Explaining glaucoma

Question 1

How should you start off a consultation when explaining glaucoma to a patient?

Answer 1

• What has brought the patient in to see you today?
• What are their symptoms, if any?
• Are there any risk factors that can be identified? (e.g. age, diabetes, cardiovascular disease, family history, being short-sighted)

Question 2

What kind of questions can you ask to explore the patient’s understanding of glaucoma?

Answer 2

“Are you aware of the results of your recent eye test?”

“What do you know about glaucoma?”

“What has been explained to you about glaucoma so far?”

ICE

Question 3

How would you explain normal eye physiology to a patient?

Answer 3

• Your eyes produce a watery fluid called aqueous humour
• This is needed to provide nutrient and oxygen to the tissues within the eye
• It also helps to maintain the eye’s normal pressure and shape
• This fluid is produced at the back of the eye, travels to the front, and leaves via a sieve-like drainage system

Question 4

How would you explain primary open-angle glaucoma to a patient?

Answer 4

• Glaucoma is an eye condition where the nerve connecting your eye to your brain becomes damaged
• This is usually caused by fluid building up in the front of the eye, increasing pressure inside the eye
• If it is not diagnosed and treated, it can lead to vision loss
• There are many different types - primary open angle glaucoma is the most common
• This is where fluid and pressure build up slowly over time
• Explain it using a clog in drain of kitchen sink analogy (sink gradually fills up and overflows)
• In your eye, there is nowhere for the extra fluid to go, so the pressure increases and it damages the nerve at the back of the eye

Question 5

How would you explain the risk factors of glaucoma to a patient?

Answer 5

• It is unclear why the drainage network in the eye clogs, but there are multiple risk factors:
  1. increasing age
  2. being short-sighted (myopic)
  3. being Afro-Caribbean ethnicity
  4. smoking
  5. +ve family history of glaucoma

Question 6

How would you explain the management of primary open-angle glaucoma to a patient?

Answer 6

• Aim: to minimise the impact on your QoL
• Discuss options and decide on a suitable plan together
• Management usually involves eye drops
• These eye drops can either reduce the amount of fluid produced, or increase the drainage of fluid
• Most commonly used eye drops are called latanoprost
• It is important that you are away of the side effects of these eye drops which include brown pigmentation of the iris and increased eyelash length
• Eye drops aren’t the only option, we can also consider surgery if you are unable to use eye drops or if they are not working out for you

Question 7

What follow-up will the patient need?

Answer 7

• Regular check ups
• Because of the increased risk of damage to your eyes, you will be invited for regular check up (local eye department or with an optometrist in the community
• Measure the pressure in your eye and look at the back of the eye to make sure the nerve looks healthy
• Also do regular visual field tests

Question 8

What complications of open-angle glaucoma does a patient need to be aware of?

Answer 8

• Acute angle-closure glaucoma
• Progression of glaucoma
• Driving

Question 9

How would you explain acute angle-closure glaucoma to a patient?

Answer 9

• If you develop sudden intense eye pain and red eye or reduced/blurred vision, you need to seek medical attention immediately
• It could be that you have a sudden form of glaucoma where the drainage system has quickly become blocked, and the pressure has increased very rapidly
• It is often accompanied by nausea and vomiting, headaches, and see haloes around bright lights

Question 10

How would you explain progression of glaucoma to a patient?

Answer 10

• People with glaucoma are at risk of worsening of their sight and eventually it can be severe enough to significantly affect their quality of life
• Important that you use the drops as and when advised to reduce the risk of damage to your eyes and therefore blindness

Question 11

How would you explain the impact of glaucoma on driving to a patient?

Answer 11

• Because your eyesight gradually worsens with glaucoma and your brain tries to adapt for any loss of vision, you often have little awareness of your blind areas
• This could lead to serious events whilst driving
• It is therefore important that we make sure you meet the DVLA eyesight requirements, for both the safety of yourself and others

Question 12

How should you finish an ‘explaining glaucoma’ to a patient?

Answer 12

“We have discussed quite a lot today, including what glaucoma is, the symptoms you might experience and how the condition is managed. I realise this is a lot of information to take in and therefore I have a leaflet which summarises everything we’ve discussed. You will require regular checks to ensure your glaucoma continues to be well controlled. It is also important that you seek a review if you notice your vision worsening or have any other concerns.”

• Is there anything you would like for me to go over again?
• Do you have ay other questions for me?