Patient and Provider Perspectives

Interviews with Eye Care Providers

Dr. Stamper

Dr. Robert Stamper, MD

Department of Opthalmology
University of California San Francisco

This is an interview with Dr. Robert Stamper for the Glaucoma Education Program.

My first question to you, Dr. Stamper, is: When you mention glaucoma, do most of your patients know what it is?

I don’t think so. Most patients have perhaps heard the word, but most really don’t have an appreciation for what it truly means.

What kind of reactions do you get when you first mention that to a patient?

Some are just puzzled, as if you mentioned a word that they don’t—not sure what it means, and others are quite frightened and upset because they know that it may have something to do with the loss of vision, and they are immediately thinking that they may lose their vision or go blind.

As a doctor, do you get any additional information about glaucoma that you pass along to your patients?

Well, as a physician I am constantly upgrading or renewing/refreshing my knowledge base as new information comes along in [inaudible] literature or from my attendance at meetings.

The first time you talk to a patient about glaucoma, what is the information you give them?

Well, I usually begin by telling them something about what glaucoma is, how it comes about, depending upon the type of glaucoma that that particular patient may have. I then go on to tell them that the vast majority of cases can be controlled but not cured, and that our best shot at keeping your vision is to prevent further damage because we can’t reverse damage once it has occurred.

How would you encourage people at risk for glaucoma to get a dilated eye exam?

Well, for one, I would—I would first of all and encourage the relatives, that is, people, my people who are already my patients, I try to encourage them to encourage their relatives to seek an eye examination because, as I mentioned before, not only can we detect glaucoma at an early stage and prevent once at the moment we catch it prevent further damage in most cases, but it’s actually easier to manage when it’s in an early stage. And since it doesn’t have any symptoms in the early stage, really the only way to detect it is to get an eye exam—or get a careful and complete eye examination.

What treatment can be offered?

Yes. Well, there are basically three broad categories of treatment for glaucoma. And here in the United States we tend to go with eyedrop treatment first. At least, that’s the most commonly used type of treatment, and we have several classes of medications that are used as eyedrops to reduce the eye pressure and prevent further damage. We also—a second category of treatment is laser treatment, which, in some cases, anyway can also be used as the first treatment and perhaps obviate the need for drops at least for a time. And then finally, if neither medication or laser treatment will lower the pressure enough or keep things under control well enough, we then have surgical intervention.

What do you think prevents people from getting dilated eye exams to check for glaucoma? Why don’t more people do it?

Well, I think for one [thing], many people may not recognize that they’re at risk. There are large segments of the population, at least in the United States and certainly in other parts of the world, that don’t have a cultural bias towards preventive medicine, and they only seek out medical treatment if they’re symptomatic. And as we’ve already mentioned, the glaucoma may not be symptomatic until it’s—until a great deal of damage has been done to the vision. Another reason why people may not get routine eye examinations is just that many people are just busy and it doesn’t rise to the priority in their thinking. Just as busy businesspeople or mothers and housewives and so forth, I think sometimes just the very fact of living gets in the way of doing some of the things we should do from a preventive point of view. And then finally, I think there are some people who don’t get eye exams because they’re actually afraid of what they might find out in that eye exam. I’ve heard this a couple times over my career, or several times in my career, that people are afraid that they will get a bad news if they go, so if you hide your head in the sand, you won’t get any bad news.

What advice can you offer to other eye care professionals about helping their patients to understand the risk of glaucoma?

Well, for one—I think I’ll come back to one of the highest risk groups—are the relatives of people who already have glaucoma. So I think educating the people who have glaucoma to make sure that they inform their relatives that they are at risk as they share some of the same genes is—I think that can be a very powerful way of getting people who otherwise might not think about having an eye exam to get in to get an eye exam. And then there are high-risk ethnic groups such as African Americans and Hispanic Americans who, just by nature of their ethnicity, have a higher-than-average risk of developing glaucoma, and I think information can be spread in those groups through their churches and other organizations that may have a large number of those at risk within the organization.

Do you have any office procedures in place to help people understand their risk for glaucoma (such as intake questionnaires, brochures in your waiting room, interviews, and community outreach)?

Well, there are several that I have in my office. For one, I use the Glaucoma Research Foundation booklet called, “Living With and Understanding Glaucoma.”  It’s a free or nearly free booklet that’s available to any practitioner, or actually anybody who asks for it, and we pass those out to all people with new diagnoses of glaucoma, and I also pass it out to any relatives that may be accompanying them, any blood relatives that may be accompanying them.  Sometimes if we have to change course or escalate treatment, I give them the booklet again just to remind them.  I also participate in the Eye Care America program, which is a program of the American Academy of Ophthalmology that advertises free initial eye examinations to those who qualify, and those who qualify will be those who are at high risk for glaucoma.  And so that—we have some of their material around in our waiting room that tells people who is at risk and so forth.