National Eye Health Education Program
See Glaucoma: Insights for Community Leaders Webinar
May 3,2017
TRANSCRIPT
Kym Collins-Lee: Good afternoon, everyone.I'm Kym Collins-Lee, acting director of the National Eye Health Education Program, also known as NEHEP, of the National Eye Health Institute at the National Institutes of Health. Thank you for participating in today's webinar, See Glaucoma: Insights for Community Leaders.
We will begin with introductions of our speakers for today and the learning objectives for the webinar. We will then move on to presentations on the fundamentals of glaucoma, NEHEP and the Glaucoma Education Program, Keep Vision in Your Future Glaucoma Toolkit, glaucoma and community engagement.We will end with questions from the audience.
Presenting with me today is Dr. Jullia Rosdahl, a practicing glaucoma specialist, clinician-scientist at the Duke Eye Center at Duke University. She also serves as the glaucoma expert on the NEHEP Planning Committee and has published numerous articles on glaucoma and vision loss.Dr. Sherrol Reynolds is an associate professor at Nova Southeastern University College of Optometry. She is currently vice president of the National Optometric Association and a fellow in the American Academy of Optometry and the Optometric Retinal Society. She chairs several subcommittees and has authored numerous articles on ocular and systemic diseases.Also, Shelly Heath-Watson, who is a program director at ICF and provides support to NEHEP, will be discussing NEHEP's new English glaucoma toolkit.
After this presentation, you will be able to explain the basis of glaucoma and its risk factors, prevention and treatment options for glaucoma, available resources for community outreach,and strategies to build glaucoma awareness at the community level.
Now, I'd like to turn over to Dr. Rosdahl, who will present on the fundamentals of glaucoma and the need for awareness. She will begin with a personal story of a patient, and then she will discuss the fundamentals of glaucoma, including diagnosis and treatment.
Dr. Jullia Rosdahl: Thank you.I'd like to start off with a story about one of my patients.He's actually unusual for me in that he wasn't sent to me by another doctor specifically for glaucoma.He came in to see me because he had a bump on his eyelid that he wanted to have checked. He'd been to the urgent care, but wanted to be checked by an ophthalmologist.
He was 64 years old and he's AfricanAmerican.He was otherwise pretty healthy, but hadn't had an eye exam in a while and glaucoma really wasn't on his radar at all.His vision was normal and his exam was significant for the bump on his eyelid, which was just a resolving sty at that point, but his eye pressure was elevated. His pressure in the right eye was 28 and he had lost some vision peripherally when we did automated visual field testing.And even though his pressure was high in the left eye too, his visual field was still normal.
So, what a shock to this gentleman and to his wife that he had glaucoma because he had absolutely no symptoms.And even though he had several risk factors—African-American race, older age—he didn't even know that he was at risk for this blinding disease.Currently, he's doing wonderfully on treatment and every time I see him, we talk about how lucky we are that that sty led to his glaucoma being diagnosed and treated.
Glaucoma is scary because it causes irreversible vision loss and vision loss is frightening to Americans.This poll from several years ago shows that Americans are more scared of losing vision than of most other diseases, including cancer and stroke.Vision loss is linked with worse quality of life, decreased mobility, more injuries, depression, and increased risk of dying.
Glaucoma is common.It's the second leading cause of blindness in the United States.Currently, there are almost 3 million Americans with glaucoma and that number is on the rise with our aging population and set to double by 2050.The worrisome corollary though is that half of people who have glaucoma who are losing peripheral vision—they don't know it.They don't know they have glaucoma, and they're not getting treatment.
The most common type of glaucoma in the United States is primary open-angle glaucoma.This short video, that I'm going to show you in a moment, shows how the eye can develop glaucoma.You'll see that the eye pressure is regulated at the front of the eye, where the aqueous fluid is made in the eye and drains back in the blood.And you'll see where the damage happens in glaucoma—at the back of the eye at the head of the optic nerve if the eye pressure is not regulated properly.So, here's the video.
[Video playing, 05:28 to 05:48]
A key point about eye pressure before we go to the next slide—because high eye pressure is really important for glaucoma—it does put you at risk for glaucoma.But not everybody with glaucoma will have high eye pressure.So measuring eye pressure alone really isn't enough to diagnose glaucoma.There are multiple risk factors that are important.
And that takes us to our first poll question.So I'd really like it if everyone out there could choose answers that they think are risk factors for glaucoma.
