An overview of the patient journey

The patient journey may start with a referral because of increased intraocular pressure detected in a routine eye examination in an otherwise asymptomatic patient, or a sudden awareness of changes in their visual field.

Clinically there are clear diagnostic procedures to follow:

• to establish a diagnosis of glaucoma
• to monitor the progression of glaucoma and guide therapeutic decisions.

Glaucomatous optic neuropathy is the hallmark of all types of glaucoma.

A current clinical definition of glaucoma is:

“A characteristic pattern of glaucomatous optic neuropathy (e.g., narrowing of the neuroretinal rim) with corresponding visual field defects.”

The type of glaucoma, the severity of the disease, and the risk of blindness can be assessed by carrying out gonioscopy, slit lamp examination, visual field tests, and intraocular pressure (IOP) measurement.

The impact of the diagnosis on the patient should not be underestimated. Most glaucoma experts would advise that educating your patients is essential for treatment compliance. However, listening to the patient is equally important as there may be a wide range of issues that affect them because of glaucoma.

The approach to glaucoma diagnosis distinguishes patients with:

• Patients with definite (or unequivocal) glaucoma: those who have definite signs of glaucomatous optic neuropathy. They are at imminent risk of visual loss, usually need treatment, and must be monitored.
• Patients with suspected (or equivocal) glaucoma: those with possible signs of glaucomatous optic neuropathy. They are not at immediate risk of visual loss, at least in the short term, and usually do not need treatment, but can/must be followed up and monitored (depending on the patient).

In this video, we look at the investigative journey that a patient follows during each visit to the eye clinic. Support for glaucoma patients goes beyond screening and medication. Each patient will have specific needs and it is important to try to understand how glaucoma affects each individual patient in order to support them in the best way possible.

Share the challenges you have encountered in investigating glaucoma patients in your setting and also the support mechanisms you may have put in place.