Glaucoma: Are You at Risk?

How to Choose a Doctor and Hospital for Your Treatment

Hospitals and doctors are not all alike…

…they vary in quality due to differences in their training, experience and services. These differences in quality become greater and matter more when you need sophisticated medical care for a complex condition.

A surgeon who performs a complex procedure often, for example, has better success with it than a surgeon who does the same procedure only occasionally. The complication rate, death rate and effectiveness of the same procedure may be many times higher at one hospital than another.

Clearly, the doctor and hospital that you choose have a direct impact on how well you do — especially when you need treatment for a problem as serious as glaucoma.

Glaucoma is a leading cause of blindness in the United States. Approximately 2 million Americans have glaucoma, and 60,000 of them are legally blind. Estimates suggest that another 5 to 10 million Americans have elevated pressure in their eye, a condition which may lead to glaucoma.

Half of the people with glaucoma are unaware of their condition; left untreated, glaucoma can cause permanent visual loss. The full picture, however, is far more hopeful. With early detection and treatment by medication, laser therapy, surgery or a combination of these methods, blindness or severe visual loss can be prevented.

But treatment cannot restore vision; it can only prevent further visual loss. This is why screening and early treatment are very important. Your community ophthalmologist can detect glaucoma and treat it by medication or laser therapy. But, if surgery becomes necessary, you may want to choose a doctor who specializes in treating glaucoma and who has experience with the full range of treatment options.

For example, if you have glaucoma and cataracts, you may benefit from a combined procedure. In this combined operation, the surgeon can treat the glaucoma and remove the cataract. In this case, you will want to make sure the doctor and hospital you choose are experienced in performing this type of procedure.

Glaucoma is a chronic condition that often requires treatment for the rest of your life, so you will want to carefully consider where to go for that treatment. Selecting a doctor and hospital involves making some difficult and important decisions. No one has more at stake than you; it is one of the most important decisions of your life.

This brochure explains glaucoma, its diagnosis and the treatment options available. You may be reading this because you are at risk for developing glaucoma or because you have glaucoma and need treatment. In either case, you will want to make a decision about your care based on careful comparisons of doctors and hospitals. This brochure provides information to help you do that.

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For an Appointment

If you would like to make an appointment with a Cleveland Clinic ophthalmologist, please call 216/444-2030 (in Cleveland) or 800/CCF-CARE (223-2273), ext. 42030 (toll-free outside Cleveland).

 

How Do You Judge Quality?

Most of us do more research when we buy a car or television set than when we choose a doctor and hospital. That may be because we don’t know what questions to ask or what to base our evaluation on.

Quality of care can be measured in many different ways, and no universal agreement exists on which should be used. At The Cleveland Clinic Foundation, however, we believe that you can use the following six points, or quality indicators, to compare health care providers:

• Credentials

• Experience

• Range of services

• Participation in research and education

• Patient satisfaction

• Outcome

Choosing a doctor or hospital is often influenced by values. You may want to go to a hospital that is close to home. You may want a hospital with a specific religious affiliation. But when you need specialized care for glaucoma, you also should consider a doctor’s qualifications and a hospital’s outcome record. These quality indicators will help you make that kind of evaluation.

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A Step-by-Step Guide

This guide helps you choose a doctor and hospital by:

• explaining the different types of glaucoma;

• identifying risk factors for glaucoma;

• explaining how glaucoma is diagnosed;

• describing treatments, including medication, laser therapy and surgery;

• explaining six points that indicate quality; and

• providing questions and answers from The Cleveland Clinic Foundation that you can use to compare doctors and hospitals.

 

Glaucoma

Glaucoma is a condition that is characterized by increased pressure in the eye and impaired vision, ranging from slight loss to total blindness. Glaucoma is not a single disease, but a group of eye diseases that have one feature in common: progressive damage to the optic nerve caused by increased pressure within the eyeball.

The pressure comes from an excess of a clear fluid called the aqueous humor. The aqueous humor circulates from behind the iris (the colored portion of the eye), through the pupil, and into the space between the iris and cornea. This fluid helps to nourish the eye and is produced and drained constantly.

In people with glaucoma, however, the fluid does not drain properly and pressure, known as intraocular pressure, builds up inside the eye. This increased pressure causes deterioration of the fibers of the optic nerve, which transmits the signal of sight from the eye to the brain. As the optic nerve deteriorates, blind spots develop, and they can progressively enlarge. Peripheral (side) vision is usually lost first. If left untreated, glaucoma can also destroy central vision and may progress to total blindness.

