Strong Patient–Doctor Communication Improves Glaucoma Care: Ariana Levin, MD

Ariana Levin, MD, assistant professor in the Department of Ophthalmology at NYU Grossman School of Medicine, discussed how open communication between the ophthalmologist or optometrist and their patient is key in giving patients the best possible outcome in treating their glaucoma.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

What is glaucoma, and what are its signs and symptoms?

Glaucoma is a disease that affects the optic nerves in the eyes, and when the optic nerves are stressed by glaucoma, the nerves get thinner. Usually this comes from high pressure, but not always. There are other factors that affect glaucoma risk as well, and when those nerves get thinner, the world gets darker, usually starting from the periphery, from the outside, and as it gets worse, it closes in. That makes glaucoma a really sneaky disease, because people don't notice at first as the world gets darker, and we hope to catch the glaucoma and start to treat it and deal with it before it actually comes to the point where patients are noticing. It usually doesn't hurt. There are situations where glaucoma does hurt, feel like pain, but usually patients don't feel anything when the glaucoma is starting.

How can ophthalmologists and optometrists approach patients with glaucoma?

I think communication between the doctor and the patient is key. I tell my patients, “Your number 1 homework is to come in and show up.” Because glaucoma is a chronic disease, patients will be seeing a lot of their doctor for a long time, maybe forever. And as I said, because glaucoma is sneaky, patients often don't know when their glaucoma is getting worse because it creeps up on people. The best way for us to realize that glaucoma is changing, getting worse, and needs treatment is for us to examine the patient, for us to do testing in the office and catch those changes. We have the worst scenarios when glaucoma has been getting worse for 5 years, let's say, and nobody knew. The doctor didn't know, the patient didn't know because they weren't seeing each other.

The patient's homework is to show up, but I think it's on the doctor to communicate the importance of that, especially in the first few visits. Ideally, the patient walks away from the doctor with an understanding of what glaucoma is and what the nature of the disease is. And then later, as the patient goes through treatment with the doctor, it's important for the doctor to communicate with the patient what their options are. Depending on the situation, we may be in a situation where we have 3 good options for a patient or 3 great options for what we need to do next for their glaucoma. Or we may be in a situation where we have 3 options that don't really sound so great, but we don't have any other alternatives, and we need to pick something to move forward. The patient should understand from the doctor, what's the nature of the disease? How concerned is the doctor about the glaucoma getting worse? Are they stable or unstable? What are the options for their treatment?