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Glaucoma: What You Need To Know (Video)

On May 15, 2020, Glaucoma Research Foundation presented an Innovations in Glaucoma Webinar, "Glaucoma: What You Need To Know."

The recorded webinar features a discussion with ophthalmologist Ruth Williams, MD (Wheaton Eye Clinic) and Thomas Brunner (President and CEO, Glaucoma Research Foundation).

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"I learn something new with each webinar."
- Elaine Lanier-Bohan

"A convenient, innovative educational offering which contained important practical information that helps patients significantly improve their treatment outcomes."
- Maryanne B., glaucoma patient

Dr. Williams provides practical information about glaucoma, answers to frequently asked questions about glaucoma, and tips for living with glaucoma. She also discusses the COVID-19 pandemic and its current impact on glaucoma patients.

Webinar Transcript

Thomas Brunner: My name is Tom Brunner and I'm the president and CEO of Glaucoma Research Foundation. Welcome to our webinar, “Glaucoma: What You Need to Know.” Today we will be providing answers to frequently asked questions and providing information and tips on understanding and living with glaucoma. We will also address some ongoing concerns regarding COVID-19 and what that means for you as a glaucoma patient.

Dr. Ruth Williams has very kindly agreed to join me today to talk about glaucoma and answer your questions. Ruth is a glaucoma specialist at the Wheaton Eye Clinic near Chicago. She received her medical degree from Rush Medical College in Chicago and went on to do her ophthalmic residency at California Pacific Medical Center in San Francisco, and a glaucoma fellowship at the University of California in San Francisco. Ruth is a past president of the American Academy of Ophthalmology, and currently serves on the Glaucoma Research Foundation Board of Directors. It is indeed a privilege and honor to welcome Ruth Williams.

Ruth Williams: Thank you, Tom. I'm so happy to be here with you, the Glaucoma Research Foundation team and all of you participants, many of whom have glaucoma. It can be very lonely to be a glaucoma patient and you can often feel like you're the only person you know who has glaucoma. But there are 80 million people worldwide who have glaucoma, and it's the number one cause of irreversible blindness worldwide. Even though the blindness that comes from glaucoma is irreversible, we have excellent treatments and we most often can prevent blindness with our excellent treatments. And as we'll talk about a little bit today, we have hope for a cure for tomorrow.

Glaucoma is a group of diseases, many diseases in a group together, and what they have in common is a particular kind of damage to the optic nerve. The picture I have on the screen shows a beautiful healthy optic nerve. I love looking at nerves like this. And if you look at the screen you'll see almost like a rim, a tire rim that goes all the way around or some people describe it as a doughnut. And that rim that goes all the way around of healthy nice nerve tissue is a collection of all the nerve endings in the back of your eye that come together as a cable and go back and synapse in the brain where we have vision.

And in this next slide, I'm going to show a picture of a glaucomatous optic nerve. And if you look up at the top of the nerve, you can see that you have that nice beautiful rim of tissue and the blood vessels gently go up over the edge. But if you see at the bottom, those blood vessels dive down underneath and come up sharply over a sharp rim where there isn't that nice cushion of nerve tissue. And that's classic damage from glaucoma.

When we follow patients, we have typically several modalities for doing that, and most of you are familiar with the visual field test, which we call a function test. And what that means is it measures what you see. And so as you sit in the bowl and the little lights are shown to you and you push a button, we can map out areas where you don't see as well.

And in this particular picture, this patient has an inferior arcuate scotoma, which means that there's that upside down rainbow sash of decreased vision, or decreased sensitivity. And then there's the optic nerve scan, which actually measures the structure of the optic nerve itself. So if the optic nerve goes all the way around like a tire, and we measure the thickness of the tire rim all the way around, and then unfold it in a long line, that's what you see. And so in this particular picture, if you look up at the top, this patient has some thinning of the superior part of the tire, and then a deep thinning at the inferior part. And that thinning is what we saw correlated on the optic nerve when it thinned down and the vessels disappeared behind.

And then the third thing we look at very carefully is how the optic nerve looks itself. And I chose this picture very specifically, because this patient also has nearsightedness or what we call high myopia. So this is a person with very thick glasses. And in those patients and some other patients, the optic nerve can be very hard to examine. It won't be so easy, like the first slide I showed you. The reason I put it here is to make the point that sometimes one test works better for us than another, and it's really putting them all together that allows us to determine what's going on and then to follow patients over time.