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Getting a Second Opinion

Second opinions provide people with an opportunity to ask questions to ensure that they have been diagnosed correctly and have chosen appropriate treatment. "As with any condition where the diagnosis and management is in question, or where the condition is refractory to treatment, consultation with referral to an appropriate subspecialist may be desirable," according to the American Academy of Ophthalmology.

Cleveland Clinic ophthalmologists recommend getting a second opinion in several situations:

1. if medication and laser therapy have failed to control intraocular pressure, and your doctor is now recommending surgery;

2. if initial glaucoma surgery has failed and you have been advised to have a re-operation;

3. if you have glaucoma that is difficult to control, such as congenital glaucoma, pediatric glaucoma or glaucoma following severe eye injury;

4. if you have multiple eye problems, such as glaucoma and retinal or corneal problems; or

5. if you need a combined procedure such as a cataract extraction and glaucoma filtration surgery.

Types of Glaucoma

There are two major types of glaucoma: acute and chronic.

Acute, or closed-angle, glaucoma accounts for about 10 percent of glaucoma cases in the United States. It primarily occurs in elderly people who are farsighted, and often runs in families. In closed-angle glaucoma, the normal drainage passage between the iris and cornea is narrowed and then blocked. Laser treatment can cure closed-angle glaucoma which, if untreated, can cause blindness.

Chronic, or open-angle, glaucoma is more common, accounting for approximately 90 percent of glaucoma cases. Open-angle glaucoma may go undetected for many years, often until one-third or more of the optic nerve has been destroyed. Because there are no early warning signs, regular eye checkups are important to detect the increased pressure in the eye. In open-angle glaucoma, the drainage passage appears open and not blocked. However, tissue changes in and along the drainage passage prevent aqueous fluid from draining properly.

How is glaucoma detected?

Ophthalmologists use a variety of tests and instruments to detect symptoms of glaucoma or early damage caused by this condition. A tonometry test measures the pressure within the eye. A visual field test measures peripheral vision and can detect vision loss in that area. The ophthalmologist uses an ophthalmoscope, a small hand-held viewer, and other instruments, to view the eye’s interior and detect damage to the optic nerve.

People who have high intraocular pressure but normal peripheral vision and an intact optic nerve may not require immediate treatment. These people are at risk for developing glaucoma, however, and should have a glaucoma evaluation every six to 12 months.

How is glaucoma treated?

The goal of glaucoma treatment is to prevent further vision loss by controlling intraocular pressure. This strategy is similar to controlling blood pressure to prevent a stroke.

Although the three types of glaucoma treatment — medication, laser therapy and surgery — all can be effective, each is associated with potential side effects and complications. An ophthalmologist with glaucoma expertise can determine which treatment is best.

Medication

Medication — in the form of eye drops or an oral medication — often is used to treat glaucoma first. Medications lower intraocular pressure by reducing the amount of fluid produced in the eye and increasing drainage. Medication alone can reduce intraocular pressure by 20 to 30 percent.

Because glaucoma medications may have side effects, their use may be limited if an individual has other medical problems. For example, some glaucoma medications should be avoided by people who have heart failure or asthma.

Laser Therapy

Laser therapy is a quick, convenient procedure that can be performed on an outpatient basis. Few complications occur with laser therapy, and vision usually recovers within minutes of treatment.

For patients with closed-angle glaucoma, laser iridectomy is used to create a tiny opening in the iris, which allows the fluid to drain. In open-angle glaucoma, laser trabeculoplasty is used to improve fluid drainage.

Laser trabeculoplasty can reduce intraocular pressure in about 75 percent of patients after one treatment. But laser therapy does not always achieve long-term intraocular pressure control, and 50 percent of all patients who have laser treatment require additional therapy within two to five years. Retreatment has a lower success rate and an increased risk for raising, rather than lowering, pressure. This could create the need for further glaucoma surgery.

Surgery

Medications and laser therapy may be enough to control intraocular pressure for many people with glaucoma. However, some people eventually require surgery. Trabeculectomy, one type of filtration surgery, is the most common surgical procedure to treat glaucoma. In this operation, the surgeon creates a second drainage channel in the eye to supplement the natural one. This often dramatically reduces intraocular pressure and allows the patient to reduce or eliminate glaucoma medications. Surgery is generally performed on an outpatient basis with local anesthesia.

