Managing the odds for good outcomes in glaucoma

Andrew G. Iwach, MD, discusses how ophthalmologists have a role in designing a treatment protocol that addresses not only a patient's state of the eye but also overall health.

San Francisco-To ensure good outcomes for patients with glaucoma, Andrew G. Iwach, MD, recommended beginning the process with the best IOP-lowering medications. Dr. Iwach, associate clinical professor of ophthalmology, University of California, San Francisco, offered his suggestions at the Glaucoma 360 CME Symposium, where he also served as program moderator.  

Dr. Iwach noted the use of prostaglandin analogues continues to grow. Beta-blockers help many patients, as do combined medications.

Ophthalmologists must keep up on new products and studies that determine which drugs are better. Patients prefer preservative-free products, which may offer benefits in general. Generic products have flooded the most areas of medicine, have begun to increase in cost-the American Academy of Ophthalmology is assessing this trend-and once-unapproved drugs undergo the approval process. 

The federal government and the FDA have taken on monitoring of compounding pharmacies as of last year, because of contamination problems that recently occurred. He noted the FDA has approved mitosol as the approved ophthalmic formulation of mitomycin-C. 

New drug delivery systems, such as sustained-release travoprost (Ocular Therapeutix), will allow for the use of more toxic medications at a lower dose for a better side effect profile. Surgical trends from 1994 to 2012 show the increase in laser use, while there has been a 40% decrease in trabeculectomy.  The newer methods and lasers have increased the quality of life for patients with glaucoma.  

Dr. Iwach recommended ophthalmologists check their signed patient informed consent (IC) records.  Many IC forms may need to be updated. The OMIC site offers free template downloads of IC forms for various procedures.

In addition, practitioners should ask patients if they smoke or use alcohol-both of which may influence the development of glaucoma.

Dr. Iwach cautioned about using a glaucoma calculator, such as PREDICT, because these applications (still 99 cents to download) have not been refined or validated.

However, the free program ePSS provides a good outline of which tests should be performed on which patient and when. The program is easy to use, though it does not specify when to monitor for glaucoma. 

The Freedom of Information Act allows for the release of information about individual physicians charging procedures. The ProPublica website offers a database to health-care consumers that includes Medicare Part D data. The PPACA will monitor physicians closely for surgeries performed to determine if the patient’s best interests were honored.  

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