You'll notice I haven't mentioned intraocular pressure. When my patients come to me, the very first thing they want to know is, "What's my pressure?" And in fact, some people don't sleep the night before worrying or wondering what their pressure is. And pressure is so important because it's what we call a modifiable risk factor or the one thing that we can change. But intraocular pressure still is a risk factor and not the disease. For example, some people can have a high pressure and never develop glaucoma. Other people will develop glaucoma with a low pressure. And so intraocular pressure is exquisitely important, but it does not define glaucoma.

Glaucoma as I mentioned is a collection of diseases, and I'm going to give you just a couple examples of things that lead to glaucoma. This beautiful art picture is of a brown iris, and the dark in the middle is the pupil. And then that snow flaky fluffy material that you see around the margin of the pupil is called exfoliative material or exfoliation. And it's a material that sloughs off inside the eye and then can clog up the eye drainage channels to cause elevated pressure and lead to glaucoma.

Primary open-angle glaucoma is the most common kind worldwide. And increasingly, we're finding that primary open-angle glaucoma can have a genetic component to it. And it's not so simple or straightforward. So if you have a glaucoma gene it doesn't mean you're going to get glaucoma, but we're finding more and more gene types that are linked to glaucoma. So there tends to be family histories. Sometimes the family history plays a larger role in certain families than in others. This is a depiction of a myocilin gene, a gene that has been found to be linked to primary open-angle glaucoma. While we can't do it today, someday I imagine that we'll be able to do genetic analysis and give patients a risk assessment as what their risk is of developing disease. But we're not there yet.

This kind of glaucoma is called neovascular glaucoma, and you'll see all those blood vessels growing on this brown iris. Neovascular glaucoma develops when there's a lack of oxygen supply to the retina and so the eye sends out factors to grow new blood vessels, and they grow in abnormal places. So in this case, the blood vessels are growing on the surface of the iris and clogging up the eye drainage channels.

We have many treatments for glaucoma, and the most traditional tried and true treatment that we've done for many decades is eyedrops. And if I've learned one thing in my 30 years of practice is that it sounds very easy to the doctor to say, "Here, take this eyedrop." Or sometimes we say, "Take these three eyedrops." But what I've learned is that it's actually very complicated and very difficult, and there are many steps along the way that include getting a prescription, getting to your pharmacy, checking the insurance, making sure your co-pay is not too high, getting the drops home, having them in the right place, deciding whether they need refrigerating or not, remembering to do it at the right time in the right eye, and getting into a routine.

I view one of my most important roles as, to come alongside patients and help you figure out how to effectively use the drops the way they're prescribed. Patients sometimes are hesitant to tell me what's really happening at home, and I really appreciate it when my patient will tell me, "I really only use my drops at night when I'm supposed to use them twice a day." And then we can talk about and strategize how to figure out how to do that. One thing that's very helpful about drops is that they're color coded. Many of you know what your color codes mean. But if you don't, it's a wonderful thing to initiate a conversation with your ophthalmologist about: which color cap do I use in the morning, which color do I use at night, and helps keep the eyedrops straight.

Another treatment we have is laser treatment, and we have several different kinds of lasers we do for glaucoma for different purposes. But the role of laser is very, very important both to open-angle glaucoma and to angle-closure glaucoma, and some of our recommendations shift over time but the beautiful thing about laser is that it's done on an outpatient basis, either in the surgery center or often in our offices. It's very, very safe and it's such a straightforward thing to do. So laser is, when it's appropriate, a wonderful treatment.

And then we have surgery. And we used to just have a few surgeries but there's been an explosion of surgical options for the treatment of glaucoma. Our traditional surgeries include trabeculectomies that we do, and different kinds of tubes that can be put in the eye. And then there's a whole new class of surgeries called micro invasive glaucoma surgery, or called MIGS. And there are many different MIGS procedures that are used in different situations. And it can be a little overwhelming for patients if you read on the internet about this one or that one. And, "How come my doctor recommends one and I've read about another?" What I'd like to tell you is that these choices are expanding and changing. And it's great to read about them but each surgeon will pick the procedure tailor made for your particular situation.

