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From the Editor: Finding a New Normal in Glaucoma

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As I introduce the current issue of Glaucoma Physician, we find ourselves in a time of extraordinary change and uncertainty amidst the COVID-19 pandemic. A fundamental part of this uncertainty lies in the reality that we are unaware at this point in time whether the dramatic changes that have overtaken our profession are temporary or permanent. The tragedy of this mysterious virus has likely touched each of our readers personally. My fellowship mentor, Jeffrey Liebmann, MD, wrote a thoughtful editorial in the Journal of Glaucoma on the myriad changes in glaucoma practice to be brought about by COVID-19.1 There are no aspects of glaucoma care that will be untouched, from gonioscopy to tonometry to perimetry. We need to approach our entire practice with a new outlook. It has been stimulating to talk with colleagues about how we will begin to practice again. The way that we calculate our follow-up intervals will now be completely rearranged, based on a new risk algorithm that incorporates risk factors for COVID-19 in addition to glaucoma.

For us here at Glaucoma Physician, part of the COVID-19 experience has been to look at many of the topics we have been covering to see how they fit in with our new post-pandemic practice reality. I am happy to see that many of the topics chosen for this issue 6 months ago are still very relevant in light of COVID-19, such as compounded medications, ergonomics in the clinic, and regenerating the optic nerve. Also, some of the most popular Glaucoma Physician topics, such as laser, MIGS, and sustained delivery, all have been useful approaches in an era when our operating room access is limited, and patients have endured extended follow-up intervals.

As always, our goal for our glaucoma patients is to maintain their quality of life, and now the emphasis is shifted toward preserving overall health in addition to vision-related quality of life. Focusing on quality of life is always important. Along those lines, how are glaucoma physicians themselves doing? Many of us have stopped practicing or have severely restricted our practices. Many are doing whatever they can to protect and support their employees in addition to their patients. Many are reluctantly wading into the waters of teleophthalmology (for more on this, see “Current Status and Needs in Teleglaucoma” in this issue). Aside from practical changes, this pandemic has brought me some fairly significant changes in perspective. I think it will be hard for any of us to take a busy patient day for granted again. But there is nothing like a pandemic and forced unemployment to show us that most of the good things in life are inexpensive or free anyway: meeting with colleagues, sitting down for a simple moment in a restaurant or coffee shop, going for a walk in public. The virus has forced one gift upon us: a once-in-a-lifetime chance to pause and think. These are indeed extraordinary times. Let’s all make the best of them and, of course, hope that we emerge from this wiser and stronger. GP

On the cover: Adenocarcinoma of the ciliary epithelium. Image courtesy of Paul T. Finger, MD. From "Glaucoma in Eyes With Intraocular Tumors."

Reference

  1. Liebmann JM. Ophthalmology and glaucoma practice in the COVID-19 era. J Glaucoma. 2020 April 14. [Epub ahead of print]