Whether we like it or not, most of us providing glaucoma care are currently comanaging our patients with the Internet. More and more, they are turning to Google for health information in an attempt to gain understanding and empowerment. The Internet's involvement in patients' care has been a mixed blessing. In the best case scenario, our patients arrive at the office with a sound understanding of their disease and a knowledge of appropriate treatment options. In the worst, inaccurate or irrelevant information causes them unnecessary anxiety and hampers their care.

Sometimes, patients are seeking information on the Internet in an effort to alleviate worry they feel about their diagnosis. In such situations, it may be most successful to directly address their anxieties and provide appropriate education or reassurance. In other instances, our best course of action is to assist patients in their quest for information by directing them toward quality Internet resources.

A BROAD STROKE
There are many great Web sites for educating patients about glaucoma, and this article will undoubtedly fail to celebrate every one worthy of mention. As a start, however, one straightforward, easily navigated Web site where patients can learn about glaucoma is http://www.glaucoma.org, which is hosted by the Glaucoma Research Foundation. Besides the benefit of its memorable URL, the resource presents information at an appropriate level and breadth for most patients, and it includes a link for Spanish speakers (¿Qué es el glaucoma?). The site contains information on the diagnosis and options for treatment (including links on trabeculoplasty and iridotomy), and a page addresses frequently asked questions. Finally, a link to “Ask Jennifer” allows visitors to e-mail specific questions to an information specialist.

Although this Web site has a useful section on normaltension glaucoma (reviewed by Douglas Anderson, MD), it provides little information on secondary glaucomas. Individuals who are looking for this level of detail may be better served by other resources.

INTERMEDIATE COMPLEXITY
For patients seeking moderately complex information on glaucoma, the Web site produced by the glaucoma faculty at the Wills Eye Institute in Philadelphia is first rate (http://www.willsglaucoma.org/education.htm). This comprehensive, rich resource covers the spectrum of glaucoma from neuroprotection and blood flow to cataract surgery and the glaucoma patient. Among several gems written by George Spaeth, MD, are two essays titled “Common Misconceptions of Glaucoma” and “Now That I've Been Told I Have Glaucoma, What Can I Expect?” These articles will likely be enlightening for both patients and physicians. In addition, the Web site contains information on Wednesday night chats with glaucoma specialists, during which patients may post specific questions to the Wills Eye glaucoma faculty. These chats are archived on the site as well.

DETAILED INFORMATION
Patients such as non-ophthalmologist physicians and others who are highly educated may feel motivated to learn specifics about their disease. Such patients (or medical students looking to read about glaucoma) who request detailed information about a given topic will find www.glaucoma.net highly informative. This well-written resource begins with background information about glaucoma and progresses to highly detailed scientific information about the major causes of glaucoma, including but not limited to pigmentary glaucoma, exfoliation syndrome, and angle closure.

SPECIFIC SURGERIES
The recommendation of a particular intervention may prompt a patient to seek a second opinion from the Internet. In my opinion, the decision to operate or not is nuanced and complex and simply cannot be delegated to any Web site. For example, a plethora of Internet sites provide information on trabeculectomy and describe both pre- and postoperative care. Because they treat the subject matter in different manners with respect to operative detail and perioperative management, each of us will likely prefer to select such Web sites ourselves.

For specific procedures that require a surgical instrument or device, the manufacturer's Web site can often provide the highest-quality information about a product. Although these resources may be somewhat promotional regarding the procedure in question, presumably the physician who directed the patient to the site is willing to perform the operation. Additionally, the information provided is more likely to be consistent with the appropriate FDA clearance for that particular procedure than that found on other Web sites not affiliated with the manufacturer. Web sites are available for selective laser trabeculoplasty (http://www.glaucomaslt.com/), canaloplasty (http://www.canaloplasty.com), Trabectome (http://www.neomedix.net/; NeoMedix Corporation, Tustin, CA), and the Ex-Press mini glaucoma shunt (for now at http://www.optonol.com/; Alcon Laboratories, Inc., Fort Worth, TX). The most comprehensive Internet resource for patients on tube shunt surgery seems to be http://www.ahmedvalve.com (New World Medical, Inc., Rancho Cucamonga, CA).

CHATS
Although the glaucoma chat room may represent the least controlled source of information on the Internet, some patients will specifically seek the kind of personal connection and empathy that such sites provide. The Wills Eye Institute's site has a link for glaucoma support (http://www.willsglaucoma.org/support.htm). It provides a weekly glaucoma chat room, a schedule of upcoming chats, a link with which users may suggest a topic, and (humorously) a link to information on how to use emoticons in the chat room. The presence of a glaucoma specialist during these chats may be of comfort to some of us physicians.

Alternatively, the glaucoma group at groups.yahoo.com “was created to provide a safe and non-threatening atmosphere for glaucoma patients and medical professionals to come together for support and the discussion of glaucoma.” This e-mail listserv has presented more than 27,000 posts from 1,421 glaucoma patients and physicians since August 1998. Patients can subscribe by sending a blank e-mail to glaucoma-subscribe@yahoogroups.com (and unsubscribe if overwhelmed by messages through glaucoma-unsubscribe@yahoogroups.com). This broad service covers a range of topics and offers to subscribers a large, searchable database of previous postings.

VISUAL AIDS
The Internet can aid us in the examination room during our efforts to educate our patients. For example, Google's image search (http://www.google.com) can be a useful resource for demonstrative images to facilitate discussions about diagnoses such as optic disc hemorrhage, exfoliation syndrome, narrow angles, cataracts, or blepharitis. I have found this site most helpful for answering questions that are difficult to anticipate (eg, What does a filtering bleb look like?).

CONCLUSION
In the Internet age, it is incumbent upon us as care providers to guide our patients toward quality sources of information. When patients use suspiciously erudite language (eg, iridotrabecular contact), it is worth asking them where they came across the term and to engage them in a dialogue about the source of information. As with any physician intervention, we must weigh the risks and benefits of as well as the alternatives to recommending a given educational Web site. We all have patients who trust us implicitly, are content with the course of their care, and would prefer we not suggest additional educational resources. When patients or their families are seeking more information on glaucoma, however, we can do them a service by recommending appropriate glaucoma resources on the Internet.

Nathan M. Radcliffe, MD, is an assistant professor of ophthalmology at Weill Cornell Medical College, New York-Presbyterian Hospital, New York. He has served as a consultant to Alcon Laboratories, Inc. Dr. Radcliffe may be reached at (646) 962- 2020; drradcliffe@gmail.com.