Specific Questions Related to Glaucoma
One of the objectives of The Royal College of Ophthalmologists is the education of the general public in all matters relating to vision and the health of the human eye. Towards the end of 2004, the College agreed to collaborate with Dr Foster, one of the leading publishers of healthcare information in the UK, on a range of articles. These articles were to be published in The Times ‘Body Beautiful’ Supplement but in the event, lack of space meant that not all the copy was featured. We believe that the work deserves an audience and we are able to post in full the articles on cataract surgery, glaucoma, laser refractive surgery and corneal disease on the College website. We hope that the readers find the pieces interesting and informative although they are not a substitue for a detailed medical consultation.
Is surgery necessary and how long will I have to wait?
As most cases of glaucoma do not require surgery, you need to ask exactly why it is appropriate for you. A surgeon might need to perform a trabeculectomy, where a small piece of tissue is removed from the eye to let fluid escape. According to Dr Foster’s hospital data the average wait for a trabeculectomy is 49 days.
How long will it take?
Each operation should take no more than 45 minutes and best practice is to perform this operation as a day case. You get to go home straight after the operation and most patients find that more convenient. However, some hospitals are better than others at managing to do this. Dr Foster statistics show that the best hospitals treat all patients as day cases while the worst treat only 7 per cent in this way. The average is 70 per cent, so ask what the day case rate is for your surgeon’s hospital. Those that remain in hospital after the operation stay for an average 1.57 days.
How many operations have you done and what is the success rate?
Some surgeons might have carried out many trabeculectomies, whereas others are relatively inexperienced in the procedure. Up to 5,000 trabeculectomies are carried out at NHS hospitals each year – non-specialist hospital trusts conduct as many as than 194 a year while some carry out only one or two, if any. One way of measuring success is to look at how often patients have to return to hospital following surgery. Dr Foster data shows that the average readmission rate is less than 7 per cent with the majority of hospitals having no readmissions after this procedure.
Do you specialise in glaucoma?
More than 40 per cent of the 1101 ophthalmologists in the Dr Foster database said they had a special interest in glaucoma. For complex cases, make sure you see someone that specialises in the surgery you are undergoing. Full details of consultant’s special interests can be found by going to http://www.drfoster.co.uk/Guides/ConsultantGuide/
What is your complication rate?
According to the National Trabeculectomy Audit, the average success rate for surgery is around 60% – ask how your consultant compares. Glaucoma sub-specialists obtain higher success rates in general, but be aware that certain surgeons take on difficult cases and so might have lower overall success rates. Also note that different surgeons use different criteria for success. Ask your surgeon to explain how and why complications can occur or have occurred and how they are managed. One in four patients will have a little bleeding in the eye and about one in five will experience leakage of the wound. Scarring is another possible complication and the opening made in the eye needs to be prevented from healing. Anti-scarring treatments are available, so ask whether these are suitable for you.
Is laser treatment appropriate?
Laser treatment for glaucoma might be available, but some types of laser therapy have proved less effective for glaucoma when compared to surgery. If your consultant suggests laser therapy, ask them to explain what type of laser therapy is being offered and why it is appropriate.
Are prostaglandin analogues available?
Around 90 per cent of glaucoma cases are treated with eye drops. Prostaglandin analogues are the latest type of antiglaucoma medication to be developed – dosing is required only once daily, they produce few side effects and are the most potent topical agents in reducing eye pressure. Beta-blockers are less favoured because of their side effects but can be useful, as can carbonic anhydrase inhibitors and alpha-agonists. If drops fail to work, surgery might be required.
What is your attitude to complementary therapies?
If you are interested in complementary treatments, you should assess your consultant’s attitude towards them and ask what they suggest in your case. Studies have shown that gingko biloba might help slow visual damage in glaucoma and cannabis (a controversial treatment) has been shown to reduce eye pressure. Vitamins A, C, E, lutein and zeaxanthin are often recommended for eye disease, but there is no evidence to show that they offer protection against glaucoma.