We used to have these algorithms for treatment decades ago when we'd start out with drops, and then when drops weren't working very well, we might try laser, and when laser wasn't working then we'd go to surgery, but there are so many choices. Now I like to think the treatment of glaucoma a little bit like a painter's palette. We have a picture we want to paint. And the picture is that we're going to control the glaucoma and save the vision. And to accomplish that goal, there's a whole palette of choices, and they're increasing.

For example, in the last few years we have some new glaucoma drugs. One has a new mechanism of action that we've never had available to us before. And there's a new injectable medication coming out where you can inject a little pellet of medicine in the eye. There are lots of new, as I mentioned, MIGS procedures, and exactly how we mix that together and the order that they're recommended for you will vary from patient to patient. And in fact, it may vary from your right eye to your left eye.

It's an interesting time to be a glaucoma patient in the era of the COVID pandemic. I'm going to make two points about glaucoma and COVID. One of them is philosophical and the second is practical. The COVID pandemic has a lot in common with glaucoma. It's scary. We don't have a cure. Our treatments are evolving over time. And we're trying to use the very, very best evidence to make recommendations and figure out how to live with this disease. Just like glaucoma, COVID's not going away. We're just going to learn and figure out how to manage it and how to make it less scary and how to get on with our lives despite the pandemic. And that brings us to the whole topic of, how do we treat glaucoma in the middle of a COVID pandemic?

In mid-March, the glaucoma and ophthalmology practices fairly abruptly closed. We were only seeing emergency patients or super urgent issues and routine glaucoma checks were postponed and rescheduled. And just now in the last week or so probably this month, most practices are starting to open up to seeing patients. And I'm finding, I myself have gone back to seeing patients. And I have two kinds of patients. The first kind is, "Oh, I'm so glad you're open. Thank you so much for being here for me. I'm so grateful that your staff is here. I can't wait to get my pressure checked and make sure my glaucoma is okay." And then there are my patients who say, "Doc, I'm so scared of the Coronavirus. I'm not coming in until there's a cure and this whole thing is over." And it's really important to realize that glaucoma goes on despite the COVID pandemic and we have to figure out how to take care of you, and take care of your glaucoma, and keep you safe and keep our staff safe. And so that's what we're trying to figure out how to do in the weeks ahead.

We've also stopped all elective surgery and in a lot of states we're opening back up for elective surgery this month. And so patients now can, who put off their glaucoma surgery or cataract surgery, we can now start scheduling your cases with the proper safety protocols in place. So what are some of the things we're doing? This is a picture of me wearing an N95 mask, I can tell you it's really hard to work all day with an N95 mask. It's sealed carefully all the way around so all the air is coming through the mask, and it's a little exhausting. My staff wears them and all our patients are asked to come with a mask. So it's created some really interesting situations. For example, some of the masks are very stiff and kind of bowl shaped. And so when I go to check the [eye] pressure, the tonometer bumps up against the mask. So I have to flatten the mask down. So I push up against the mask and then I get a pressure check.

I even had a patient come in with one of those World War II gas masks on, which was very entertaining and we enjoyed it very much, but he had to take it off because you can't check the pressure with a gas mask on. An eye exam is especially challenging during the time of COVID because we have to get so close to your face. And so, our staff ophthalmologists are extremely thoughtful about how to do that safely for us and safely for you. One of the things we've employed is called a breath shield, and you'll see it here, it's that plexiglass shield that's coming down from the oculars, and that creates a little barrier between the doctor and the patient. I always took my glasses off to see patients, I like that much better. But for safety now I leave my glasses on and that's an adjustment and I even have scratches all over my glasses from looking through the oculars.

We're also asking patients to come in alone and leave family members in their car. Many ophthalmology offices have created all kinds of innovative patient flow changes like checking patients in from their car, over the phone, and taking the history, and then when it's time to see the doctor the patient can be ushered right into a patient room, be seen, and leave. There are other practice flows where someone might come in, get a pressure check, get an OCT, go home, and then the doctor will call by tele-health later. We're figuring this out. But what I can assure you is that your ophthalmologist is working very hard to make it safe for you to come in and get checked. Because we don't want to let your glaucoma go [unchecked] however long this is going to go on, and it's going to go on a long time.

