Describe your assigned client’s situation. Why are they presenting
to the clinic? What medications are they currently taking?
My client is a 55-year-old female with a PMH of atrial fibrillation taking
atenolol for rate control presenting by referral from NP with decreased
peripheral vision, slightly reduced overall vision, and redness to the white of
her eyes. Upon assessment, it is noted the client has decreased peripheral
vision and increased intraocular pressure per tonometry testing. She denies
a social history of both smoking and drinking.
Assess the applicable clinical practice guideline (CPG) for your
assigned client. What treatment is recommended by the CPG for
your client’s situation?
According to the clinical practice guideline written by the American
Optometric Association (2024) suggests that topical medication treatment is
used for newly diagnosed open angle glaucoma with the first line treatment
being prostaglandin analogs such as bimatoprost, latanoprost, and tafluprost
as they have proven to decrease the intraocular pressure by 25-30% with
limited systemic and ocular side effects. Additional treatment may include
combination therapy with adrenergic antagonists, adrenergic agonists,
carbonic anhydrase inhibitors, rho-kinase inhibitors, and cholinergic agents
to increase the lowering of intraocular pressure.
Discuss your personal professional assessment of the client’s
situation provided in the scenario. What pharmacological treatment
is necessary and why?
Based on the provided information, the reported signs and symptoms, and
the increased intraocular pressure noted by tonometry, the patient is
suffering from open-angle glaucoma. Prostaglandin analogs are appropriate
for initial treatment and as monotherapy to determine efficacy. Latanoprost
0.005% ophthalmic solution, one drop in each eye once daily at bedtime is
appropriate treatment for new diagnosed open angle glaucoma with changes
in visual fields. Beta blockers were not chosen as first line treatment at this
time due to the patient already taking a beta blocker, increasing the risk for
systemic adverse effects (Gedde et al, 2021).
Reflect on additional questions you have about your assigned client
that may influence treatment. What else do you need to know?
What follow-up assessments, labs, or conversations are required to
ensure optimal health outcomes?
A thorough review of patient history including surgeries both systemic and
ophthalmic, personal and familial history of glaucoma and eye drop use,
medical history of hypertension, cardiovascular disease, asthma, migraine,
