Dr. Richard Madonna on HTN and why it is a risk factor for glaucoma

[AdminWolf]

In this InSight Studio interview from SECO2019, we speak with Dr. Richard Madonna from SUNY Optometry, where he explains why hypertension is a risk factor for glaucoma. (surprisingly, the answer has part to do with hypotension!

 

[AdminWolf]

Thanks again for Dr. Madonna for sitting down with us.

I appreciated his "tips" on modifying when the patients take their HTN meds to reduce the risk. The big question is can you get a cardiologist (or GP for that matter) to agree to adjust the patient's dosing schedule?

 

[AdminWolf]

BTW, Dr. Madonna also has a course at CEwire2019 about systemic disease & optometry, if you haven't seen it yet, here's an excerpt:



You can watch the full show from now until July 1st at CEwire2019!

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[Lloyd Pate]

Thanks again for Dr. Madonna for sitting down with us.

I appreciated his "tips" on modifying when the patients take their HTN meds to reduce the risk. The big question is can you get a cardiologist (or GP for that matter) to agree to adjust the patient's dosing schedule?

If you write a letter or call them with your concerns, I have found that they will do it.

 

[Ken Elder]

New patient comes to your office. 55wm. He’s being treated for hypertension and reports it’s controlled well. BP in office is 120/80.

Cd is 0.3 OU.

Is this patient a glaucoma suspect?

If so....what tests do you order?

 

[Lloyd Pate]

New patient comes to your office. 55wm. He’s being treated for hypertension and reports it’s controlled well. BP in office is 120/80.

Cd is 0.3 OU.

Is this patient a glaucoma suspect?

If so....what tests do you order?

You have not told us enough to decide. What are the rim ratios? VDD? IOPs?

However, I tell my students there are two types of patients: glaucoma suspects, and glaucoma patients.

 

[Ken Elder]

You have not told us enough to decide. What are the rim ratios? VDD? IOPs?

However, I tell my students there are two types of patients: glaucoma suspects, and glaucoma patients.

Let's assume it's all "normal."

The question is.....is a patient with controlled hypertension a glaucoma suspect? If so, what tests, if any should be ordered?

 

[Lloyd Pate]

Let's assume it's all "normal."

The question is.....is a patient with controlled hypertension a glaucoma suspect? If so, what tests, if any should be ordered?

Yes they are a suspect, all patients are. But there level of suspicion is low. I don't think you can medically justify any glaucoma testing unless you notice a change or have something suspicious. If I did any testing it would be an OCT of the GCC and RNFL.

 

[Richard Pagan]

Let's assume it's all "normal."

The question is.....is a patient with controlled hypertension a glaucoma suspect? If so, what tests, if any should be ordered?

no, and that is not what the op was alluding to at all

 

[Richard Pagan]

New patient comes to your office. 55wm. He’s being treated for hypertension and reports it’s controlled well. BP in office is 120/80.

Cd is 0.3 OU.

Is this patient a glaucoma suspect?

If so....what tests do you order?

again...no, not what is being discussed here

 

[Richard Pagan]

SOP for many glaucoma cases is to limit the use of BP meds before bedtime, especially bblockers.