For more advanced cases, or for glaucoma that is difficult to control, an artificial glaucoma drainage implant may help decrease pressure by tapping excess fluid from the eye, usually through a tube that drains fluid from the eye to a plate placed above and behind the eye. The excess fluid is then absorbed into the body.

One of the more commonly used implants is the Baerveldt implant. In the past, several smaller implants were needed to drain fluid, requiring multiple surgeries or multiple eye incisions. The number of implants needed was based on the amount of fluid present. Because the Baerveldt implant comes in different sizes and is larger than other implants, only a single device implant is needed, significantly decreasing the need for further surgeries and the number of medications required. The three sizes of the implant allows the surgeon to choose the most appropriate size for the patient’s specific need.

Cataracts and glaucoma

Cataracts, a clouding of the lens of the eye that prevents light from entering, are a natural condition that becomes more common with aging. Since many people eventually develop cataracts, many with glaucoma also have them. The two problems can be treated successfully in many patients with a single procedure combining trabeculectomy for glaucoma with cataract extraction and intraocular lens implantation.

One combined procedure tends to be more effective than two separate procedures for several reasons. Glaucoma surgery is highly successful in people who have not had previous eye surgery. When it follows cataract surgery, the success rate of glaucoma surgery is decreased. When cataract surgery is performed after glaucoma surgery it may make the glaucoma surgery less effective, or lead to its failure. By combining cataract surgery and glaucoma surgery, vision is restored faster, less glaucoma medication may be needed and further surgery is usually not needed.

Pediatric Glaucoma

Congenital glaucoma is rare, occurring in 1 of every 20,000 births. Often this condition is detected by a pediatrician. It usually occurs in both eyes and, if not treated, will eventually cause blindness. Signs that an infant may have glaucoma include excessive tearing, sensitivity to light, a cloudy cornea or an eye that appears to be enlarged.

In infants and children, early surgery is the only treatment that can prevent vision loss. Because this is such a rare condition, parents should have their child seen by an ophthalmologist with experience in treating pediatric glaucoma.

Glaucoma and Uveitis

Some people may develop uveitis, a chronic and recurrent inflammation of the eyes. Uveitis can be managed with medication, although in some cases it can lead to other conditions, such as cataracts and glaucoma. If you have uveitis, you may benefit from obtaining treatment at a multidisciplinary medical center where physicians who specialize in the treatment of uveitis, cataracts and glaucoma work together to successfully manage all of your eye problems.

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Risk Factors for Glaucoma

Glaucoma has no warning signs. Having regular eye examinations and being aware of the risk factors for glaucoma provide the best assurance of early detection. The most important risk factor is high intraocular pressure. Other risk factors include:

1. Family history: Approximately 20 percent of people with glaucoma have a parent or grandparent with glaucoma.

2. Race: African-Americans have a significantly higher risk of developing glaucoma.

3. Steroid medication: People who are taking oral or high-dose topical corticosteroids more than a few weeks at a time have a higher risk of developing glaucoma.

4. Age: Risk of glaucoma increases after age 40.

5. Diabetes: Diabetes increases the risk of glaucoma by 300 percent.

6. Eye injury: People who have had an eye injury are at an increased risk for glaucoma.

7. Poor vision: People who are extremely nearsighted or farsighted have an increased risk for glaucoma.

 

Where Do

You Begin?

Measuring quality in ways that are useful to consumers is a new idea in health care. Because of that, it may not be possible to get complete information for each of these quality indicators. But the willingness of providers to give you as much information as possible is a good sign. It shows that they are dedicated to maintaining and improving their quality, responsive to patients, and confident of their capabilities.

If you have glaucoma or are at risk for glaucoma, ask your ophthalmologist or optometrist about referral to a specialist in glaucoma. This specialist should have experience in diagnosis and the full range of treatment options.

If you have congenital glaucoma, glaucoma associated with uveitis, neovascular glaucoma or glaucoma and cataracts, ask to be referred to a specialist with experience in performing combined surgery.

Get the names of several doctors who have the most experience in treating glaucoma and of hospitals that offer the newest, most effective treatments, including experimental drugs and devices.

