World Glaucoma Week, March 11-17, was a timely reminder, if we needed it, that damage from this disease is largely preventable and it is a disease that should be absolutely central to what optical practices and professionals are about. A core part of the eye examination is to identify signs and symptoms of glaucoma and to take appropriate action.
With the basic eye examination, it has been the norm for many years to perform the appropriate tests to screen for glaucoma; fields, tonometry and disc assessment. Imaging with indirect ophthalmoscopy has improved on the previous direct method. We now have new technology that has enhanced the eye examination and our ability to detect glaucoma.
Retinal cameras in many practices are invaluable to image the disc in detail and to identify subtle early signs of glaucoma and perhaps their greatest benefit is to enable monitoring over a series of visits to directly be able to compare from one visit to the next and so see changes. OCT machines can go one stage further to help diagnosis with the aid of their sophisticated algorithms.
Optical professionals are obviously very aware of glaucoma and to varying extents are active in the identification, monitoring and diagnosis of this disease. However if you asked members of the public if they are A) aware of glaucoma, B) know what the effects are if untreated and, C) where to go to get screened – what response do you think you would get? I suspect it would not be the one you wanted. I would opine that optical practices are not, at the moment, ‘owning’ this area of health and so should be doing more.
This disease, characterised by increased incidence in the elderly, will become of epidemic proportions by the year 2050, with almost double the numbers of patients diagnosed with the condition compared to today, and many more undiagnosed. This is according to the National Eye Research Centre. We know that the NHS system is unable to cope with numbers now, so we know we need to do something different to cope in the future. This means the optical professions have a clear opportunity for the future and yet to realise it, we have to be doing things differently to educate and change public perception.
Firstly, we have to shout more about what we do. I’m sure there will be some who have not been impressed with the recent joint campaigns between Specsavers, (the marmite of the optical world), the Royal National Institute of Blind People and the International Glaucoma Association. These have raised awareness of glaucoma through television adverts and developed training packages for retail staff to help patients with the condition.
Some will say that the charities should not be as close to one brand; however you cannot get away from the fact that the charities’ aim will be to prevent avoidable blindness, Specsavers are prepared to put in the money to support this and so good luck to all concerned. If the campaigns succeed in educating and informing the public that is excellent, and for those who criticise, they know what they need to do – put their own hands in their pockets to fund their own campaigns.
As a profession, while we are equipped to do our basic case finding roles, are we equipped for a future role in monitoring and diagnosis? We need to plan ahead and encourage more optometrists to have the appropriate additional qualifications to take on these roles. Without doing this we will never be in a position to be the ‘go to’ professional for taking the strain when it comes to glaucoma.
Finally, we have to also be better at talking to our existing patients about what we are doing and why. We measure pressures and fields, but do we tell the patient why we are doing this?
In many practices where there is a retinal camera, we can view the optic disc, which is a little over one millimetre in size, on a screen where the image is one hundred times as big. Do we explain to patients what we are looking at, how impressive this technology is, and the significance of regular visits to monitor potential changes? Do we inform all our patients regarding the risk factors for glaucoma, that may apply to them and others they know – for example where there is family history of glaucoma?
If we do not set the rationale for the importance of regular eye examinations, it is no wonder that patients will not attend every two years.