How I Practice

Principled Care | Glaucoma

Glaucoma care offers fertile ground for embodying our values — not in theory, but in how we choose, intervene, and refrain.

Glaucoma is rarely an emergency.

Yet it is often treated as one.

I see many patients arrive on multiple drops — added quickly, layered without clarity, driven by fear rather than understanding.

Action becomes a proxy for care.

But glaucoma does not respond well to panic.

One principle quietly guides my approach:

Minimum effective dose.

Not just pharmacologically — but systemically.

The minimum intervention that achieves the intended outcome, while preserving tissue, trust, and nervous system safety.

What this looks like in practice:

Discernment before accumulation

If we don’t know which drop is working, we don’t know what we’re treating.

Stepwise care is precision, not delay

Glaucoma is longitudinal. Rushing escalation creates noise, side effects, and loss of signal — not safety.

Side effects are data

Periorbital fat atrophy, pigmentation, ocular surface toxicity — these affect adherence, identity, and long-term engagement.

They are not cosmetic footnotes.

Education is a therapeutic intervention

Explaining why, how, and what next is not optional.

A regulated, informed patient gives better data over time.

Earlier minimally invasive options deserve consideration

SLT and MIGS, used appropriately, can reduce medication burden and long-term harm — especially in patients who will live with glaucoma for decades.

The same principles apply in surgery.

There is no one-size-fits-all — only careful, respectful discernment, followed by precise execution.

When fear leads, care escalates.

When discernment leads, care becomes precise.

Good glaucoma care is not loud.

It is measured, relational, and grounded in respect.