Ask the questions we suggest. Make comparisons. Then make your decision. Be an informed consumer for yourself and your family.

 

How to Use

Quality Indicators

How can you use these indicators to judge if one doctor or hospital is better for you than another? By combining information from more than one quality indicator, according to the report, "The Quality of Medical Care: Information for Consumers," produced by the U.S. Congress, Office of Technology Assessment.

The report states that patients about to have surgery can be confident if the hospital’s surgeons perform a high number of operations with a low mortality (death) rate, and have extensive training and experience in the procedure.

On the other hand, the report states "...if a hospital has a high mortality rate and a low volume of procedures, the patient might wish to question the surgeon about that hospital and about alternatives, even if other hospitals require longer travel."

 

1. Credentials

Do the doctor and

hospital measure up?

Credentials have been set by nationally recognized medical professional organizations to verify that doctors and hospitals meet certain standards in health care delivery.

Doctors:

Board certification, or the international equivalent, is a sign that doctors are highly trained in their fields. Doctors who specialize, such as ophthalmologists, should be board certified in the specialty in which they are practicing. Each specialty has a national board that is responsible for setting standards doctors must meet in order to be certified. Doctors who are board certified in their specialties have completed the amount of training that the specialty board requires, have practiced for a specified number of years in that specialty and have passed a difficult examination in their specialty area. Some excellent doctors are not board certified. Board certification, however, is generally a good indicator of competence and experience. Additional training in a specific area of a specialty, called subspecialty training, also can be used as an indicator of further competency in an area, such as glaucoma, retina or cornea disorders.

Hospitals:

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. The JCAHO decides whether a hospital gets, keeps or loses accreditation based on certain criteria for staffing, equipment and facility safety requirements. Although accreditation is voluntary, most hospitals go through the process. If the hospital that you are considering is not accredited, it is important to know why.

Some of the best hospitals are often in the public spotlight for their medical advances and the quality of their care. Information about a hospital’s reputation is widely available through the mass media, the government, consumer groups, books and magazines such as U.S. News & World Report.

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For information about a hospital’s status, call the Joint Commission on Accreditation of Health-care Organizations at 708/916-5800.

Is the ophthalmologist board certified?

All Cleveland Clinic staff ophthalmologists are board certified in ophthalmology.

Have the doctors been recognized for excellence?

Nine Cleveland Clinic ophthalmologists are named in the book "The Best Doctors in America: Midwest Edition" (1996).

Is the hospital accredited by the JCAHO?

Yes. The Cleveland Clinic has JCAHO accreditation.

Has the hospital been positively and consistently recognized for medical excellence and leadership?

Yes. The Cleveland Clinic is often named among the top medical centers in the country. Some of the publications that have recognized the Clinic for excellence are listed in the box at left.

*Board certification or its international equivalent became a requirement at the Cleveland Clinic in 1989 for doctors being appointed to the medical full staff.

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One of America’s Best

• U.S. News & World Report has named the Cleveland Clinic one of "America’s Ten Best Hospitals" every year since 1990.

• The April 1993 issue of American Health named the Clinic among the top medical centers in the country.

• The Cleveland Clinic was named to a "top 100" list of the best performing hospitals for the last two years in a survey published by Modern Healthcare magazine. The Clinic was one of 15 institutions named in the category "Major Teaching Hospitals of 400 or More Beds." According to the study, if all U.S. acute-care hospitals performed at the level of these 100 hospitals, it would save $21 billion a year, trim nearly a day off average inpatient stays, reduce mortality an average of 24% and decrease complications 17%.

 

2. Experience

Does practice

make perfect?

In treating a serious problem such as glaucoma, the more experience the doctors and hospital have, the better the results usually will be.

According to the American Academy of Ophthalmology, "certain diagnostic procedures (in the areas of tonometry, perimetry and photography, for example) may be delegated to appropriately trained and supervised personnel. However, the interpretation of results and management of disease require the high degree of clinical training and experience of the ophthalmologist."

Seeking treatment from a doctor with experience in treating glaucoma is particularly helpful for high-risk glaucoma surgical patients, including patients who have had previous glaucoma surgery, cataract surgery, retinal surgery or any other eye surgery. Patients with congenital and developmental glaucoma, as well as those with rare types of glaucoma, also benefit from the expertise of a glaucoma specialist. People who require combined glaucoma and cataract surgery may have better results if they seek treatment from a surgeon who has performed many combined procedures.