I picked up this picture (there's something wrong with this picture). I picked this picture from a newspaper in Pittsburgh. And it shows the social distancing that we're creating in our waiting rooms when we do have to have patients wait in the waiting room. So if you have to wait in a waiting room the chairs are far apart. But the problem with this picture is no one has a mask on. I can assure you that every person in your doctor's office will be wearing a mask. And then surgeries are starting up. And we're figuring out how to make surgery a safe place with everyone with their PPE [personal protective equipment]. At this time, most patients are required to have a COVID test before surgery. Some practices have drive-up COVID testing to make it easy for patients. I don't know how those recommendations are going to unfold over time.

For example, I got an email from my hospital system this morning saying that they were going to amend their requirements before surgery for COVID testing. So all of this landscape is evolving, and what exactly we do today may not be what we do in six months. But what I can tell you is that the medical community is so committed as we always have [been] to keeping our patients safe and doing what's best for them, and keeping our staff safe as well. So I think there's going to be a lot of change. It's a sobering time but we're getting through it.

Glaucoma and COVID remind me of one of my very favorite stories. This is the story of Ernest Shackleton, who was an Antarctic Explorer, and he took his ship the Endurance to explore Antarctica in 1914 to 1917, and the ship was caught between two ice floes and smashed in half and it sunk, leaving all 27 crew members on an ice floe. And Shackleton had a vision for saving his crew. And he did so. He ended up rescuing all 27 of his crew members. And that reminds me a little bit of what we're doing in the middle of the COVID pandemic, we have a challenge, it's a very serious time, it's a sobering time, but we're going to use evidence, and science, and patient safety, the principle of patient safety, to get to our goal. Shackleton said, "Optimism is the true moral courage." And that's true of the COVID pandemic. And it's also true of being a glaucoma patient. We're using the evidence-based science and commitment to your health and the health of your eyes and that is optimistic. And someday our optimism will even lead us to a cure for glaucoma.

Thomas Brunner: Thank you, Ruth. That was fantastic. I always learn something when I listen to you and the pictures and graphics were terrific. And I certainly agree that this is a time when we all need to be as optimistic as we can. Now, we do have some time for questions and the first question is about eyedrops. You talked about that earlier and you mentioned some of the issues. But maybe you could just comment a little bit on some of the tips that you give to patients on how to actually put in their eyedrops effectively. And I know there are issues like punctal occlusion, or lying down, or sitting up. Could you comment on what's the best way to put in eyedrops?

Ruth Williams: Sure. It can be confusing for patients. Because you'll read one thing on the internet and see a video about something else and as Tom alludes to, "do I have to pull down my eyelid, do I have to do it standing up or sitting down." And I would say first of all, discuss it with your physician because he or she may have her own favorite tips. But here's what I tell my patients. First of all, wash your hands. One thing I didn't say in my talk (because I forgot to) is that hand washing is absolutely central to patient safety for physicians, and we've done it forever. So when COVID came around, we were already in the habit of washing. I use Purell probably six to eight times every patient. So the same is true for you taking care of your eyes — wash your hands first.

I think it's easiest to get the drop in if your head is leaned back or you're lying down, and that's because gravity becomes your friend. You're not fighting gravity, you're using gravity. Some people need that help, some people don't. The same is true of pulling your eyelid down, if that can be helpful. But you know, the way we put drops in children or babies is we wait till they're asleep. And then we just pop it in the little corner there and it leaks in. So that can work for you as well.

Punctal occlusion — there are lots of different opinions about punctal occlusion. I personally only use punctal occlusion if I'm trying to decrease the drop getting into the nasal passages; if it's irritating or causing some kind of post nasal drip. Others feel like if you do punctal occlusion it keeps your drop around. But if you have a good size drop in the eye, that drop is larger than it needs to be to get maximal absorption. I'm personally not big as a punctal occlusion person, but your doctor might be, so I would ask.

Thomas Brunner: Okay. Thank you, Ruth. Another question — you described SLT a little bit during your talk. And [the question] was about, "do I need to take drops after SLT?" And "can SLT be repeated?" And I'm going to add one more question for you. Because I was interested when you were talking about all the important things that one has to remember with eyedrops. Getting them, and taking care of them and putting them in and administering them daily and so on. And one of the benefits of SLT, which I'm not telling you anything, but certainly the fact that one treatment might last years. So for a newly diagnosed patient I'm just wondering, which do you recommend, SLT or eyedrops?