So, we see everyone's answers here.A lot of people noting African-American race, family history, older age.Those are really important.But actually all of those are risk factors for glaucoma.So, really, anyone can get glaucoma.It can happen in babies and children, although that's very rare.It's much more common in adults.And people that are at higher risk for glaucoma include AfricanAmericans and HispanicAmericans, older people of all races and ethnicities, and people with a family history of glaucoma.And these are the populations that NEHEP works with its partners to reach.
There are a few more risk factors that can surprise some people.Glaucoma is associated with other common diseases like diabetes and high blood pressure.And another way that you can help your patients is by educating them about their risk of glaucoma if they've had an eye injury in the past because even a relatively mild eye trauma that didn't need surgery or treatment could damage the delicate drainage tissue in the eye and set you up for glaucoma in the future.And it could happen within days to weeks after the trauma, or all the way to years or decades later.So lifetime surveillance after eye trauma is really crucial.
The way that we detect glaucoma is through a dilated eye exam.So it's really a dilated eye exam that's needed to diagnose glaucoma.A glasses check, an eye pressure check—they're really not enough because some people with glaucoma won't have elevated eye pressure, albeit they'll still be losing vision from it.
We don't currently have a cure for glaucoma, but there are many excellent treatments.All are aimed at lowering eye pressure.Even if it's not too high, it's too high for that person's nerve and so, we lower it.Most people who are treated for glaucoma do not go blind.Most commonly, eye drops and lasers are used to treat glaucoma patients and surgery is usually reserved for cases that can't be controlled medically.
A common question that I get from patients is diet and glaucoma.There really isn't a vitamin or a diet that's been proven to treat glaucoma.I do usually recommend a heart-healthy diet and a good multivitamin because those are good for overall eye health, even though they don't directly address glaucoma.There are new treatments coming as well for glaucoma, both a couple of new classes of eyedrop medications that should be coming out soon as well as new, safer glaucoma surgeries that look like they're most useful for patients with less advanced disease.
We have our next poll question for the audience.I'll give you a moment to read it and choose your answer.It's a true/false question.
Now, I see—wow—well you guys are a good audience.I see that you already know a lot about glaucoma.So the correct answer is "false."People with glaucoma do not usually have changes to their central vision until late in the disease.And that's really why awareness is so important about glaucoma—because it's known as the silent thief of sight.Really no early warning signs and the blindness from glaucoma is irreversible.So early detection,which is made possible by the awareness work of people like all of you in the audience, and diagnosis with a complete dilated eye exam—those are the things that can save sight.
There are still huge gaps in awareness about glaucoma and knowledge about glaucoma.There is a study done in patients who are sitting in an ophthalmology clinic.And in those eye patients, almost three-quarters of them had actually heard of glaucoma.But the rates of awareness were lower in AfricanAmericans and Hispanic eye patients.And those are the folks that are particularly at risk for glaucoma.
And even when people had heard of glaucoma, knowledge about the disease was strikingly poor.For example, three-quarters thought that glaucoma would have symptoms when it was getting worse and two-thirds thought that central vision was affected first.That's why NEHEP and the work that all of you are doing is so important because as a glaucoma specialist, we can't offer those proven treatments to patients that don't come to us and don't know that they have glaucoma.
In the next portions of this webinar, you'll see how NEHEP is developing resources for increasing awareness about glaucoma.And you'll hear from Dr. Reynolds and see the amazing work she's doing, bridging this knowledge gap about glaucoma and helping prevent blindness from this important, but poorly understood disease.
Kym Collins-Lee:Thank you, Dr. Rosdahl.Now I'm going to discuss the NEHEP and our glaucoma education program.
NEHEP is committed in making vision a public health priority by translating eye and vision research into public and professional education programs.NEHEP supports collaboration among eye health professionals, healthcare providers, and intermediary organizations.The current program areas under NEHEP include diabetic eye disease, glaucoma, low vision, ¡Ojo con su visión! (Watch Out for Your Vision), Vision and Aging, and Write the Vision: Make Your Plan to Protect Your Sight, our soon-to-be newest program that is currently being pilot-tested.
The NEHEP Glaucoma Education Program isdesigned to help you raise awareness about glaucoma among the people you serve.Our educational resources are designed to communicate the following messages to help prevent vision loss in people at higher risk.Glaucoma often has no early symptoms.People at higher risk need a comprehensive dilated eye examination every one to two years.Early detection, treatment and follow-up care are key to preventing vision loss and blindness.
Shelly will now present the role of community outreach in glaucoma awareness and the newlyimproved glaucoma toolkits.
Shelly Heath-Watson:Thank you, Kym.And thanks to all of you who have joined the call today.We're very excited to have you.
