A Foundation for Change in Glaucoma Care

There are times when a profession needs to be retrospective to move forward, to understand the completeness of their development, no matter how quick it may have seemed. We believe that such a time is now for the profession of optometry with regard to the spectrum of diseases known as glaucoma. For those of us involved at the academic level, both with respect to teaching and research, both basic and clinical, the last decade has been one of excitement and discovery. For the profession, the last 20 years have seen a dramatic expansion in our scope of practice. Many of us are involved in the management of patients with glaucoma; some even specialize almost exclusively in the diagnosis and medical treatment of the condition. What would the pioneers of yesteryear have made of such developments? Would the postwar educators with their models of refracting by numbers and the behavioral approach to patient care welcome such change? We would like to think so, just as we would like to think that worldwide optometry in the 21st century has the vision to embrace such change. Of course, there are foundations that need to be strong and unassailable for any profession to truly progress rather than simply believing in their own bluster and lobbying abilities. One essential foundation block is a history of, and contribution to, research. When it comes to glaucoma, we, as a profession, can be proud. There are researchers around the world from an optometric background who have been, and are currently, contributing at the very leading edge of glaucoma research. Our optometric research colleagues have been responsible for the development of standard of care perimetry; fast algorithms and SWAP algorithms; analytical methods for diagnosis and the recognition of disease progression; new drugs for the treatment of both OHT and the neuroprotection of the retinal ganglion cells; the development of animal models and cell culture models; discoveries in disease pathophysiology; methods of clinical electrophysiology and ocular blood flow; and imaging of the optic nerve and retina. Another important foundation block is that of education. We have faculty who specialize in glaucoma at our schools and universities, in hospitals, referral centers, the Veterans’ Administration, and private practice. We educate our professional students, residents, and educators; we educate family physicians, nurses, and ophthalmologists. We also work in collaboration with other professions for the care of our patients. At last year’s meeting of the American Academy of Optometry, another “glaucoma” milestone was reached when we had our first glaucoma diplomate in the disease section. Finally, we have our own international society. Five years ago, the Optometric Glaucoma Society (OGS) was founded with Murray Fingeret as its President and each of this special issue’s guest editors as founding members. The OGS was accepted as a full member of the Association of International Glaucoma Societies (AIGS), a global umbrella organization of international societies. Fourteen OD members, six non-OD OGS members, and four specialists with an optometry background were among the 49 delegates (24 of 49) invited to the first international consensus meeting of the AIGS in November 2003. The topic was “Structure and Function in the Diagnosis of Glaucoma.” As a profession, we have arrived and continue to make contributions. This special issue reflects that acceptance. We will not all choose to treat glaucoma just as we do not all care for patients who wear contact lenses, but we sincerely believe that the world’s patients with glaucoma, the second largest cause of global blindness, will be better cared for with optometric involvement. John G. Flanagan Waterloo, Ontario, Canada Murray Fingeret Hewlett, New York Thomas L. Lewis Philadelphia, Pennsylvania William H. Swanson New York, New York

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