Hadley Presents: A Conversation with the Experts
Episode: Glaucoma Questions, Concerns, and Answers
Release Date: January 16, 2025
Host: Ricky Enger
Guests:

• Ed Haynes: Specialist in working with older adults with vision loss
• Dr. Julia Rosdahl: Glaucoma Specialist at Duke Eye Center

Introduction to Glaucoma

In the January 16, 2025 episode of Hadley Presents: A Conversation with the Experts, host Ricky Enger delves into the complexities of glaucoma, one of the most prevalent eye conditions affecting millions. Joining him are Ed Haynes, an experienced professional in vision loss among older adults, and Dr. Julia Rosdahl, a glaucoma specialist from the Duke Eye Center. The episode aims to educate listeners about glaucoma's risk factors, treatment options, and the importance of early detection.

Understanding Glaucoma

Definition and Types
Dr. Rosdahl begins by defining glaucoma as a group of eye diseases characterized by the thinning of the optic nerve due to the death of retinal ganglion cells. This degeneration leads to vision loss, typically affecting peripheral vision first. “Glaucoma is actually a group of eye diseases,” explains Dr. Rosdahl (04:35).

Prevalence and Silent Nature
Primary Open-Angle Glaucoma is identified as the most common type in the United States. A significant challenge with glaucoma is its asymptomatic progression, meaning individuals often remain unaware until substantial vision loss has occurred. “Glaucoma, the most common type of glaucoma in the United States is primary open angle glaucoma,” Dr. Rosdahl notes (04:35).

Risk Factors
Key risk factors include a family history of glaucoma, older age, and certain ethnicities such as Black and Hispanic backgrounds. Dr. Rosdahl emphasizes that glaucoma does not discriminate solely by race, urging all individuals, irrespective of ethnicity, to undergo regular screenings. “Older age is an important risk factor for glaucoma too. And actually black race and Hispanic ethnicity are risk factors, although a lot of white people can get glaucoma too,” she states (06:07).

The Patient Journey

From Diagnosis to Specialist Care
Dr. Rosdahl outlines the optimal patient journey: routine eye examinations by local eye doctors who identify early signs such as elevated eye pressure or suspicious optic nerves, followed by referrals to glaucoma specialists like herself for comprehensive evaluations. “We hope for that they're coming early enough where we can save vision,” she explains (06:18).

Treatment Continuity and Control
Most patients, when diagnosed and treated early, do not progress to blindness. Dr. Rosdahl reassures that with appropriate management, the majority of glaucoma patients maintain their vision. “Actually, most People who are diagnosed with glaucoma and treated for glaucoma don't go blind from it,” she affirms (08:12).

Impact and Treatment of Glaucoma

Vision Loss: Permanent but Preventable
While glaucoma leads to permanent vision loss due to retinal ganglion cell death, early and consistent treatment can prevent significant impairment. Dr. Rosdahl clarifies, “So it is a permanent loss of vision with the treatments that we have at this point,” highlighting the current limitations in reversing vision loss (09:35).

Treatment Modalities
The primary goal in treating glaucoma is to lower intraocular pressure (IOP). Treatment options include:

• Eye Drops: Often the first line of treatment. Dr. Rosdahl stresses the importance of adherence, stating, “This eye drop is a very powerful way to lower eye pressure, but it does not work if it is sitting in the bottle” (11:09).
• Laser Treatments: Targeting the eye's drainage system to improve fluid outflow.
• Surgical Interventions: Reserved for cases unresponsive to medication or laser therapy. Minimally Invasive Glaucoma Surgeries (MIGS) are gaining traction for mild to moderate cases.

Adherence to Treatment
Dr. Rosdahl underscores the critical nature of following prescribed treatment regimens to maintain lower IOP and protect the optic nerve. She acknowledges the challenges patients face with complex medication schedules but emphasizes their role in preventing vision loss (11:09).

Lifestyle Modifications and Long-Term Management

Lifestyle Adjustments
While extreme lifestyle changes are generally unnecessary, certain modifications can aid in managing glaucoma:

• Avoiding Prolonged Head-Down Positions: Activities like headstands in yoga can increase eye pressure.
• Healthy Diet: Incorporating leafy greens and antioxidants may support optic nerve health.
• Regular Exercise and Adequate Sleep: Promotes overall eye health.
• Sleeping with Elevated Head Position: Using a wedge pillow can decrease IOP progression (12:57).

Lifelong Condition and Monitoring
Glaucoma is a chronic condition requiring lifelong management. Treatments and patient responses can evolve, necessitating ongoing monitoring to ensure effective control. “Glaucoma is a lifelong condition. Once you have it, we have lots of good treatments, but we really don't have a cure,” Dr. Rosdahl explains (15:37).

Genetic Considerations and Family Screening

Genetic Counseling and Family Testing
Given the hereditary nature of glaucoma, Dr. Rosdahl advises that family members of diagnosed patients undergo regular comprehensive eye exams. Early detection in relatives can lead to timely interventions, preventing vision loss. “They should have complete eye exams on a regular basis,” she advises (16:24).