As community leaders, health and community professionals, and educators, you play several important roles in the communities that you serve and one of those roles is as a trusted source of information.As such, it uniquely positions you to share eye health education messages, increase awareness about glaucoma, and even encourage the members of the communities you serve to take action as it relates to glaucoma.And that action could very well help save their sight.
Now the National Eye Health Education Program, or NEHEP, supports the various outreach efforts that you do in the community by offering free downloadable resources.NEHEP has fact sheets, brochures, social media content—such as posts, tweets, infocards, and infographics—and presentation toolkits.
And there's one toolkit in particular that I think you'll be interested to learn about and that's Keep Vision in Your Future: Glaucoma Toolkit.It was originally developed almost 10 years ago and has undergone a significant refresh, and that includes the content as well as the graphic presentation.
I'm sure you'll find that the format supports the use by the novice and the experienced presenter as well as someone who has glaucoma background and someone with little or no glaucoma knowledge.The information was assessed by a group of experts and was tested with a key audience segment and it provides a great background for you to do your community outreach.
So, what's in the toolkit?That's a good question and I'm glad you asked.There are some great things in the toolkit.We've got an animated PowerPoint presentation.We've got a speaker's guide that contains very detailed speaker's notes and directions.And, as I shared, you do not have to be a professional speaker in order to use the toolkit.There are several handouts; many of them are customizable.There's a glaucoma IQ test and also a promotional event announcement that you can customize, including your organization's name and logo.The toolkits are available in both English and Spanish, and you'll see the information in terms of where you can locate it online.
I now have the honor of turning the slides over to Dr. Reynolds.As you heard, she is a member of the National Optometric Association and she will share with you some of the great work that her organization is doing in communities around the country.Dr. Reynolds?
Dr. Sherrol Reynolds:Thank you, Shelly.Let me begin by introducing the National Optometric Association, the NOA, which was founded in 1969 and is dedicated to improving the quality and accessibility of eye care in minority and underserved communities.We are comprised primarily of minority optometrists throughout the United States and I'm proud to currently serve as vice president for this organization.
Our mission of advanced individual health of minority populations is a shared priority with NEHEP.We too are committed to reducing visual impairment and blindness from eye diseases like glaucoma among populations at higher risk—our African-American black population and our Hispanic Latino population.And as previously mentioned by our glaucoma specialist, Dr. Rosdahl, awareness and knowledge of sight-threatening conditions like glaucoma is the lowest amongst the patients at higher risk—the very population the NOA is focused on.So we conduct numerous awareness campaigns and community outreach events throughout the year.
Also, an effort to address our diverse patient population, the NOA is actively involved in helping to recruit minority students into our schools and colleges of optometry, providing mentorship and guidance, scholarship, and assistance in job placement after graduation.And we also work with and support our student organization, the National Optometric Student Association, or NOSA, in increasing eye care and awareness in minority communities through our schools and colleges of optometry as well.
As we discuss strategies to build awareness about glaucoma, I would like to share with you, the audience, what the NOA has done.Our Three Silent Killers initiative, which focuses on the top diseases causing blindness among racial and ethnic minorities, specifically our African-American and Hispanic communities, is one of our most successful programs.These diseases include glaucoma, diabetic eye disease, and high blood pressure.
It was branded the Three Silent Killers to not only stress that they could lose their vision and go blind from these conditions, but to emphasize the negative impact these diseases have on their quality of life, with disability and depression that Dr. Rosdahl mentioned, and most importantly, that these diseases can kill and kill them early.
Our Three Silent Killers brochures are available in Spanish and English and emphasize the importance of prevention with timely and routine eye care before it's too late.We also conduct ThreeSilentKiller–focused community outreach events, particularly during key awareness months like January which is Glaucoma Awareness Month.We perform vision screening, distribute our Three Silent Killers and NEHEPeducational material, and we also hold talks about glaucoma at these events.
Our partnership with NEHEP has really been effective in helping to build awareness about glaucoma and we recently partnered on their newest pilot program, Write the Vision: Make Your Plan to Protect Your Sight, which was designed to inform AfricanAmericans about eye diseases and encourage them to take action to maintain healthy vision.
Our partnership includes monthly communication with personalized messages as seen in the image on the right of "Celebrate Your Life.Protect Your Sight," which are focused on glaucoma, diabetic eye disease, low vision, vision and aging, and ways to maintain healthy vision.These personalized messages may better resonate with our target audiences and are shared with our NOA doctors, who are encouraged to share them with their patient base and to provide feedback.I personally believe that this is a great way to capture both the doctor's and patient's attention and getting the message out about these diseases and I look forward to having this as an established NEHEP program for all of you to have for your community outreach efforts as well.