Ruth Williams: Oh, that's such a fun question. Well, SLT is Selective Laser Trabeculoplasty, and it's a treatment that we do commonly for patients with primary open-angle glaucoma. There is a new study that was recently performed looking at using SLT versus drops for primary therapy. And what that means is, for the very first thing you do [to treat glaucoma], do you go to drops first or SLT first, and it showed fairly equivalent outcomes. And so, of course, some people would prefer to do SLT. What I would say is that your doctor will have his or her own opinion about that. And there's not a right and a wrong answer. But certainly SLT has a very central place in our treatment, and a lot of physicians are using it earlier in the treatment paradigm.

One thing I will say, my personal goal, when I look at a patient is to get your glaucoma controlled with the least number of drops possible. So I'm always thinking, how can I make this simpler and easier for my patient? And of course SLT has a place in that. The question about "do you take drops after SLT?" Oh, well, that's a good one because until a few months ago, I actually didn't give my patients any drops after SLT. There's a study, it's not a real big study, meaning there weren't lots of patients in it, so you could argue the point; but the study shows that giving steroids or anti-steroidals, it's kind of like ibuprofen for the eye, non-steroidals increases the outcome of the laser. So if your doctor doesn't do drops, that's a traditional and good way but some of us have shifted to using steroids or non-steroidals after SLT.

Can SLT be repeated? It can. And again, usually we would only repeat it either zero times (in other words, don't repeat it) or we might repeat it once. In the rarest of occasions, we might do it more often than that, but it's typically once or twice you would have SLT.

Thomas Brunner: And I think there's one more question. And this one is an important one. It's about communicating with your doctor. And I know that would not be a problem for you, Ruth. But sometimes patients do have difficulty communicating with their doctor. And in this case, a patient was talking about their pressure not stabilizing, feeling like somehow the medications were right and just, didn't know how to deal with that. And I'm just wondering what you would suggest if a patient feels like somehow they're not communicating well with their doctor.

Ruth Williams: This is probably the biggest challenge for being a patient and for being a doctor is communicating well. Actually, I'll say, it is a problem for me sometimes. No matter who we are, we're two human beings trying to communicate. And the physician is taking a very complex picture with complex language and distilling it down to offer education and recommendations to the patient. The patient comes in, each of you with different fears, different hopes, different needs.

And what I always encourage people to do if you're unhappy with your doctor is to try again. So go back and say, "The most important thing for me in this visit is to talk, and here's my concern." So it's helpful if you don't come in with six things you want to talk about, but come in with one or two things. Really one. So if you come in and say exactly what this person just asked, so come in and say, "My eye pressure isn't stabilizing and I don't think my drops are right, do you have another option? And that's what I'd like to talk about." So advocate for yourself. Most doctors really, really care about communicating well. Sometimes there's a lot of pressure on us and we move too quickly. So ask us for time. Or here's another strategy. You could say, "Can I make another appointment with you just to talk about my one question?" So, push back. And most of the time, most physicians will stop and listen to you and address your issue.

Thomas Brunner: Great answer. Thank you, Ruth. Another question that we have is, someone who's a caregiver and they were wondering about heavy lifting, and whether there should be a concern about that with glaucoma. And also weightlifting and this kind of thing. Is that a problem for a glaucoma patient?

Ruth Williams: Oh, that's such a good question. Well, the first thing I want to say is the caregivers are our national heroes too. Caregiving, I said at the beginning of this talk 'having glaucoma is a lonely thing,' well, being a caregiver is too. So, heavy lifting can be a problem under certain circumstances. For example, during the post-operative period we may not want you heavy lifting. And there are certain, if you have very severe glaucoma your physician may or may not want you to do some heavy lifting. So what I would say is, ask your physician. If you have mild glaucoma, it's probably not an issue. If you have very severe glaucoma your ophthalmologist may have an opinion about that.

Thomas Brunner: And what about allergic reactions? How would a patient know if they're reacting to a drop inappropriately let's say, or if they have an allergy or an allergic reaction? How would they know?

