Before it went off the rails in its final season, ABC’s Lost was a peerless example of great storytelling, full of puzzle-box mysteries and philosophical musings, but ultimately a human drama of survival about people from different walks of life forced to cooperate. Early in season two, “man of science” Jack Shephard and “man of faith” John Locke square off against each other when faced with the prospect of having to enter a series of numbers into a computer every 108 minutes. Once they make that fateful first push of the button, they’ll be signing up for a tedious, unending series of events—or else risk their lives by abandoning the task. 

Locke couldn’t do it alone. He needed the man of science to do it, to validate it in the eyes of the others.

Sometimes I think about that scene as I wonder why more optometrists don’t manage glaucoma. Diagnose the disease and you instantly put a lifelong burden on your patient—to commit to therapy and frequent office visits, which they might not even need. You’ll put in motion a series of events from which there’s really no good escape.

You and your patients will be pushing the button, pretty much forever.

With stakes that high, reluctance to manage glaucoma is understandable. But that doesn’t make it excusable. The stark reality is that more people will experience vision loss if optometrists don’t embrace glaucoma care more fully. There simply aren’t enough ophthalmologists to do it. And because ODs do the bulk of primary care, you’re the ones on the front lines seeing at-risk patients at the stage when early intervention can give them the best possible prognosis.

Our current four-part series, Take Charge of Glaucoma, addresses the obstacles many ODs encounter. In the May issue, Part 1 tackled the mindset needed to add glaucoma. June’s installment covered diagnostic technology. This month we explain the principles of medical therapy (still the first line of defense) as part of a bigger theme detailing nearly every IOP-lowering effort used in practice or on the drawing board. Next month, the series will conclude with advice on surgical comanagement.

We hope the series leaves you with a roadmap forward. But ultimately, of course, it comes down to you. Start by acknowledging that uncertainty lies at the core of glaucoma care, even among experts. A new study in the Journal of Glaucoma finds only middling agreement among doctors, at the same institution using the same generally accepted protocols, in how they decide if glaucoma progression is present. In a report on a two-OD, two-MD team, the optometrists agreed 74.2% of the time; the ophthalmologists, at 78.7%, didn’t do much better. And all four providers only agreed 54.4% of the time.

Bottom line: if you wait until you’re dead certain you’re seeing glaucoma before pulling the trigger, odds are you’ll have missed your best chance at mitigating its effects. 

“It’s never been easy” to believe, an emotional John Locke confesses to Jack in that scene. But sometimes you have to take on a burden for the greater good.