Use positive approach when discussing glaucoma diagnosis

San Francisco-Ophthalmologists should always strive to emphasize the success of treatment when discussing glaucoma with their patients, said Reay H. Brown, MD, at glaucoma subspecialty day during the American Society of Cataract and Refractive annual meeting.

"Speaking with glaucoma patients is something we may do on a daily basis, but it is something many ophthalmologists may not think about in a systematic way," said Dr. Brown, chairman, ASCRS Glaucoma Clinical Committee, and a private practitioner in Atlanta. "Remember that glaucoma patients often fear blindness to a degree that is far beyond their actual risk, and your words have a powerful influence and are critical to their care. Most glaucoma patients are being treated successfully, and I would encourage you to emphasize and remind them of that. Recognize that there is no better feeling than walking out of the physician's office with a good report."

He explained that patient perceptions of glaucoma are in large part determined by what they are told by their physicians, therefore it is important to project an appropriately positive attitude. That can be a challenge considering the downsides of treatments and the fact that glaucoma is a potentially blinding and incurable disease.

The reality of the situation is that most affected individuals do well and do not go blind, treatments usually work, and even if intervention is not perfect, damage occurs slowly.

"We need to remind patients of this information, because it is our encouragement that is the countervailing force against their fear of becoming blind," he said.

Furthermore, emphasizing success may have self-fulfilling consequences since results from various studies show that patients who feel positive about their disease tend to be more compliant with their treatment.

The difficult situation

While patients who are having problems should not dominate the physician's view of the glaucoma universe, it is important to recognize those individuals present a "no-spin" situation. Even in that scenario, it is important to avoid passing on doubts and concerns to the patient.

"I have been humbled by glaucoma many times by patients who have had serious problems," Dr. Brown said. "In those cases, it is important to discuss the facts of the situation frankly. In addition, a full explanation of the options will show the patient you have a plan and are in control. That approach by itself can be very reassuring."

Careful wording

Phrases that should be avoided in patient interactions include "nothing is working," "I've tried everything," "I don't know what else to do," and "I give up," because they only act to bring forth existing negative images.

"Keep in mind that we almost never run out of therapies, and there is always something else we can do," Dr. Brown said. "Even if you personally run out of ideas, referring the patient is an option that might be helpful."

On the other hand, there are an infinite number of possibilities for expressing a positive message. Depending on the individual's situation, patients can be informed about the success of their care by being told there is no need to change their therapy or need for surgery.

Patients can be asked to compare their pretreatment IOP with their current IOP, the stability of their visual field, or the ongoing efficacy of their filtering procedure in controlling IOP.

"These observations give patients a boost and are something they will remember," Dr. Brown said.

Steer clear of target IOP

He also suggested avoiding discussions of a target IOP with patients because it may only be a set-up for disappointment and unnecessarily turn the visit into a pass-fail encounter.