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Patient and Provider Perspectives

Interviews with Eye Care Providers

Dr. Tsai
Dr. James Tsai
New York Eye & Ear Infirmary of Mt. Sinai

Dr. Tsai: Glaucoma is a group of diseases that is one of the leading causes of blindness and visual impairment for Americans and many people worldwide.

Interviewer: I’m talking with Dr. James Tsai, President of the New York Eye and Ear Infirmary at Mt. Sinai and Chair of the Glaucoma Sub-Committee for the National Eye Health Education Program at the National Eye Institute. What these diseases have in common is an increase in the eye pressure, more than the eye can withstand, which causes damage to the optic nerve, and that leads to vision loss. Dr. Tsai, does glaucoma have any warning signs or symptoms?

Dr. Tsai: Sometimes patients will complain of some eye discomfort, but the scary thing about glaucoma is oftentimes the disease is asymptomatic, that is, patients do not have any warning signs or symptoms.

Interviewer: You mentioned that it is something that can affect Americans or basically anyone around the world, but are there people who are particularly at higher risk?

Dr. Tsai: Yes. African Americans are particularly at higher risk for developing blindness from glaucoma. Also, patients who are 40 years and older; everyone over age 60, especially elderly Mexican Americans; and finally, people with a family history of glaucoma also are at higher risk. Also, if you are either profoundly farsighted or nearsighted, you also may be at risk for developing glaucoma.

Interviewer: And if you have more than one of those risk factors, does it compound your risk?

Dr. Tsai: We do believe that the more risk factors that a patient has, the more likely they are to either have glaucoma or suffer vision loss from glaucoma.

Interviewer: But it is both people that have the risk factors and maybe even people without the risk factors that should have an eye exam, is that right?

Dr. Tsai: Yes. We believe that patients and people should visit an eye care professional every one to two years for a dilated eye exam. It is important just not to focus on the eye pressure. You can have glaucoma with normal eye pressure. So the eye care professional has to do a dilated exam and carefully look at the optic nerve for signs of glaucoma, as well as assess the side vision, or visual field, in that patient. What we have learned over the past decade is that a third of patients, at least in the United States, have glaucoma and do not have elevated eye pressure. And in some countries, such as Japan, over 90 percent of the patients with glaucoma do not have elevated eye pressure.

Interviewer: So that emphasizes the importance of having the screening and having that found early?

Dr. Tsai: Absolutely. I think early detection of glaucoma and early treatment of glaucoma, if you have glaucoma, is important in helping elderly Americans retain their vision, and also independence. We, as eye care professionals, realize that the more vision that we are able to preserve in patients, the more we are likely to make them comfortable living alone and continue to live independent lives.

Interviewer: Where can people get more information about glaucoma? Say they wanted to see a diagram of how the disease works in the eye and things like that. Are there some good resources for that?

Dr. Tsai: Yes. There are excellent resources. One resource is the National Eye Institute Website at www.nei.nih.gov/glaucoma. There is information there and people can also send an e-card to loved ones to remind them to get an eye exam. The nice thing about the National Eye Institute Website is there is also information available in Spanish. Also, medical centers and other medical organizations have a lot of information on glaucoma on the Internet.

Interviewer: That covered all of the questions I had. But is there something that maybe I didn’t cover, or perhaps something you think is worth re-emphasizing?

Dr. Tsai: I think that it’s worth re-emphasizing that glaucoma is a very challenging disease to manage. And the reason is it oftentimes is quite insidious. It causes very slow vision loss that is very difficult to perceive, especially in its early stages. And the therapies that we oftentimes use sometimes have some side effects. So it’s important for the patient to establish a very close relationship with their eye care provider, so that they understand what the potential for their vision loss could be and they understand all the therapies that would help them keep their vision.

Interviewer: Thanks to Dr. James Tsai, Chair of the Glaucoma Sub-Committee for the National Eye Health Education Planning Committee at the National Eye Institute. For more information on glaucoma, visit the NEI Website at www.nei.nih.gov/glaucoma.