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Uploaded: Thursday, July 23, 2009, 4:25 PM

VA investigates glaucoma patients' treatment
'Exhaustive' internal review found inadequate referrals; optometry chief sidelined

by Sue Dremann
Palo Alto Weekly Staff

Posted by PAmoderate, a resident of the Old Palo Alto neighborhood, on Jul 23, 2009 at 4:29 pm

But... but... the VA is supposed to be the shining example of how government-run healthcare is supposed to work!

Posted by Perspective, a resident of the Midtown neighborhood, on Jul 24, 2009 at 12:12 pm

Well said. Efficient, best practices and only the interest of the patient at the heart of any government official.

Posted by rem, a resident of the Adobe-Meadows neighborhood, on Jul 24, 2009 at 2:01 pm

I hope they went back to 2000 to review records AND WHO WAS DOING THE EXAMS and who was signing the paperwork. From 2001 to 2003 I had appointments with the Optometry Clinic and I was not impressed with the service or quality of work.

On visits I was seen by “Fellows” from Stanford, these are Senior Residents or Optometrists that has “just” completed his/her residency. On my last visit (2003) I had to “demand” to see the Chief of Optometry because they, “ the FELLOWS”, would not turn “down the “Slit Lamp”. On all of my visits I NEVER saw or was examined by the Chief of Optometry!!!

NOTE::: I am a retired AF Medic and was around Optometry Clinic for a few years..

Posted by John Walters, a resident of another community, on Jul 25, 2009 at 9:42 pm

I am very sorry to hear that several patients have lost their vision due to glaucoma at the Palo Alto VA hospital. It is worth noting that glaucoma is a chronic eye disease that is difficult to diagnose and actually very difficult to treat, because there is no true cure for the disease. Glaucoma is the leading cause of blindness in African Americans and Narrow Angle Glaucoma is the leading cause of irreversible blindness world wide. Even in the care of very experienced Glaucoma Specialists (ophthalmologists who were fellowship trained in glaucoma), patients still suffer from blindness or at the very least progressive vision loss. The reason this can happen is that some people have far more aggressive disease than others.

Posted by Jerry Peters, a resident of the Green Acres neighborhood, on Jul 26, 2009 at 5:16 am

Your article does an injustice to the fine work of the Optometry department. Glaucoma, especially in its' early stages, can be a very gray area as evidenced by the words in this article (suspected, potential, high risk)

To be fair, did they happen to review the patient records of ophthalmology department ? Is it possible that they are perfect in their abilities to detect all glaucoma ? What was their definition of glaucoma, glaucoma suspect, and progression ? (for your reader, these definitions are rarely agreed upon even by ophthalmologists).

How about an article about the failure rate of ophthalmological surgeries. Let he that hath no sin, let him throw the first stone

Posted by Perspective, a resident of the Midtown neighborhood, on Jul 26, 2009 at 7:26 am

Good points. Pointing to the apparent failures without any context of comparative "rates" of failure across medical systems here in the States, or even in other industrialized nations, and comparative rates between the two "warring" professionals could be misleading.

Out of curiosity, does anyone know what the rate of blindness from glaucoma is in the VA system versus non VA over 65 population? Versus over 65 population in Canada, England, or France?

Posted by Mark, a resident of the Southgate neighborhood, on Sep 25, 2009 at 7:33 am

A rather salient point from the article: "We informed them ... and of the fact that we COULDN'T SAY FOR SURE if treatment would have slowed down the progression of their disease...." This may be a political thing between two somewhat competing professions, optometry and ophthalmology, with ophthalmology trying to make the optometrists look bad and limit competition. Unless the ophthalmologists had specialty training in glaucoma they may have been no more adept at treating the glaucoma that the optometrists were.

Posted by Leon, a resident of Stanford, on Jan 8, 2010 at 2:55 pm

I would wager that patients have also gone blind from glaucoma under the care of opthalmology. I understand that even with the best of treatment some cases result in blindness.

Posted by George Schmidt, a resident of another community, on Feb 1, 2010 at 9:00 pm

A recent study showed that even glaucoma specialists (all ophthalmologists) missed 50% of patients with early glaucoma demonstrates that this is not an easy disease to detect. It's safe to assume that even more cases are undetected by general ophthalmologists. New technology has improved early detection (GDx and OCT scans), but even with them a definitive diagnosis is impossible unless the disease is fairly progressed. In my opinion (as an optometrist) NO eye specialist should attempt to make a glaucoma diagnosis without doing a retinal scan of the nerve fiber layer, but most ophthalmologists do not have the instrumentation in their offices.

Posted by owen LinderMD, a resident of another community, on Feb 2, 2010 at 5:36 pm

excellent comments from an uppercrust commnunity

My Dad was an optometrist and grandfather too. And so is my second cousin. I am not biased against the profession.

But my Florida Medical Association has used this Ca. affair as the "factual" basis for an anti expansion of practice ad.

Lets have health care reform. Let's see bundling of service so that the fiscal incentives are tied to good service not exclusivity of relationship. Instead of having a mixed martial arts cage for eye doctors lets see how far they can run in a three legged race hopping together.

There is a big pot of gold in the unregulated side of eye care. Let's reign it in and distribute it universally.

Posted by John, a resident of the Palo Alto Hills neighborhood, on Feb 4, 2010 at 5:43 am

I can't believe those optometrists would treat patients independently when they are regulated not to. All these arguments about whether some patients with glaucoma progress even with treatment are irrelevent. These specific cases were reviewed and ERRORS in clinical care were found. Why would any health care provider who has the patient's best interest in mind attempt to treat patients independently when there are more highly trained people to do the job. Even non glaucoma subspecialists in Ophthalmology have on average 5-7 years more training than Optometrists!