People with multiple eye problems, such as glaucoma and diabetic retinopathy, should seek treatment from a multispecialty group practice where glaucoma specialists work closely with retinal, corneal and other ocular specialists.

Patients also benefit from seeking treatment at a facility that conducts clinical research studies. Physicians who engage in clinical research compare and study the results of different treatments in thousands of patients. They apply what they learn from the large clinical trials to future treatment decisions. In this way, all the patients at a facility that engages in clinical trials benefit from research, even if they have not personally participated.

How many patient visits are managed by the medical center’s ophthalmologists each year?

Cleveland Clinic ophthalmologists managed nearly 60,000 patient visits in 1995.

How many glaucoma patient visits are managed at the medical center each year?

In 1995, Cleveland Clinic ophthalmologists managed more than 6,500 glaucoma patient visits.

How many laser surgeries for glaucoma are performed at the medical center each year?

Cleveland Clinic ophthalmologists performed more than 200 laser procedures to treat glaucoma in 1995.

How many surgeries were performed for glaucoma?

Cleveland Clinic ophthalmologists performed more than 230 surgeries for glaucoma in 1995.

How many glaucoma implant procedures are performed?

Cleveland Clinic ophthalmologists performed 28 implant procedures for glaucoma in 1995. One type of glaucoma implant was developed by Dr. George Baerveldt, an ophthalmologist at the Cleveland Clinic.

How many combined glaucoma and cataract operations are performed each year?

In 1995, 89 combined glaucoma and cataract surgical procedures were performed at the Clinic.

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If You Have Multiple Medical Problems

Understanding the total health picture is one advantage of the Cleveland Clinic’s group practice approach to care. This approach is even more important for patients with multiple medical problems. Patients with multiple medical problems may benefit from seeking diagnosis and treatment from a multispecialty group practice environment, where specialists in different disciplines communicate about their patients and collaborate to provide the most effective care. For instance, patients with glaucoma and diabetic retinopathy would need to seek treatment from glaucoma and retina specialists.

 

3. Range of

Services

What services

are available?

Hospitals with a broad range of services can treat more complex medical conditions and better handle complications that may occur. If complications arise, you want the best medical care available, and you want it immediately.

Range of specialty departments

Medical conditions do not always exist in isolation. Therefore, immediate access to a full range of specialty departments within a facility is critical.

As people age, they tend to develop multiple eye problems, such as retinal problems and glaucoma. These patients will want to seek treatment at a facility that provides a team of specialists who can treat many different types of eye problems.

Also, it is to your advantage to seek treatment at a facility equipped to treat multiple medical problems. For example, someone with diabetes and glaucoma may develop diabetic retinal problems. It may benefit the patient to seek treatment from a doctor and hospital that not only provide various treatment options, but also have expertise in all areas.

Sometimes glaucoma medication can interact with other medications or affect medical conditions such as heart disease, hypertension and asthma. If you have a medical condition or are taking medication that may interact with your treatment for glaucoma, you may benefit from receiving treatment at a facility that can coordinate medications and treatment plans successfully.

Range of diagnostic and treatment options

The choice of diagnostic and treatment options depends on the severity of the condition at the time of diagnosis and how quickly the disease progresses. Some patients are treated first with medication and later require laser therapy or surgery. For these reasons, it is important to choose a facility that can diagnose and treat glaucoma in a variety of ways. That way, you will get the most effective, appropriate and cost-effective treatment available.

Is help available from a full range of specialty departments?

The Cleveland Clinic’s 700 physicians — all on staff full time — provide care in 100 specialties and subspecialties, including ophthalmology, cardiology, endocrinology, and hypertension and nephrology. All of these specialties are present in one facility, so prompt consultation, diagnosis and treatment are available.

Does the medical center offer a variety of options for diagnosing and treating glaucoma?

The Clinic offers a full range of diagnostic and treatment options, including:

• tonometry

• manual and automated visual-field testing

• optic nerve and retinal photography

• ultrasonography

• glaucoma medication

• laser therapy

• glaucoma filtering surgery

• glaucoma drainage implants

• combined glaucoma and cataract surgery

• special surgical techniques for children with glaucoma

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For Your Convenience

• The majority of glaucoma procedures are performed on an outpatient basis in the Cleveland Clinic Eye Institute.

