SLT for Choroidals
The following letter refers to an article titled "Why Do Choroidals Form, and How Do You Treat Them?" by Malik Y. Kahook, MD, and Robert J. Noecker, MD, MBA, that appeared in our September/October 2007 edition.
I would like to point out a possible oversight in the practical article on choroidals by Drs. Kahook and Noecker.
They state that choroidals "can occur after all types of laser procedures." Having just written a review on selective laser trabeculoplasty,1 I can state that, to the best of my knowledge, no choroidal was ever reported following this procedure. This is hardly surprising in view of the minute energies employed in this type of laser trabeculoplasty, which are three orders of magnitude less than used during argon laser trabeculoplasty.
Michael Belkin, MA, MD
Tel Hashomer, Israel
Dr. Belkin is a consultant to Ellex (Minneapolis, MN).
Glaucoma Flow Chart
In the busy general ophthalmologist's office and in a glaucoma practice, many patients may be seen in a day. A flow chart system allows the physician to quickly review a patient's pertinent medical information, be more efficient, and improve patient care. Glaucoma is a chronic disease that is typically followed over many years. Paper charts may become very large, and finding important information can be time consuming. Each visit requires, along with a complete or problem-focused eye examination, a review of the date when necessary testing was last done, current medications, previous medication-related problems, compliance, and trends that indicate the adequacy of glaucoma management.
The simplified flow chart shown in Figure 1 readily allows evaluation of the patient's pertinent history, testing, and medications, thus making management quicker and reducing the risk of missing important information. It is designed to be an overview of the patient's history. From the flow chart, the ophthalmologist can easily reference, as necessary, a date in the chart to find and review in more detail descriptions of the optic nerve rims, size, parapapillary appearance, drawings, photographs, visual fields, gonioscopy, nerve fiber layer analysis, surgeries, reactions to medications, etc., for appropriate glaucoma management. The chart is designed to require minimal time to update the data and to provide an "at a glance" summary of the patient's glaucoma history.
Amy T. Kelmenson, MD, and Richard Kelmenson, MD
Denver
