GUIDANCE FOR GLAUCOMA PATIENTS

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The CIRRUS HD-OCT from ZEISS is unique in that it
contains several options for displaying progression,
including the Guided Progression Analysis for
assessing RNFL and optic disc change.

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Automatic 3D Stereo Imaging, a standard feature in
the AFC-330 from Marco, gives patients the
opportunity to view their retinal anatomy in 3D.

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Heidelberg Engineering’s SPECTRALIS OCT
Glaucoma Module Premium Edition enables
clinicians and patients to visualize glaucoma
progression using a built-in progression map.

How to support a glaucoma practice—from patient education materials to imaging techniques.

Glaucoma, known as a silent blinding disease, is a test of communication between doctors and their patients. Its asymptomatic nature leaves it to the discretion of doctors to explain its slowly progressive tendency toward blindness. Thus, glaucoma is a disease that relies on the ability of a practitioner to impart the seriousness of the condition and the subsequent importance of strict compliance with medications and follow-up schedules.

Luckily for us, technology has advanced in ways that can make this daunting task more manageable. Utilizing patient education materials both in and out-of-office as well as the implementation of a communication system can help convey the disease process to our patients, which in turn can improve compliance and loyalty to a practice.

START IN THE WAITING ROOM
It has never been easier to implement effective education materials in the office. The waiting room, both before and after seeing the doctor, sets the stage for the overall patient experience. The use of educational videos, interactive tablets, diagrams and pamphlets placed around the office not only show your patients that you care about their understanding of their disease but encourages them to take their condition more seriously.

CONTINUE DURING THE EXAM
Imaging techniques used in the management of glaucoma may be intimidating, confusing and not enjoyable for the patient. At diagnosis, it is helpful to explain that there is a battery of tests needed to be performed regularly for properly monitoring the progression of the disease. At each follow-up appointment it is important to go over the results from whatever imaging was performed. Unfortunately, this is not always accomplished, and patients may leave confused.

There is no shortage of instruments used in the management of glaucoma patients, but imaging techniques commonly used are optical coherence tomography (OCT), visual field and retinal photography. Here’s how to best utilize these tools to help patients understand their disease.

OPTICAL COHERENCE TOMOGRAPHY
When shown to a patient, OCT results indicated by the red, yellow and green colors can alert patients to the seriousness of their disease. However, OCT images can further inform patients and offer more detailed explanations of such results to them.

Heidelberg Engineering’s SPECTRALIS OCT Glaucoma Module Premium Edition (GMPE) offers a 3D analysis through the optic nerve head with a dramatic display of the optic nerve head morphology. This is even more impressive when these images are compared to the patient’s previous scans, showing changes that illustrate potentially progressive damage. Furthermore, the GMPE enables clinicians and patients to visualize such progression using a built-in progression map. The sequence of these scans can show patients the importance of visiting their eyecare specialist on a consistent basis in order to have OCT scans of their eyes acquired for close monitoring of such small but irreversibly damaging changes.

The CIRRUS HD-OCT from ZEISS is unique in that it contains several options for displaying progression. Slowing progression is the primary goal of therapy and highly dependent on patient compliance. Guided Progression Analysis (GPA) assesses retinal nerve fiber layer (RNFL) and optic disc change. Focal Progression Analysis has up to six progression maps compared to two baselines, and the Trend Analysis with Rate of Change plots RNFL thickness values over time. With color-coded areas marking possible to definite progression, CIRRUS HD-OCT offers a range of tools that can help patients understand that their glaucoma may be worsening, despite its asymptomatic nature.

VISUAL FIELD
The visual field is the only test we have that can show a patient functional vision loss. Simply showing the Guided Progression Analysis of the Humphrey Visual Field (which identifies statistically significant changes in visual field threshold sensitivity) or an up-to-date sequence of tests over a few years help patients appreciate that they are losing vision.

Although not much has changed with the standard visual field printout, the advent of the Compass Fundus Automated Perimeter allows for a qualitative structure-function type assessment. The Compass accomplishes this with displaying the results of the visual field overlying a photograph of the patient’s posterior pole. To mimic this printout, a practitioner can show patients the results of their visual field side-by-side with their retinal photograph and explain the correlation when appropriate.

RETINAL PHOTOGRAPHY
A high resolution optic nerve head (ONH) photograph in the exam room can go a long way to educate patients on their condition. The structure of the glaucomatous ONH, when compared side-by-side to that of a normal nerve head, can be displayed and discussed in simple terms in order to help patients “˜visualize’ glaucoma. Taking this experience to the next level by including “Automatic 3D Stereo Imaging,” a standard feature in the AFC-330 from Marco, gives patients the opportunity to view their retinal anatomy in 3D as well. Having an “automated” stereo fundus camera provides the clinician with repeatable diagnostic information in order to accurately compare the ONH over time.

Another function of a colored retinal photograph is the visualization of “wedge defects” in the areas of RNFL loss. The Centervue Eidon camera, with its true color confocal scanner, allows clear identification of wedge defects. The SPECTRALIS MultiColor Scanning Laser Imaging offers a modality for clear visualization of RNFL wedge defects. The blue and green reflectance images from the MultiColor modality accentuate the boundaries of such defects, enabling clinicians and patients to appreciate their extent.

CONTINUING EDUCATION
Choose your favorite resources and encourage your patients to stay educated about their glaucoma. The internet is the most common source for people to look for information, so giving suggestions of specific websites prevents your patients from finding inaccurate or difficult-to-understand information. Implementation of a reminder system with a portal for patients to be able to ask questions is an invaluable addition to an office setting as well.

These steps are easy to implement even in very busy glaucoma practices and make all the difference for more effective management and establishing loyal patient-doctor relationships.

Shira Kresch, OD, MS, is an instructor of Optometric Sciences at Columbia University Medical Center and an optometrist at New York Presbyterian Hospital. She is also the founder of EyeInquire.com, a patient-facing website for eyecare information.

 

WHERE TO FIND IT:
Carl Zeiss Meditec, Inc.
800.342.9821 | Meditec.Zeiss.com/USA
Centervue, Inc.
408.988.8404 | CenterVue.com
InfoUS@CenterVue.com
Heidelberg Engineering, Inc.
800-931-2230 | HeidelbergEngineering.com
Marco
800.874.5274 | Marco.com

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