• All Cleveland Clinic physicians accept assignment for their fees and all other services that are covered by Medicare Part B (the medical insurance portion that pays doctors’ bills).

 

4. Participation in

Research and

Education

What type

of hospital is it?

Selecting a hospital that combines patient care with research and education offers many advantages.

Ideally, the individuals engaged in patient care, research and teaching are organized around a given disease or class of patients, facilitating the sharing of knowledge, research and clinical findings. This approach results in the most rapid transfer of basic scientific knowledge from the laboratory to the patient care setting.

Those individuals on the staff of such a hospital are exposed to an important interchange of ideas. They also are exposed to the newest treatments and technology. At teaching hospitals, physicians are available 24 hours a day.

Choosing a teaching hospital for your care may offer other advantages as well. Private, not-for-profit teaching hospitals have lower mortality rates than other types of hospitals, a study in a December 1989 issue of the New England Journal of Medicine suggested.

Is the hospital associated with a teaching program?

Yes. Incorporated in 1935, The Cleveland Clinic Educational Foundation sponsors one of the nation’s largest physician postgraduate training programs and is affiliated with The Ohio State University College of Medicine.

Does the hospital have a fully accredited residency program in ophthalmology?

Yes. The Cleveland Clinic offers a fully accredited three-year residency program in ophthalmology. Physicians also come to the Clinic for advanced postgraduate subspecialty training.

Does the hospital conduct clinical trials related to glaucoma?

Yes. The Cleveland Clinic Eye Institute is conducting ongoing outcomes research on glaucoma filtering surgery and combined glaucoma and cataract surgery.

In addition, the Clinic is currently participating in three national ophthalmology studies to determine the best initial treatment for glaucoma. One is a five-year study funded by the National Institutes of Health, the Collaborative Initial Glaucoma Treatment Study (CIGTS). It compares outcomes between patients who receive medical treatment initially and those who are treated initially with surgery. In two additional studies sponsored by a national drug company, Cleveland Clinic ophthalmologists are investigating a new medication to reduce intraocular pressure.

Cleveland Clinic glaucoma specialists are participating in research studying new glaucoma drug therapies and new combinations of drug therapies. Cleveland Clinic ophthalmologists also are looking for solutions to other ophthalmologic problems by participating in research evaluating new drug therapies that may develop into new treatments.

 

5. Patient

Satisfaction

Are expectations

being met?

If you ask one person about his or her experience with a doctor or hospital, you get one person’s point of view. Patient satisfaction surveys allow you to judge quality based on the experience of many previous patients. This provides you with a more objective measure to use.

Most hospitals routinely use surveys to learn if patients are satisfied with their medical experiences. The hospitals can use these results to improve their services.

Patient satisfaction often reflects the personal side of care. Surveys ask questions such as, How willing are the doctors and nurses to listen? Do they answer questions and explain treatments? How much time does the doctor spend with the patient? Is the hospital clean? Is the food good?

Patient satisfaction information can predict what your experience in a particular hospital is likely to be.

How satisfied are patients with their overall experience?

96% of patients who visit the Cleveland Clinic Eye Institute are satisfied with their overall experience.

How many patients would return to the medical center?

99% of patients would return to the Cleveland Clinic Eye Institute.

How satisfied are glaucoma patients with their experience at this facility?

96% of glaucoma patients treated at the Cleveland Clinic Eye Institute said they were satisfied with their experience.

How many glaucoma patients treated at this medical center would recommend it to their family and friends?

92% said they would probably or definitely recommend the Cleveland Clinic to a friend or relative for treatment of glaucoma.

Is there a program to help patients and their families with any problems that may arise during their care?

Cleveland Clinic patients may call an ombudsman — another name for a patient-relations representative — if they have any problems, questions, suggestions or concerns related to service.

 

6. Outcome

Indicators

What is the outlook?

Many different outcome indicators can be used alone or in combination to measure the success of treatment and the risks associated with it. Which indicators to use depends on the treatment or procedure being done.

Treatment is considered successful and glaucoma is considered under control when the intraocular pressure is reduced and vision is stabilized. Another way to evaluate treatment outcome is by comparing the number of medications needed to control intraocular pressure before and after the surgery. When surgery effectively lowers pressure, fewer medications are needed. Also, prevention of visual loss and further damage to the optic nerve can be used as measures for the success of treatment.

