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Editors Selection IGR 9-4

General aspects: Fear of blindness

Comment by John Walt on:

19996 Fear of blindness in the Collaborative Initial Glaucoma Treatment Study patterns and correlates over time, Janz NK; Wren PA; Guire KE et al., Ophthalmology, 2007; 114: 2213-2220

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Why do we treat glaucoma? Why does glaucoma need treatment? Why do patients seek medical care for their disease called glaucoma? It is their fear of blindness and functional visual loss? If glaucoma was just high eye pressure with no quality of life effects or no vision loss, would it even need to be treated? If patients walked around with IOPs in their 20's and 30's and there was no chance of vision loss or fear of vision loss, would we even need to treat all these patients? Fear of blindness from glaucoma is reality and it is a good, healthy thing. Even with the fear of blindness, Paul Lee and others have demonstrated, patients do not return for their regularly scheduled follow-up treatments. And their lack of glaucoma medication compliance is well documented by many. Even despite the best medical care available today, patients continue to progress and some to blindness. It is healthy for patients to fear blindness from their disease called glaucoma, and yes, that is why it needs continuous treatment. Blindness is the second most feared aspect of life, after the fear of death. And glaucoma patients should be informed of the risk of blindness and play an active role in their medical treatment. Fear drives human behavior and the fear of blindness is a healthy fear for glaucoma patients. The fear of a heart-attack is why patients seek cardiovascular medical care for high blood pressure and high cholesterol. The fact that the fear of blindness dropped in this study by Janz et al. (1173) from 34% to 11% five years later, may demonstrate the apathy for follow-up glaucoma care, medical compliance and thus the general overall progression of the disease. This study may actually show why patients do not continue to participate with the medical system in their care continuum. They lose the fear of the reason for their initial treatment.

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