to treat OSD.

Health-related quality of life and treatment plans

Patients—especially glaucoma patients—are often dealing with many variables in their life that are affecting their overall quality of life. As eye doctors, we must understand that the mere diagnosis of a chronic, irreversible, and potentially blinding disease such as glaucoma can adversely affect our patients’ overall sense of well-being and perceived quality of life. Since self-assessed health status is a more powerful predictor of mortality and morbidity than many objective measures of health, we must pay attention to how our patients are doing in all aspects of their health.

In ocular surface disease, we’re used to considering the many possible factors affecting our patients’ health. Our patient questionnaires are based on the environmental factors and self-perceived effects of dry eye as well as the objective measurements of disease progression.

When it comes to glaucoma and ocular surface disease, the single person who can have the strongest impact on disease progression is often the patient, with their ability or willingness to follow their treatment plan. We can prescribe as many drops as we like, but they will have no effect on the patient’s IOP if our patients aren’t instilling them—whether that’s because they’re too busy to instill a drop twice per day, or the drops are painful or have unpleasant side effects.

When starting a patient on multiple medications, you have to take time with them to discuss the disease itself and the consequences of the disease. Many of our patients in the early stages of glaucoma might not know that they have it. While we might be very happy to have caught the disease so early, our patients have not yet realized they may be at risk of decreased functional vision, so a treatment plan—especially one that includes multiple medications and even surgery—can come as a shock.

At the same time, we must remind ourselves that the treatment plan should never become overwhelming for our patients. That might mean a patient cannot take a particular drop, and we will need to think of alternatives to pressure-lowering eyedrops. It might mean a patient who can take one drop but won’t be compliant with two or three drops. Always read your patient and verbally discuss with them what they’re able and willing to do.

The great news is that we have so many effective treatment methods for glaucoma as well as ocular surface disease in our armamentarium—it really just becomes a question of which choice is best for the patient sitting in our exam chair.

Surgical intervention, glaucoma, and ocular surface disease

In the early days of glaucoma treatment, we understood the disease by how we could describe the nerve and how the visual field looks. Now, we have so many great tools that are able to precisely measure the nerve fiber layer, retinal ganglion cell layer thickness, the optic nerve anatomy, corneal hysteresis—the list goes on. We have the incredible ability to image and diagnose glaucoma, and that has opened up entirely new possibilities for treatment that go beyond drops and incisional surgery and into the minimally invasive glaucoma surgeries.

Conjunctival health has major implications for incisional surgery in glaucoma patients, so it’s crucial to keep track of that and other signs of ocular surface disease. When we talk about the ocular surface, we’re not just talking about the corneal epithelium, we’re also talking about the conjunctiva. It’s important to zero in on how much conjunctival injection there is and how that might relate to the number of medications our patients are using.

Early MIGS procedures can help preserve the ocular surface, a critical factor for surgical success of the patient that may later on progress to need a more invasive glaucoma surgery later on.

When it comes to discussing ocular surface disease in glaucoma patients, earlier is always better. In general, we all should be thinking with an interventional mindset, because we have safer procedures to intervene earlier in both glaucoma and ocular surface disease. There are multiple innovative treatments that now help us avoid advanced stages of glaucomatous progression and severe ocular surface disease: early intervention is key.

Both glaucoma and ocular surface disease are multifaceted problems with a lot of moving variables, and there are many pieces that go into an adequate treatment plan. Offering quality treatments early on is crucial for long-term patient outcomes.

Of course, with that many moving parts, patients can quickly become overwhelmed. That’s where communication and family support come in.

Clinical pearls and takeaways

Co-morbid diseases demand more aggressive therapies. However, OSD severity impacts patient compliance with glaucoma drops, making both conditions crucial to track and treat simultaneously. Don’t forget to take advantage of preservative-free glaucoma drops!

If you’re in a high surgical volume glaucoma practice, it’s even more important for you to address OSD. Luckily, there’s a natural synergy with OSD lines of service: they’ll fit seamlessly into your practice with a little work, and will result in better patient outcomes. There’s a growing list of glaucoma and OSD treatment options that complement each other.

And finally—and perhaps most importantly—talk to your patient. Not just about the therapies you’re prescribing, but about the disease as a whole and their life, plans, and goals. Knowing your patient will help you to arrive at the best possible treatment plan with them, and patient buy-in is a huge factor in improved outcomes.

Watch the whole lecture to:

  • Describe the recent algorithm for the pre-operative diagnosis and treatment of OSD for patients undergoing ocular surgery
  • Develop an understanding of the key features and indications of topical medications commonly used in the treatment of glaucoma and ocular surface disease
  • Recognize potential challenges of glaucoma surgery in patients with OSD
  • Develop an understanding of the key features and indications of minimally invasive glaucoma surgeries commonly used in the treatment of glaucoma with co-morbid ocular surface disease
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About Justin Schweitzer OD, FAAO

Dr. Justin Schweitzer is a fellowship-trained optometrist specializing in the treatment of glaucoma, corneal-related vision conditions, and cataracts at Vance Thompson Vision in Sioux Falls, SD.

About Ahmad Fahmy, OD, FAAO, Dipl. ABO

Dr. Ahmad Fahmy is the Director of Optometric Services at Minnesota Eye Consultants. He received his professional training and the Doctor of Optometry degree in 2001 from the Illinois College of Optometry, and completed residency training in the perioperative care …

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