Glaucoma Specialty - General Q&A

[ophthodude]

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Hello, I have a few basic questions about glaucoma specialists and couldn't find much by googling it.

1) What sort of things do you do in practice?

2) I read most practice 50% glaucoma and 50% comprehensive, is this true? This is intriguing to me because I would like to specialize but also still see a variety of things.

3) Most glaucoma fellowships seem to be 1 year. Are the 2-year ones better? What's the difference?

4) What are the hours like? I know acute angle closure glaucoma will get you called in, but isn't that fairly rare so is the call really that bad? How do the hours and call schedule compare to other ophtho fields?

5) Why do residents complain about having to do glaucoma procedures? That seems to be a common theme discussed here...

 

[LightBox]

1) Cataract surgery, lasik, filters, tubes, ECP, LTP, etc

2) You can do what % you want. If you do 100% glaucoma, then it is more likely that regular 'ole comprehensives will refer to you. If you take away more of their cataracts, the less likely they will refer glaucoma cases to you.

3) Do a 1-year fellowship. Two years is overkill.

4) Hours are like any other anterior segment field. The call schedule depends on your practice environment. In my practice. the optoms take all of the call.

5) Because taking care of chronic patients whose disease has no cure can be depressing. Patients typically do not understand why their vision is MORE BLURRY initially after a glaucoma operation. Compare this to cataract surgery or lasik where you improve the patient's vision (usually) immediately. Also glaucoma operations have a fair # of complications (e.g. bleb leaks, hypotony) and even when they don't have these complications, alot of the operations fail anyways! Ever see a patient with 3 or 4 tubes in one eye? I have 🙂

 

[ophthodude]

1) Cataract surgery, lasik, filters, tubes, ECP, LTP, etc

2) You can do what % you want. If you do 100% glaucoma, then it is more likely that regular 'ole comprehensives will refer to you. If you take away more of their cataracts, the less likely they will refer glaucoma cases to you.

3) Do a 1-year fellowship. Two years is overkill.

4) Hours are like any other anterior segment field. The call schedule depends on your practice environment. In my practice. the optoms take all of the call.

5) Because taking care of chronic patients whose disease has no cure can be depressing. Patients typically do not understand why their vision is MORE BLURRY initially after a glaucoma operation. Compare this to cataract surgery or lasik where you improve the patient's vision (usually) immediately. Also glaucoma operations have a fair # of complications (e.g. bleb leaks, hypotony) and even when they don't have these complications, alot of the operations fail anyways! Ever see a patient with 3 or 4 tubes in one eye? I have 🙂

Aw man your #5 makes glaucoma sound like a depressing field. Do you do any any comprehensive still? I've been told retina and glaucoma are the highest in demand. Is that because ppl stay away from glaucoma since it's depressing or just more and more pts with glaucoma?

 

[orbitsurgMD]

Deal with it. There is no "wow" factor in glaucoma surgery or treatment. It takes an introspective person to appreciate not getting worse as an endpoint, and not losing something just doesn't have the same psychological impact as getting something, like clearer vision, or going without glasses. You have to be satisfied yourself with the knowledge and by your investigation that your patients are better for your intervention and care, whether they understand or appreciate or acknowledge that. You will have to get used to the person who only complains about needing their readers (despite having needed them for thirty years) while saying nothing about not needing their their six drops a day of four medicines because you did a good job on their trab or tube As I said, deal with it.

 

[LightBox]

Aw man your #5 makes glaucoma sound like a depressing field. Do you do any any comprehensive still? I've been told retina and glaucoma are the highest in demand. Is that because ppl stay away from glaucoma since it's depressing or just more and more pts with glaucoma?

Yes, I still do a ton of comprehensive (see #1). I would go insane just doing all glaucoma

Glaucoma is in demand because not many people are going into it. Many eye docs want the "easy" stuff that don't have many complications. Unfortunately, incisional glaucoma surgery has a higher complication rate (early and late) than most other ophthalmic surgeries. You have to develop a thick skin to do lots of filters every week!

Plus, like orbitsurgMD said...there is no "wow" factor in glaucoma. No patient is saying, "Wow, my bleb is perfect without any ischemia and my IOP is 8 mmHg with no drops. Thanks doc!" But it's a much-needed service, so I don't mind doing it.

 

[DiveMD]

Glaucoma=job security. Glaucoma patients are like barnacles.