A glaucoma update with AOA’s EBO Committee

Excerpted from page 12 of the January/February 2021 edition of AOA Focus.

The AOA Evidence-based Optometry (EBO) Committee is working diligently to produce a new clinical practice guideline, Care of the Patient with Primary Open Angle Glaucoma. Danica Marrelli, O.D., is one of three glaucoma stakeholder experts serving on the EBO Guideline Development Group.

Dr. Marrelli has 25 years of experience caring for patients with the eye disease—she estimates that 75% of patients in her practice have glaucoma or are glaucoma suspects.

“About 2.7 million Americans suffer from glaucoma, and that number is expected to rise dramatically as the population ages,” Dr. Marrelli says. “Because it carries the potential for irreversible blindness, early diagnosis and treatment is key. Unfortunately, because it is usually asymptomatic, about half of Americans with glaucoma are unaware that they have it.

“Optometrists play a key role in the early diagnosis and management of glaucoma, because they provide the majority of comprehensive eye exams,” she says. “Staying up to date on new technology and treatment options for glaucoma is imperative to providing the best care for our patients.”

Dr. Marrelli shares three ways AOA members can brush up on all things glaucoma.

1. Familiarize yourself with the AOA’s guideline.

The AOA first released clinical guidance on glaucoma in 1995. It was a consensus-based guideline that was reissued in a second edition in 2002 and then revised eight years later.

“They’re online and so easy to access,” Dr. Marrelli says. It’s important to raise awareness of the guideline as a resource not only for doctors, but also among optometry students as they prepare for careers that involve lifelong learning, she adds.

The beauty of any guideline is that it largely does the work for doctors of optometry. “Doctors, as much as they might try, can’t keep up with all the new evidence-based developments in care,’’ Dr. Marrelli says.

The EBO Committee, employing a very rigorous, 14-step process for developing a guideline, does the heavy lifting for colleagues in the profession. Not only do they read and review thousands of pages of research, they grade the studies for quality of evidence to come up with recommended action steps doctors can use in their practices.

“These are practicing optometrists who are spending their ‘free’ time doing this work,” Dr. Marrelli says. “They work all day long with patients and then they go home, and they read, and they read and they read. They work extremely hard with the goal of improving patient care.”

2. Grow your appreciation for the merits of evidence-based optometry.

Optometric, evidence-based, clinical practice guidelines are recommendations for patient care developed through best-available, current, scientific evidence and research, coupled with the clinician’s

expertise and experience, to recommend appropriate steps in the diagnosis, management and treatment of patients.

“The original AOA clinical guidelines are consensus-based; not the highest, evidence-based guideline,” Dr. Marrelli says. That doesn’t mean there isn’t something to be learned from them. Landmark research can still be found there. “But a lot has happened even in the past 10 years regarding diagnostic tools and treatment options,” she says. “If we don’t look to the evidence, we will be practicing behind the eight ball.”

3. Assess your current approach to glaucoma care and how you might grow your skill set.

How does your management of individuals with glaucoma stack up against the clinical recommendations? Are there areas in which you need to change things up? Are you sharing with patients all of their treatment options? Those are just some of the questions doctors of optometry might ask themselves as they assess their current approach to glaucoma care.

“Not all doctors of optometry manage glaucoma. Some doctors diagnose and refer because they either don’t have the technology, the desire or the training to manage those cases,” says Dr. Marrelli.

But with glaucoma’s growing prevalence, it’s good to brush up to meet patients’ needs. According to the National Eye Institute, the number of Americans with glaucoma will jump to 6.3 million by the year 2050.

“You may not be treating a lot of patients, but you should be up to date and file away that knowledge at the very least,” she says. “There’s probably glaucoma in every practice. The guideline can be a great platform from which to build your clinical care for glaucoma patients.”

Stay tuned to AOA news for updates and send an email to crg@aoa.org if you’d like to volunteer and assist in AOA’s evidence-based process.

Educate patients about glaucoma

The “sneak thief of sight,” glaucoma frequently has no symptoms and, if left untreated, can lead to complete loss of sight. The AOA offers resources, including an infographic and template press release, to help you educate your patients about the importance of an annual, comprehensive eye exam for early intervention.