OP7.5 | Glaucoma Treatment Counselling and Prognosis Discussion — Summary & Reflection

KEY TAKEAWAYS

Glaucoma counselling (OP7.5, SH-level) requires accurate disease knowledge translated into patient-accessible communication. Key counselling occasions: at diagnosis, at initiation of drops, before laser/surgery, and when vision loss occurs. The core message for all POAG patients: treatment prevents further vision loss but cannot restore vision already lost — this must be set as an expectation from the first consultation. POAG counselling: explain prostaglandin analogue mechanism (latanoprost, once nightly, increases uveoscleral outflow), side effects (hyperaemia, eyelash changes, iris colour change), and the lifelong monitoring requirement. PACG counselling after an acute attack: explain LPI mechanism (alternate aqueous route, eliminates pupil block), why the FELLOW EYE must be treated (same anatomy, high risk), and precipitants to avoid (dim light, anticholinergics). Prognosis communication: honest, hopeful, and action-oriented — separate irreversible past loss from protectable current vision. Adherence barriers: validate the concern, provide evidence-based explanation, offer practical solutions (generic drugs, NPCBVI programme, dose anchoring to routines). Teach-back is the gold-standard method for confirming patient comprehension.

REFLECT

Return to Mr. Ramachandran from the opening hook. He drove himself to the clinic, sees fine subjectively, and is sceptical about daily drops. After working through this module, you have the tools to address his specific concerns: validate that he feels well; explain that glaucoma's silence is its danger; use the blood-pressure analogy; set the prognosis expectation ('we are protecting the vision you have, not recovering what has already changed'); address his concern about side effects specifically; give him a practical instillation plan anchored to his bedtime routine; and use teach-back to confirm he has understood. Reflect on how much of effective clinical medicine depends not on knowledge of drugs and mechanisms, but on the ability to translate that knowledge into a conversation that motivates a human being to take protective action against a disease they cannot feel. This is the skill that the OSCE is testing — and the skill that, in real practice, determines whether Mr. Ramachandran goes blind or keeps his vision for the next two decades.