Ruth Williams: There are two kinds of reactions that you could have to drops; one is what we call intolerance. Patients are intolerant if it stings too much, if your eye is so red you hate it, those are intolerances. An allergy is an actual immunologic reaction that looks very specific on exam. Sometimes that I can itch. They usually come on gradually and we typically diagnose them by looking for certain kind of little bumps on the conjunctiva at the slit lamp. So this is what I would say about any eye problem. If you're having redness, decreased vision, or pain, or any kind of discomfort, come and see us and let us take a look and find out what's causing it. It might be an allergy, it could be something else.

Thomas Brunner: So now this next question is really a tough one.

Ruth Williams: Oh good.

Thomas Brunner: And this sadly does happen — the patient is asking, "what happens if my vision continues to deteriorate or my loss progresses despite the fact that I'm taking all the meds, the pressure is low, or I've had laser. We've done everything we could and yet I'm still getting worse?"

Ruth Williams: Yeah, that's a really, really tough situation for you, the patient, and honestly for your physician too. We care so much about you and your vision and really, pour our lives into taking care of it. What I would say is that glaucoma is a chronic progressive disease and most of the time, we can arrest it or even slow it down slowly enough that it doesn't affect your quality of life, or at least we can keep you seeing. Occasionally we do have patients like this, who despite perfect pressures, despite perfect treatments, you can progress. Usually, not always, but usually, the eyes don't do that together. And usually people have one eye that's worse than the other. Occasionally though people do go blind from glaucoma despite our very, very best treatment. And that underscores how important it is for us to stay on top of it and do everything that we can do. It also underscores the importance of our conversation about curing glaucoma because until we cure it, we're going to have some of you that do progress despite everything we do.

Thomas Brunner: Your last comment is one of the things that really motivates us at Glaucoma Research Foundation. And certainly our new "Catalyst for a Cure" on vision restoration, where we're actually talking not just about stopping progression, but literally being able to possibly put new ganglion cells back into the eye, possibly reconnect the retina to the brain. And these ideas, which seemed impossible not that long ago now seem feasible, and the scientists are actually working on cures and on vision restoration.

Ruth Williams: I completely agree. When I talk to young people going into either research or some kind of healthcare field, I say, "Neuroscience is the frontier of medicine right now." We figured out so many things, but neuroscience is where we're just starting to figure it out. And I think, in my children's generation, that will be the thing we figure out. And it will be so exciting. So I hope we do it soon and I really am looking to the young people to pour their lives into solving these problems. We'll get it done.

Thomas Brunner: Well, and they are.

Ruth Williams: They are.

Thomas Brunner: A lot of scientists [are working on this], and as you say, neurodegeneration is really [an important problem to solve] ... because it's not only glaucoma; it's Alzheimer's, it's Parkinson's, it's these age-related neurodegenerative diseases that we're trying to tackle.

Thomas Brunner: Another interesting question is... someone who has occasional use of steroids is asking, what is the impact of that on my glaucoma?

Ruth Williams: Yes, I get asked this all the time — the association between steroid use and intraocular pressure rise is well known. It's most common with chronic use of topical steroids. So if you're taking a steroid eyedrop for a long time, it can increase your pressure. Occasionally pressures can go up even with short steroid use, say after cataract surgery or some short term use. And elevated pressure is more common in people with glaucoma or even a family history of glaucoma. So if you're using a topical steroid, it's extremely important to get your [intraocular] pressure checked.

It's much less common to get a pressure rise from taking steroids by mouth, or nasal sprays, or say an injection in your joint. And I tell my patients, don't worry about those short term steroids like the packs, that med pack of steroids that you take for six or seven days. Don't worry about that. If you're on long term oral steroid use, we definitely want to see you and check your pressure. I also tell my patients, don't worry about the injections in your joints. Joint pain is no fun to live with and it's very unlikely to affect your eye pressure.

Thomas Brunner: Another question that has come up is about anxiety related to glaucoma. And I know you communicate so effectively with your patients. How do you deal with that stress, that worry about, "am I going to go blind? How often do I need to get my pressure checked, how often should I be coming in for visual fields?" How do you handle that?

