What to expect at office visits: Tips for Successful & Less Stressful Pediatric Glaucoma Office Visits

Written by Dr. Karen Joos, Glaucoma Specialist, Vanderbilt Eye Institute

All Ages:

• Bring a list of questions to the appointment

• Bring a copy of the list to hand to the doctor so he/she has a record of what was discussed, and the doctor can make sure all questions were answered. Write down all answers during the exam for later reference. A companion can also assist in recording the answers. If you still have questions, remember that there will be many future appointments, and only time will provide the answers to some questions.

• Read the literature that your doctor may provide to gain a better understanding of your child’s condition.

• Bring all eye and oral medications and note when you are administering them so the doctor can review whether your child is receiving the correct medications.

If you hear disappointing news at an appointment, try to remember that your child is the same person as he/she was yesterday. One may feel devastated and believe that EVERYTHING has changed but and your child are the same people, except you are more informed about the status/ progress of the glaucoma. A positive way to look at difficult news is that you now know the current status, and can use that information to make the best treatment decisions for your child. Sometimes bad news gets in the way of thinking clearly. You may later have additional questions. Be sure to contact your doctor to have the additional issues addressed.

After appointments, whether receiving good or bad news, discuss the positive aspects from that appointment. For example, if the glaucoma remains controlled with the current therapeutic regimen, reinforce in an age-appropriate manner with your child that following the current therapy is currently keeping the health of his/her eyes stable. If you learn that your child needs additional eye medication or surgery, discuss with your child that it is good to correct a problem, that the medication or procedure typically has good results, and that he/she is receiving excellent care.

One most important outcome of an appointment for a child is to know whether his/her parents are OK with what has been discussed and planned. Children often judge the severity of the problem at appointments based upon their parents’ reactions.

Young Infants:

• The clinic exam may be easier in an infant if he/she is due for a feeding during the exam.

• After placement of the eye drops, breast-feeding or feeding formula to an infant will often make him/her calm or even sleepy, so that the doctor can more easily examine the eyes and measure eye pressures.

Older infants and toddlers:

• It is likely that an exam under anesthesia may be needed periodically to determine whether the glaucoma is remaining stable or progressing, because this age group is less likely to cooperate with all elements of the glaucoma examination.

• It may be helpful to schedule a toddler as early in the morning as possible, and to avoid scheduling an appointment around nap time when he/she may be more irritable.

• It is important for you to remain calm so your child is more likely to remain calm.

• It may be helpful to discuss with your child what to expect at the doctor’s office. Special coloring books or sticker books or special toys may help to pass the time while waiting for the exam. It may help to explain that there will be “special games” to play during the office exam. A child’s favorite video on a small electronic device also may be useful during the exam to increase cooperation.

• A small snack or pacifier, if he/she takes one, may be helpful during the exam.

• It is helpful for future clinical exams to introduce your child to the clinic eye examination room and equipment, even if he/she is unwilling yet to perform the examination in the clinic.

• If your child receives dilating drops, it is fine to permit your child to eat or fall asleep while waiting for re-examination. The rest of the examination is actually easier for your child and the doctor if the child is sleeping.

Older Children:

Many older children will cooperate and permit examination with the slit lamp if it is called a “motorcycle” with handle bars. The child is directed to place his/her head in the “helmet” which is the chin rest. Motorcycle–like sounds can then help the child remain calm while the eyes are examined. If your child has had several exams by this age with the same doctor, the doctor may be able to even gain your child’s trust to perform eye pressure measurements. Your child should be told that he/she will not feel anything if he/she remains absolutely still. You or a technician may hold his/her head in the slit lamp, and the doctor will hold the eyelids open. Your child may find that he/she actually prefers this blue light method over the hand-held Tonopen, and subsequently may cooperate more easily with eye pressure measurements than many adult patients! An iCare tonometer is another instrument to measure eye pressures. An older child who is experienced with examinations under anesthesia is also motivated to cooperate to avoid going to the operating room.

It is helpful to make the examination day a “special” day with a larger reward for cooperation. This may include picking a place to eat lunch, a special snack, or a special toy. Some parents also reward the accompanying siblings if they behave well at the doctor’s office.

Older children may also be able to perform a visual field test, if available at your doctor’s clinic, to begin to evaluate your child’s peripheral or side vision. The doctor may describe it as being a video game while one eye is covered. There is a learning curve in performing the field test so the first couple fields may be only a rough approximation.