EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/194331
64 EW GLAUCOMA October 2011 February 2013 Glaucoma editor's corner of the world What our glaucoma patients know— and what they don't by Tony Realini, MD W e all know that educating our glaucoma patients about their disease is a key part of their therapy. However, it is challenging to take the time to be as thorough and informative as we know we should be. This month's "Glaucoma editor's corner of the world" reviews several studies from Fabian Lerner, MD, Aaron Smith, MD, and Anjali Sheth, MD. These studies emphasize the importance of education in helping our patients meet their therapeutic goals. Work from Dr. Sheth showed that the most effective intervention was time spent by the doctor educating the patient about glaucoma and showing him/her how to take eye drops. Since we are responsible for maintaining our glaucoma patients' visions, we tend to focus on the visual fields, pressures, OCTs, and other indicators of whether the glaucoma is stable or progressing. While these tests are important in management, they are not therapy. We tend to think that only the medications we prescribe or the surgeries we perform are therapies. We forget that what we say to our patients is also part of their therapy. When we explain glaucoma to them and why we want them to take this medication, it sends a clear message that we care about how they are doing. But how exactly does education lead to more pressure goals achieved? Perhaps a better understanding of their glaucoma leads patients to adhere to their drop schedules and this leads to lower pressures. But perhaps it is not just us educating them— perhaps a critical element is that we show them that we care. Research has consistently shown that when patients know their doctors care, they are more likely to keep appointments, take medications, and follow instructions. Reay Brown, MD, glaucoma editor P atient education is a fundamental part of the management of any medical condition. In glaucoma, education is particularly important. The disease has no symptoms early in its course, so patients must understand the seriousness of a disease that they can't tell they have. They must also understand the importance of therapeutic adherence —even though therapy doesn't make anything perceptibly better from their perspective. When it comes to educating our patients with glaucoma about their disease, we may not be doing the best possible job. A series of studies presented at the 2013 Association for Research in Vision and Ophthalmology (ARVO) meeting in Seattle demonstrated the knowledge gaps that our patients have and the consequences of those gaps. Gaps Fabian Lerner, MD, Buenos Aires, Argentina, and colleagues evaluated the glaucoma knowledge of a group of 54 patients spanning the range from mild to advanced glaucoma upon initial presentation to their referral glaucoma practice. They documented surprising knowledge gaps. A full 74% of patients could not name the glaucoma medication(s) they were using. Also, 61% could not explain the purpose of their glaucoma medication. "In addition, 81% did not know the type of glaucoma they had," Dr. Lerner said. Fortunately, 91% were aware that glaucoma could lead to vision loss and blindness if left untreated. However, two-thirds of the group did not know what a normal intraocular pressure (IOP) level was, and 78% did not know what their IOP was at their last visit. To close this knowledge gap, Dr. Lerner and colleagues then provided a detailed explanation of glaucoma, its consequences, and the nature and importance of treatment. After this, they reassessed knowledge levels in the same group of patients one and six months later. The one-time education session was quite effective. At six months, only 35% of patients could not name their glaucoma medications— half as many as before. Only 2% continued to be unaware of the purpose of their glaucoma medications. Further, only 20% still did not know what type of glaucoma they had. The knowledge rates at one month were fairly similar to the sixmonth values, but Dr. Lerner cautioned, "Some regression could be observed from month one to month six, so continuous education may be needed." The family connection It is equally important that relatives of glaucoma patients have some knowledge of the disease, as family history is a significant risk factor for having glaucoma. Aaron Smith, MD, and colleagues at the University of Mississippi, surveyed 52 first-degree relatives of established glaucoma patients to assess their awareness of the disease and its potential impact on them. "The questions we asked assessed their basic knowledge of the disease, risk factors, and [we] asked if they had glaucoma and if not would they like to be screened," he said. continued on page 66