Debunking Misconceptions

Fear of Blindness vs. Reality
A prevalent misconception is the inevitability of blindness following a glaucoma diagnosis. Dr. Rosdahl counters this fear, emphasizing that with proper treatment, most patients retain their vision. “The message should really be one of hope,” she states (17:27).

Understanding Treatment Effects
Patients often mistakenly believe that glaucoma treatments can improve existing vision. Dr. Rosdahl clarifies that treatments aim to prevent further loss rather than enhance current vision. “Eye drops for glaucoma help to lower the eye pressure to prevent future vision loss. So they help keep your vision, but they don't make vision better,” she explains (17:27).

Coordinated Care with Local Eye Specialists

Collaboration Between Specialists
Dr. Rosdahl highlights the importance of collaboration between glaucoma specialists and local optometrists or ophthalmologists. This partnership ensures comprehensive care, addressing both glaucoma management and other eye health needs. “Optometrists and the comprehensive ophthalmologists are really important partners for us,” she notes (18:48).

Future Directions in Glaucoma Treatment

Innovative Treatments on the Horizon
The field of glaucoma treatment is evolving with the introduction of new medications and delivery systems. Recent advancements include:

• New Medications: Approved with novel mechanisms of action, offering additional options for lowering IOP.
• Implantable Drug Delivery Systems: Tiny implants that release medication over several months, enhancing adherence (21:17).
• Advancements in MIGS: Continued development aims to make these surgeries safer and more effective for a broader range of patients.

Hope for Nerve Regeneration
Despite current limitations in reversing vision loss, ongoing research holds promise for future therapies that may regenerate or replace damaged retinal ganglion cells. Dr. Rosdahl expresses optimism about these scientific endeavors but acknowledges that such treatments are not yet available (21:17).

Addressing Alternative Treatments: Medical Marijuana

Medical Marijuana's Role in Glaucoma Management
When queried about the efficacy of medical marijuana in treating glaucoma, Dr. Rosdahl advises against its use. She emphasizes that marijuana has not been proven effective or safe for glaucoma treatment and recommends relying on established therapies. “Medical marijuana ... has not been shown to be effective or safe for treating glaucoma and preventing vision loss,” she cautions (23:39).

Encouraging Access to Proven Treatments
For patients facing financial barriers to treatment, Dr. Rosdahl suggests exploring pharmaceutical company assistance programs rather than resorting to unproven alternatives like marijuana. “There are actually a lot of great programs that a lot of the drug companies offer to help patients get the medications that they need,” she recommends (23:39).

Resources for Further Information

Educational Resources
Dr. Rosdahl provides several reputable sources for patients seeking more information on glaucoma:

• American Academy of Ophthalmology’s Patient Education Website: eyesmart.org
• National Eye Institute: Offers comprehensive information on glaucoma and ongoing research.
• American Glaucoma Society: Maintains a directory of fellowship-trained glaucoma specialists searchable by zip code.

Personal Story: Living with Glaucoma

Angela Delgado’s Journey with Glaucoma
In a segment from the sister podcast, Insights and Sound Bites, Angela Delgado shares her personal experience living with glaucoma. Diagnosed after noticing floaters and peripheral vision loss, Angela initially struggled with the emotional impact of her diagnosis, fearing blindness and feeling isolated. Her turning point came when her daughter encouraged her to use a cane, which helped her regain confidence and safety in navigating daily life. Angela emphasizes the importance of accepting assistance and overcoming the stigma associated with vision loss, highlighting the profound personal adjustments required to live with glaucoma.

Conclusion

This episode of Hadley Presents offers a comprehensive exploration of glaucoma, shedding light on its silent progression, the critical importance of early detection, and the multifaceted approaches to treatment and management. With expert insights from Dr. Julia Rosdahl and practical perspectives from Ed Haynes, listeners gain a nuanced understanding of living with glaucoma and the avenues available for preserving vision. Additionally, Angela Delgado’s heartfelt narrative underscores the personal challenges and triumphs faced by those navigating this condition.

For more information, listeners are encouraged to visit the recommended resources and consult with eye care professionals to ensure timely and effective glaucoma management.

Notable Quotes:

• Dr. Julia Rosdahl (04:35): “Glaucoma is actually a group of eye diseases.”
• Dr. Julia Rosdahl (08:26): “It is a permanent loss of vision with the treatments that we have at this point.”
• Dr. Julia Rosdahl (11:09): “This eye drop is a very powerful way to lower eye pressure, but it does not work if it is sitting in the bottle.”
• Dr. Julia Rosdahl (15:37): “Glaucoma is a lifelong condition. Once you have it, we have lots of good treatments, but we really don't have a cure.”
• Dr. Julia Rosdahl (17:27): “Eye drops for glaucoma help to lower the eye pressure to prevent future vision loss. So they help keep your vision, but they don't make vision better.”
• Dr. Julia Rosdahl (21:17): “We have a lot of scientists and researchers around the world who are working hard to develop those treatments for our patients.”

For more episodes and resources, visit the Hadley Helps website and explore the Insights and Sound Bites podcast for additional stories and support.