Even if the annual glaucoma incidence numbers were declining, the prospects for making headway against this insidious disease could be described as abysmal. “Current estimates are that 60% to 70% of glaucoma in the US population is undiagnosed,” notes Mark Swanson, OD, MSPH, in his article on epidemiology on page 44 of this issue, our 20th Annual Glaucoma Report. “When taking into account the low levels of adherence to glaucoma medication regimens,” he goes on, “as much as 80% of glaucoma in the US population may be untreated.”
But we all know the numbers aren’t declining—they’re increasing, both in the aggregate and in the lifetime exposure per patient. Because the population is aging, and average lifespan has lengthened, we have more elderly people than ever, and they live longer nowadays. If it’s true that only one in five glaucoma patients is adequately maintained on therapy, the challenge to eye doctors seeking to reverse those trends is formidable.
For minority patients, the future looks especially grim. Various racial and ethnic subgroups have higher rates of glaucoma, higher rates of poverty and higher rates of population growth than the country as a whole. Put all those together and they point to a crisis in the making: more patients in need of care, with a disproportionate lack of access to routine medical services, and cultural and financial obstacles to contend with too.
For patients, it’s the perfect storm; for ODs, the perfect opportunity to rise to the challenge.
With its chronic, slowly progressive nature, glaucoma is best suited for doctors who can invest the time to document its course over a long time span. The battery of standard tests—visual fields, OCTs, optic nerve exams—can make patient visits time consuming for the practice. The clinical decision-making responsibilities—though potentially life-changing for the individual—are typically non-urgent, allowing time for careful analysis and consideration, including consultation with specialists when needed. And the doctor/patient rapport must be strong enough to break through the barriers to medication adherence.
Every one of those aligns exactly with the strengths of optometric practice (and, not coincidentally, with deficits in ophthalmology), as ODs cultivate relationships with patients through years or often decades of routine care. With MD practices fewer in number compared to optometry’s footprint, and their practitioners so overwhelmed with surgical case loads, glaucoma is an inherently poor fit for most busy ophthalmology practices.
Put another way, glaucoma care won’t improve until ODs take charge of it. Now’s your chance to shine.
ODs: We’re Up to the Task
Fortunately, optometrists seem both willing and able to take on the extra work. In the recently released AOA manpower study of eye care supply and demand in the US, optometrists said that they could fit in an additional 19.8 patient visits per week even if they already had a full schedule, without adding more hours to their clinic time.
The manpower study cites a previous AOA research effort, the 2012 National Eye Care Workforce Survey of Optometrists, in which “responding optometrists indicated that, if they were able to operate at their full capacity without increasing their current patient care hours, they could provide about 32% more patient visits per year than they were actually providing.”
“If we take this excess capacity into account and compare supply including excess capacity to the baseline demand, there is no longer excess demand,” the manpower report states. “In fact, our estimates indicate that there is significant excess supply when this excess capacity is included.”
There’s no shortage of patients in need of care to take up that excess capacity, of course. The AOA report cites the often-mentioned increase in pediatric patient visits in the wake of the ACA, and also the need for more diabetic eye health screenings. Without diminishing those pressing needs, glaucoma might be the ideal place to start.
Fitting in lots of extra patient visits won’t be easy. Relating to the increasingly diverse population will pose challenges too. But glaucoma is a public health crisis in the making—and optometrists are ideally positioned to conquer it.