Doctors Can Work With Patients to Be More Proactive in Glaucoma Care: Christine Funke, MD

Christine Funke, MD, a glaucoma specialist at Bennet Dulaney Perkins Eye Center in Phoenix, Arizona, discussed how being proactive in treating glaucoma is a burden that both doctors and patients share when it comes to making sure there is no progression in the disease.

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

Transcript

How can doctors be more proactive when it comes to treating glaucoma?

Proactive, I think is kind of the new best word to talk about when we're looking at glaucoma. We have to think about glaucoma, not only as, again, this progressive disease, but [also] not thinking of it as something that's precious and having to wait until the very end to treat it, especially surgically. Now we have to flip the way we look at this disease, flip the way that we [look at] all these different tools, and realize that there are low-risk procedures that are available that can help slow down the progression of disease. We have to adopt them and I think that's what's hard. Becoming a progressive surgeon also means taking the mantle or burden off of the patients and saying, “You have to do all these things in order to not lose vision,” and saying, “I will take that on for you.” And that's a big burden to take. I think it's worth doing. It's probably why we all went into medicine in the first place. You're just taking a lot more ownership, and that's a big change, and it's a big shift.

It's also a big change in how to talk to patients. Before it would be, “Here's your eye drop. Have a wonderful day.” Now I have this whole armamentarium of different things that we can talk about, and it can be overwhelming for the patients. It can be overwhelming for the physicians as well. It's a lot longer of a discussion that we haven't had to have before. And sometimes I think [physicians] shy or shirk away from the idea of discussions of surgical interventions, injectable medications, or lasers, and I think a lot of that also has to do with maybe their own hesitancy. But once they start to use these tools more and more and realize how effective they are for the patients and how happy patients are to no longer be taking medications and having that burden on them, you start to slowly evolve your practice because you realize how effective this option is.

Also, you've got to learn with time [how to identify] patients who are taking the medications. I always say when I see a patient taking medication, I know if they're doing their drop, because they're red, and I know they're not using their medicine because they look good. And either way, we probably don't want either of those options to be there and we have so many other wonderful things that can be used instead. The quality of life change also is a huge discussion that we have never had in glaucoma. You definitely didn't have happy glaucoma patients coming into clinic 10 years ago, and now we do. Now we have people who are getting off medications, feeling like they're well cared for, good control of their disease. And it's just a very different kind of clinic than it used to be when I was first training, which is great. As we continue to teach others about it, we just want them to understand—and by “them” I mean other physicians, who may be hesitant to change into this new way of looking at glaucoma and treating it—is to realize how happy their patients are going to be and how often they're going to want to return for their care because they feel like they are truly being cared for by their physician.

I was in an interesting group of people who got their offices looked at specifically, and we found that patients who did have some sort of intervention, and it didn't matter what the intervention was, but non-drop therapy had a much higher rate of return to the office, meaning more compliant with follow-up, which is very important for glaucoma patients compared to those who were given a drop. There's another whole component too to talk about, of not only compliance of treatment, but also compliance of follow-up. Because when somebody gets lost to follow-up, I'm assuming too they're not doing whatever they need to be doing to keep their disease stable, and the likelihood of them coming back several years later with significant vision loss is pretty prominent and pretty prevalent, and we want to cut that out too. This whole paradigm shift is good for so many different reasons that now we just have to start to get more and more people to catch on to the same idea of it and why it's so important.