Eyeworld

WINTER 2024 | EYEWORLD | 77 G "You have visual fields to assess the amount of damage to the optic nerve, and the visual fields now are much better than they were when I was a resident," Dr. Robin said. "They're black and white, and you can point out black is bad; white is good. It's always good to repeat visual fields because often on the first time, patients have trouble with it, and you can get a better idea of the amount of damage." He added that OCTs and slit lamp examinations are crucial to deter- mine the type of glaucoma and any potential adverse effects of medications used to treat the glaucoma. Treatments and education If a patient is young and understands what's going on, Dr. Robin often starts with either eye drops or laser treatment. He will give patients a bottle of artificial tears and see if they can get a drop in their eye. Using drops is extremely diffi- cult, and some people just can't do it. Addition- ally, many don't have a partner or significant person in their lives who can help them. The second thing that you have to consider, if you decide to go with drops, is what kind of systemic diseases or illnesses the patient has. All topical IOP-lowering medications have different side effects. Some of the prostaglandins can cause eye redness, change the color of the iris, etc., so you have to make sure that a patient un- derstands this. Additionally, Dr. Robin said that beta blockers, like timolol, can cause asthma and exacerbate congestive heart failure. They can also cause a slowing of the heart rate, and a slowing of the heart rate in someone who's a 25- or 30-year-old track runner whose baseline heart rate is 55 or 60 could cause significant medical issues. You want to make sure you have a full understanding of their systemic health, he said. "If they can't put in a drop, my first choice would be a laser trabeculoplasty. You have to ex- plain to patients that this is not a cure; patients always think that there's a cure," he said. The other thing to consider, Dr. Robin said, is how low you want the patient's pressure to be. You want to make sure that you explain that to the patient. What's the goal? How do you as- sess if there's a change? How do you know you should be more aggressive? You want to ensure that you're lowering the pressure in a way that prevents visual field loss, so you have to explain the purpose of visual field to the patient. "I have never met a patient who loved taking visual field examinations," he said. "I think the important thing is to explain what the treatment is, why you picked that treatment, and what has to be done. Show them how to take drops, and make sure they under- stand why you're doing visual fields. Usually, I'll advance treatment if the eye pressure isn't ade- quately controlled, based on the target pressure. I'd either substitute or add a drop or do a laser," he said. For patients who can't put in drops but need a drop, there are some newer devices available. These include Durysta (bimatoprost intracameral implant, AbbVie) and iDose (travoprost intracameral implant, Glaukos). "Both require making a little hole in the wall of the eye and implanting these devices. Durysta is a little pellet that dissolves over time that continued on page 78 Determining what the patient understands about the disease and developing trust are crucial, according to Dr. Robin. Source: Alan Robin, MD

• Blank Page
• Blank Page (1)