April 23, 2025
3 min learn
Key takeaways:
- One speaker argued that common ophthalmologists may enhance early prognosis of glaucoma.
- One other mentioned glaucoma is a fancy illness that necessitates specialist-level data.
SEVILLE, Spain — Whereas glaucoma prevalence is rising, glaucoma specialists are briefly provide, and accessibility to specialised facilities is proscribed. Can this hole be stuffed by common ophthalmologists?
This concern was debated on the Congress on Controversies in Ophthalmology.
Information derived from Suarez J, et al. Debate 1: Ought to glaucoma be managed by complete ophthalmologists or glaucoma specialists? Introduced at: Congress on Controversies in Ophthalmology; April 4-5, 2025; Seville, Spain.
For
Joel Suárez, MD, mentioned the basis of the issue in Spain particularly, which he mentioned is uneven distribution of hospitals within the nation. Round half of the hospitals are situated in three cities, Madrid, Barcelona and Seville, and rural areas are normally removed from secondary and tertiary care amenities.
Joel Suárez
Printed papers on the geographic distribution of ophthalmic subspecialties present that this case will not be a lot totally different in the US.
“We will see how there’s a discount of glaucoma specialists and different subspecialties within the rural areas yr after yr,” Suárez mentioned.
Issues with entry to care have a big influence as a result of if sufferers are undiagnosed and never correctly managed, glaucoma can result in blindness.
“As a glaucoma surgeon, I’ve to inform you that our predominant problem and principal goal will not be the working room however the early prognosis,” he mentioned. “No less than 50% of glaucoma circumstances stay undiagnosed in Europe, and this fee is way increased in different areas like Asia and Africa.”
For this reason common ophthalmologists are an indispensable useful resource, he mentioned. They’ve a complete view of eye pathologies, are extra accessible and are greater than able to detecting the early indicators of glaucoma.
“I believe we should always commit our efforts to offering schooling and coaching for common ophthalmologists in glaucoma,” Suárez mentioned.
He famous that there’s growing curiosity in AI utilized to glaucoma prognosis, prediction and identification of development.
“We must always benefit from what this new expertise gives us,” he mentioned.
In opposition to
Given the complexity of glaucoma, development variability and remedy intricacies, administration by specialists is sure to result in higher outcomes, fewer problems and enhanced affected person satisfaction, in response to José Belda, MD, PhD.
José Belda
Glaucoma will not be one illness however a gaggle of power, progressive optic neuropathies, and every of them requires totally different approaches to prognosis and remedy, necessitating specialist-level data, he mentioned.
It additionally requires the mixing of a variety of diagnostic instruments that may solely be present in specialised clinics, together with optic nerve evaluation, IOP measurement, visible discipline testing, superior imaging, central corneal thickness measurement and gonioscopy.
Misdiagnosis can result in overtreatment or missed development, in response to Belda, and since the prevalence of glaucoma is rising worldwide, mismanagement of prognosis or intervention would even have a heavy influence on well being care and social prices.
When surgical procedure is required, which has change into extra widespread with the appearance of MIGS, particular coaching is required not just for the process however for the follow-up, which is crucial to make sure the success of surgical procedure. Coaching can be crucial to watch progress and decrease the danger for problems.
Glaucoma specialists are in a position to obtain this as a result of they handle a excessive quantity of glaucoma circumstances and a excessive quantity of surgical procedures, which improves their procedural experience, in response to Belda.
Common ophthalmologists are overloaded with work, have lengthy ready lists and are below quite a lot of stress from an more and more excessive variety of sufferers.
“We can’t stress them extra by imposing on them extra work and the prognosis of adverse circumstances of glaucoma for which they aren’t correctly educated,” Belda mentioned.
Nevertheless, common ophthalmologists can play a job in a coordinated, team-based, patient-centered care mannequin. This method can contain optometrists, common ophthalmologists and glaucoma specialists.
Rising applied sciences reminiscent of AI and new imaging modalities will assist to evaluate extra sufferers, monitor development and choose the circumstances that should be handled by glaucoma specialists, Belda mentioned.
An environment friendly teamwork-based mannequin would meet sufferers’ expectations and the demand for specialised care, avoiding many potential medicolegal points.
“Misdiagnosis or delayed remedy below generalist care can result in authorized penalties,” in response to Belda’s presentation, so it’s essential to work collectively.
American Academy of Ophthalmology and European Glaucoma Society tips advocate referral to a specialist for average or superior glaucoma, whereas the preliminary screening and secure case monitoring will be performed by a common ophthalmologist, he mentioned.
References:
- European Glaucoma Society. Br J Ophthalmol. 2021;doi:10.1136/bjophthalmol-2021-egsguidelines.
- Gedde SJ, et al. Ophthalmology. 2021;doi:10.1016/j.ophtha.2020.10.022.
- Gibson DM. Prev Med. 2015;doi:10.1016/j.ypmed.2015.01.008.
- Li F, et al. J Clin Make investments. 2022;doi:10.1172/JCI157968.
- Tonti E, et al. J Pers Med. 2024;doi:10.3390/jpm14101062.
- Wang KM, et al. JAMA Ophthalmol. 2022;doi:10.1001/jamaophthalmol.2022.1001.
Sources/Disclosures
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Suarez J, et al. Debate 1: Ought to glaucoma be managed by complete ophthalmologists or glaucoma specialists? Introduced at: Congress on Controversies in Ophthalmology; April 4-5, 2025; Seville, Spain.
Disclosures:
Belda and Suárez report no related monetary disclosures.
