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HomemiprofessionThe Lion’s Share: Co-Managing Glaucoma in Regional Australia

The Lion’s Share: Co-Managing Glaucoma in Regional Australia

Rural and remote optometry has provided Lian Walker with a crash course on the importance of cooperative care for glaucoma patients.

From the first intriguing lectures at university to the daily challenges in my optometry practice, glaucoma has been a constant fascination for me. I find it incredibly unfair and constantly challenging that glaucoma usually reveals itself as a silent thief of sight, lurking unnoticed until irreversible visual field loss occurs.

After graduating from Flinders University in 2020, my awareness of the profound impact of glaucoma deepened. Commencing my career in the rural South Australian town of Clare, I faced the stark reality of limited access to full-time ophthalmologists. The closest one was over an hour away and visiting ophthalmologists, though invaluable, were only available once a month, with appointments booked out many months ahead.

The arduous journey patients and their families undertook to attend ophthalmology appointments highlighted the critical need for comprehensive and consistent glaucoma workups within optometric practices. It became paramount to ensure the patients who made the journey genuinely required specialised care.

Moving to the even more remote city of Port Lincoln, on South Australia’s Eyre Peninsula, intensified this realisation. Here, local optometrists were expected to manage the lion’s share of stable glaucoma cases. Referrals to visiting ophthalmologists were reserved for situations of significant deterioration or those that required ophthalmic intervention. This shift underscored the importance of a proactive approach, emphasising the need for robust glaucoma detection and management within community optometry.

Fortuitously, at Specsavers, we’ve integrated optical coherence tomography (OCT) scans of the macula and optic nerve into every eye examination. This technological advancement has empowered me to identify subtle glaucomatous signs in the retinal nerve fibre layer, neuro-retinal rim, and ganglioncell complex far earlier than relying solely on fundoscopy. The synergy of OCT with the Humphrey Field Analyser 3 allows for the identification of minute changes in the optic nerve and peripheral vision, providing crucial insights long before symptoms manifest. The availability of OCT scans from previous visits facilitates trend analysis, enabling the monitoring of patients with preperimetric disease.

In Port Lincoln, I’ve come to appreciate the significance of collaborative care in managing glaucoma and optimising healthcare resources. The value of establishing strong relationships and managing expectations with local ophthalmologists cannot be overstated. This ensures efficient referrals and communication, guaranteeing that our patients receive prompt and specialised care when necessary, while routine monitoring remains a community-driven effort.


Beyond the clinical realm, my role extends to that of an educator. Empowering patients with knowledge about glaucoma, its risk factors, and the critical importance of adherence to prescribed treatments is a cornerstone of my practice. Open communication fosters a proactive approach to eye health, enabling patients to make informed decisions about their treatment journey.

As I have gained experience, I have discovered that motivating patients to adhere to their medication often requires more than the stark warning of potential blindness. Understandably, most topical glaucoma medications come with side effects that can be challenging. Therefore, alongside treating and educating patients about glaucoma, I consistently focus on optimising the ocular surface to maximise treatment compliance, comfort, and quality of life.

The Specsavers Early Career Optometrist Program, which provides special support and opportunities to optometrists in the third and fourth year of their careers after they complete the Specsavers Graduate Program, provided invaluable support, enabling me to complete the Australian College of Optometry’s Advanced Certificate in Glaucoma Course. This not only bolstered my confidence in glaucoma workup and management skills but also signalled to visiting ophthalmologists my unwavering commitment to providing the highest level of care to our patients.

Overall, my journey as an early career optometrist in Port Lincoln places me at the forefront of glaucoma detection and management. The nuanced nature of glaucoma, with its subtle onset and potential for devastating consequences, demands a modern and collaborative approach. By leveraging advanced technology, nurturing co-management relationships, and empowering patients with knowledge, we can detect and manage glaucoma effectively. This approach ensures the preservation of sight and maximises quality of life for those under our care.

Lian Walker graduated from Flinders University in 2020. He practises at Specsavers in Port Lincoln, South Australia.