Ruth Williams: Well, I think there's two sides to that. And the first one is knowledge. It's scary to know what your visual field looks like, or what your pressure is doing, but I think knowledge is power. So I show my patients their visual fields, I want them to see... whether it's a mild one or a severe one, I want my patients to know what I know. So I'll show it to you. I'll take a picture of your optic nerve and I'll show you where it's thinning. And so then patients know that we're telling them everything, they're not feeling like we're hiding anything or that the other shoe is going to drop tomorrow and you never told me. So I think that's one part of it.
The other part of it is really telling patients how hopeful things are. Actually, there's three things. I'm going to say the second thing is acknowledging anxiety. So, you know it's really common to be anxious. It's really normal. People who I know just will say, "Oh, you're my..." Anxious patients are my favorite. And it's true because we can offer so much support. And so think of your ophthalmologist as your person who comes alongside you to support you in this journey. So yes, it's scary. Yes, it's sobering, but you're not doing it by yourself, you're doing it with a team. And we'll tell you if we're really worried about your vision getting worse. We'll tell you if you're doing great and you don't need to worry.

I told one patient that she needed to write on a piece of paper: "I am not going blind," and put it on her mirror. And she did that. "I am not going blind." Because she wasn't, but she was so afraid of it. So, you have a whole team of people behind you, helping you with this disease. Anxiety is normal. I already mentioned, I have patients who don't sleep the night before. I have people who are actually fine except for the day they come into the office and then the whole load of anxiety dumps at once. It's normal because it's not something we fix and get rid of in your life, it's something that you have to live with. And we help teach you how to live with it.

Thomas Brunner: I think that's such an important point, and certainly Glaucoma Research Foundation is there also to try to help. And if there are questions that are bothering you in between office visits or you get home and you think, "Oh my gosh, I wanted to ask the doctor this and I forgot." Try our website - www.glaucoma.org. Seriously, there's a huge amount of information. And most of it from ophthalmologists, from glaucoma specialists. And there are articles, and blogs, so if there's a question you forgot to ask, just get on glaucoma.org and go to the search box and put your question in and you'll find a lot of information. So that can also be very helpful.

This is just a picture of our website. And you can see there's a [search] box at the top there where you can put in a question and click "search," and you'll get all kinds of references and you can look at the articles. And even videos. I mean, there's a video even on how to take eyedrops.

Ruth Williams: It probably tells you to do punctal occlusion.

Thomas Brunner: No, I don't think so. I think this is one that Dr. Syd Williams did and it just talks about how to position yourself to, as you said, to use gravity to help you.

Ruth Williams: Gravity is your friend.

Thomas Brunner: Yeah. So I guess we've used up our time here for the questions and answers and, Ruth, you've done a fantastic job as always. And we hope that we'll be able to answer more of your questions at future webinars. And, again, remember, as I just said, visit our website and ask your questions up in that search box and hopefully that will help you to learn more about your glaucoma. And as Ruth said, I think it's so important to recognize it really as a partnership between you as a patient and your doctor, and you have your responsibilities to make sure you're taking your drops, or coming in for your visits, and the doctor has their responsibility to keep you seeing and working together is how you really accomplish that. So, it is a partnership.

And we'll talk a lot more about that at the second annual Glaucoma Patient Summit which is coming up in Oak Brook Illinois near Chicago. There'll be panels and speakers, leading ophthalmologists, glaucoma specialists, patients, caregivers will all be there. And also, we're going to have something new. We'll have some workshops where you can talk in small groups about understanding and how to cope with glaucoma. So I hope that you'll consider joining us in November.

At Glaucoma Research Foundation, we're as committed as ever to helping glaucoma patients even as we live in these very trying times. The staff is working safely from home, and we continue to advance our mission to cure glaucoma and restore vision through innovative research, and to provide information and education about glaucoma. So please do take your health and your vision seriously, and as both Ruth and I have said, work closely with your doctor to maintain your vision. Together we will cure glaucoma and we will restore vision. We would also like to thank Aerie Pharmaceuticals for their sponsorship of our webinar series, and the interest and support of all glaucoma patients.

So thank you all again so much for joining us today. Thank you for taking good care of yourselves, and your eyes, and your vision, and thank you for your continued interest and support of Glaucoma Research Foundation. So please stay safe, stay home, and stay healthy.

End Transcript.

Last reviewed on June 29, 2020

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