Perspectives

‘This added to my multiple myopia’

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7402.1336 (Published 12 June 2003) Cite this as: BMJ 2003;326:1336
  1. Les Irwig (lesi@health.usyd.edu.au), professor of epidemiology
  1. Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006, Australia

    Ayear ago, at the age of 55, I was diagnosed as having normal-tension glaucoma. I had an upper visual field loss in both eyes—about 20% of the field in the right eye and about 30 % in the left eye, in which the area of loss was close to the centre of the visual field and therefore potentially threatened fixation. This added to my lifelong myopia, which I now know is a risk factor for glaucoma. Like many patients with a chronic condition, I read extensively about glaucoma after receiving the diagnosis. However, I had the advantage of epidemiological expertise, a special interest in screening and diagnosis,1 2 and a deep-seated belief in the importance of patient involvement in decision making.3 I will discuss issues that were important to me as a patient and that highlight potential improvement in management. Many of these points may be generalisable to other chronic conditions. Health care often involves a partnership between practitioner and patient sharing the best evidence, deciding how to make decisions, and incorporating patient preferences.4


    Embedded Image

    The correct procedure for using eyedrops: (left) pulling open the bottom eyelid to insert the drops and (right) pressing on the tearduct for two minutes to prevent drainage into the nose/mouth

    MEDISCAN/DANIEL GEE

    How should I decide whether to start treatment and, if so, which treatment?

    Randomised trials show that pressure reduction by drugs, or trabeculoplasty by laser or surgery, will slow the loss of the visual field.5 6 Deciding whether to start treatment, and if so which treatment, depends on the extent to which the benefits outweigh the harm of adverse effects of treatment. If my visual field loss was stable rather than progressive, treatment would involve harm without any potential for benefit. Ophthalmological opinion was …

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