A Glaucoma Conundrum

Using different forms of testing to guide therapy.

Jacob Brubaker, MD; Jason Bacharach, MD; Jeffrey L. Goldberg, MD, PhD; and Christine Larsen, MD

Glaucoma Today

Key Takeaways Myopia and unreliable visual field testing can make diagnosing glaucoma challenging. When standard perimetry is consistently unreliable, alternative strategies may be warranted. Genetic testing can provide insight into patients’ glaucoma risk. CASE PRESENTATION A 68-year-old woman presents for routine follow-up glaucoma care. She was initially referred by her optometrist 5 years ago because the appearance of the patient’s optic nerves raised suspicion of glaucoma, and she has been monitored as a glaucoma suspect ever since. The patient has no family history of the disease and no ocular complaints. She wears soft contact lenses for myopia and has been happy with her vision. She does not use eye drops. On examination, the patient’s BCVA is 20/20 OU, and a manifest refraction reveals -4.50 D of myopia in each eye. At her first visit, her IOP measured 16 mm Hg OU, but it has slowly risen since then.

Educating Patients on IOL Options

Check out these patient-facing scripts designed to aid in decision making and managing postoperative expectations.

Patrick Schultz, OD

Modern Optometry

The Bright Side of AI

Alan Ruby, MD

Retina Today

In April 2026, we ran an excellent article detailing how owners and administrators can use data monitoring to improve their practices. Tonya LaRue, MBA, explained why it’s important to track profit and loss statements, accounts receivable and collections, balance sheets, scheduling, and other metrics. While this is all very important data to monitor, the proposed monthly tracking with a spreadsheet and even (gasp!) some manual input may be a difficult ask for some practices. Isn’t there an app for that? For this issue, we asked data guru Bill James, MHA, COE, chief financial officer at Talley Eye Institute in Indiana, to discuss ways to automate some that data collection and analysis. During the 2025 ASRS Business of Retina meeting, he presented on his practice’s AI program, which uses automated “scrubbers” to review their patient management and electronic health record databases and identify potential workflow, coding, and billing issues. In his article, Using Data to Catch Problems Early, he shares how the system flagged a change in the allowable reimbursement for an anti-VEGF medication, ensuring the practice had time to minimize any financial ramifications. It’s a great example of how a carefully implemented AI system led to significant savings and efficiency without much ongoing work for staff. The key to its success isn’t necessarily the programming itself, but the collaboration with staff to identify stress points that needed automated monitoring. FURTHER READING Using Data Monitoring to Drive Practice Success By Tonya LaRue, MBA Once you have your data under control, we have several other important articles to help boost your practice management acumen.