January is Glaucoma Awareness Month. John Berdahl, MD, a cataract refractive cornea and glaucoma specialist at Vance Thompson Vision in Sioux Falls, South Dakota, talks with Ophthalmology 360 about the importance of patient communication and fitting the right tool to the right patient.
Question:
How can ophthalmologists contribute to the education and conversation around glaucoma and general eye health?
John Berdahl, MD:
Glaucoma is a powerfully scary disease. It’s the second leading cause of blindness and a lot of people don’t even know they have it until it’s too late. That means it’s incumbent upon us as ophthalmologists to raise awareness of the condition and provide hope to these patients. Be diligent about being facile with all the tools to treat the disease because if we see patients early enough, most of them, we can keep sighted all of their lives.
Question:
How do you talk to, guide, and counsel your patients following a glaucoma diagnosis?
John Berdahl, MD:
The first thing is anytime you get a diagnosis that you’ve heard of, but you don’t really know what it is, especially if it relates to blindness, the obvious emotion is fear and being scared. For the vast majority of those patients, I lean in and I touch their knees and I say, “You are not going to go blind from this. If you do your job and we do our job, we are going to keep you sighted all of your life. Your job is to show up for appointments, do the treatments we ask you to do, and if you can’t do those, then you have to let us know, and then our job is to find another one. Our job is to be diligent, see you back regularly, and do the necessary testing to make sure you’re not getting worse.”
Question:
Can you talk about the treatment options for glaucoma? How do you determine the best course of treatment for each patient? What are the important factors you consider when determining a care plan?
John Berdahl, MD:
When it comes to being a proficient glaucoma specialist, it’s our job to get good at the tools and fit the right tool to the patient, not fit the patient to the tools that we happen to be comfortable with. In general, what that means is treating this with SLT first because it’s efficacious and there’s no question about the therapy being delivered and there’s not toxicity to the anterior segment. Moving other interventional treatments earlier into the paradigm such as MIGS procedures or intraocular pharmaceuticals is really important. Then there’s other new emerging treatments that are also noninvasive that can control IOP. It really is about understanding how scary is this glaucoma, how can we protect their eye with having the least burdensome impact on their lives and applying the right technology to their individual situation.
Question:
What are some recent advancements or things on the horizon that you think are important to highlight regarding glaucoma?
John Berdahl, MD:
It’s a great time to be a doctor and an innovator with glaucoma because there are things that are improving dramatically. On the diagnostic side, we have more insight into the retinal nerve fiber layer and exciting diagnostics coming in addition to the application of AI on the top of it. From a therapeutic standpoint, MIGS feels new, but that was about a decade ago when MIGS hit the market, so that’s a big, big innovation. Now we’ve got drug delivery. That’s also a big innovation both with Durysta and iDose. Then I’m really biased on this one, but also excited that the first non-surgery, non-drug way to lower eye pressure with the physics ocular pressure adjusting pump will be available primarily to treat patients that are in that normal tension glaucoma category and have some of the most severe diseases. Bringing more and more hope to those that have the worst types of glaucoma.
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