For combined glaucoma and cataract surgery, outcome may be measured by reduced intraocular pressure, vision improvement and improvement in quality of life. Visual improvement is determined by how far down the eye chart a patient can read after surgery. If people can function and perform their normal and desired activities better after surgery than before, they have gained improvement in their quality of life.

Complications related to glaucoma surgery include serious events such as major intraocular hemorrhage (bleeding), ocular infection or serious medical events during surgery. However, serious complications are very rare.

Reducing risks prior to surgery may help to prevent complications. For example, someone who has diabetic retinopathy as well as glaucoma and cataracts may decrease the risk of complications by first undergoing laser treatment for diabetic retinopathy. Once the diabetic retinopathy is managed, combined surgery can be performed to remove the cataract and control intraocular pressure.

Making Comparisons

If you require surgical treatment for glaucoma, ask the doctor and hospital how successful they are in controlling intraocular pressure and reducing the number of medications after treatment. If you need combined glaucoma and cataract surgery, ask about their rates for improving vision and controlling pressure, and how patients assess their quality of life following surgery. Try to compare rates for patients most like yourself. It is important to try to compare apples to apples so that you know what your risks really are. This may be difficult, however, because rates may be reported differently. If a doctor or hospital cannot give you their rates or is reluctant to give information, look for alternatives.

On the following page, we provide our rates for glaucoma treatment at the Cleveland Clinic Eye Institute.

How many patients who undergo glaucoma surgery at this medical center achieve control of intraocular pressure?

Approximately 97% of patients undergoing glaucoma surgery at the Cleveland Clinic Eye Institute achieve short-term pressure control.

How many patients who undergo combined glaucoma and cataract surgery at this medical center require fewer glaucoma medications after surgery than before?

More than two-thirds of patients who have combined glaucoma and cataract surgery at the Cleveland Clinic Eye Institute reduce their medications after surgery.

How many patients who undergo combined glaucoma and cataract surgery at this medical center have better vision after surgery?

Visual acuity following combined glaucoma and cataract surgery improved in 93% of these patients who underwent the combined procedure since 1995.

How many patients who undergo combined glaucoma and cataract surgery at this medical center require additional surgery?

At the Cleveland Clinic, approximately seven out of every eight patients who have undergone combined procedures have required no further glaucoma surgery.

What is the medical center’s serious complication rate for glaucoma surgery?

At the Cleveland Clinic Eye Institute, the risk of serious ocular complications following glaucoma surgery is 1 to 2%.

 

A Leader in Ophthalmology

The Cleveland Clinic Eye Institute and its ophthalmologists are recognized worldwide for their comprehensive commitment to understanding, controlling and treating eye diseases. The Eye Institute is conducting many prospective clinical trials, and its ophthalmologists have made many contributions to understanding and treating eye diseases.

• A Cleveland Clinic ophthalmologist, Edward J. Rockwood, M.D., wrote an educational module for the American Academy of Ophthalmology for ophthalmologists for the medical treatment of primary open-angle glaucoma.

• A Cleveland Clinic glaucoma specialist, George Baerveldt, M.D., invented the Baerveldt Glaucoma Implant.

• Cleveland Clinic Eye Institute glaucoma specialists have received the Honor Award of the American Academy of Ophthalmology (AAO) based on participation in AAO activities and contribution in the field of ophthalmology.

• Physicians at the Cleveland Clinic have developed numerous surgical techniques and new treatments for several eye diseases.

• Cleveland Clinic ophthalmologists participate in many national research studies to continually develop better methods of diagnosing and treating all ophthalmologic problems.

• Cleveland Clinic ophthalmologists are studying outcomes of glaucoma and combined cataract and glaucoma surgeries to find ways to improve the surgeries and improve the success rate in higher risk patients.

 

Cleveland Clinic Florida

Drawing upon the Cleveland Clinic’s experience, Cleveland Clinic Florida has established an ophthalmology department with a glaucoma specialist. For more information or to make an appointment at the Cleveland Clinic Florida, please call 800/359-5101.

 

For More Information

If you would like to receive any

of the other guides in our series "How to Choose a Doctor and Hospital for Your Treatment," please call 216/444-8919

(in Cleveland) or 800/545-7718 (toll-free outside Cleveland)

or visit us online at:

http://www.ccf.org