Glaucoma Consultations with Dr. Schertzer

How to be referred to Dr. Schertzer
What to bring with you for your visit
In office tests prior to seeing Dr. Schertzer
Consultation day with Dr. Schertzer
How long will all this take?
What is the follow-up plan?

 

How to be referred to Dr. Schertzer

Dr. Robert Schertzer sees new patients by referral only from other ophthalmologists, optometrists, family doctors and other physicians. His practice is restricted to patients who either have or have significant risk factors for developing glaucoma such as family history, high myopia, characteristic optic nerve or visual field changes, or raised intraocular pressure.

Consult requests must be faxed to (604) 873-2937 for consideration; they will be assessed by an ophthalmic technician and prioritized based on the findings. Referring doctors are asked to provide as much relevant information so that we may triage accordingly.

 

What to bring with you for your visit

All patients are asked to bring their glasses for distance (driving) and for reading along with either all their medications or a detailed list of them, whether they are for their eyes or any other medical conditions. Many eye conditions are related to other medical conditions. The different treatment options for glaucoma may depend on any other medications you might be taking for ANY other conditions.

 

In office tests prior to seeing Dr. Schertzer

A full assessment includes a medical history, physical examination of your eyes, and ancillary testing. We are proud to be able to offer all of these at one place at the West Coast Glaucoma Centre. If you have not had a visual field test or HRT nerve head scan recently, these will be performed prior to your consultation. These tests are fully covered by your BC Medical Services Plan but are not fully covered when performed on the same day. Therefore, you will have to come on two different days in order to undergo your ancillary tests and see Dr. Schertzer.

As the visual field test takes longer than the HRT nerve scan, it is more likely to take place on a date prior to the consultation. An ophthalmic technician, Teresa or Linda, will call you from the waiting room to either the diagnostic testing room or to one of their examining rooms.

For an accurate test, it is very important that we have your most recent glasses prescription. We then use this value to calculate the strength of a lens that will be placed in front of each eye during the test. You will be instructed to place your chin on the chin rest and place your forehead against the forehead rest. One eye will be covered with what looks like a pirate’s patch and a lens will be positioned in front of the eye being tested. You will have a “clicker” in one hand and will be asked to press the button whenever you see a small light appear anywhere within the testing bowl while you keep looking straight ahead. The visual field test will take under 20 minutes.

You will return on a future date for the HRT nerve head scan and to see Dr. Robert Schertzer in consultation. The HRT scan will be performed first. The ophthalmic technician, Teresa or Linda, will call you from the waiting room to the diagnostic testing room after they enter some preliminary information into the scanner. The nerve scan is painless and takes less than five minutes. You will be asked to put your chin on the chin rest and your forehead again the forehead rest. You will then be asked to look straight ahead at a green target with one eye while a red laser light flickers as it does a 3-D scan of your other eye. The process is then repeated for your other eye. If you have limited vision in one or both of your eyes, then sometimes a little extra time and patience is needed to get the best possible scan.

The technicians’ role When it comes to these ancillary tests, our technicians role is to obtain the most accurate results possible. They do not interpret the results. Dr. Schertzer will analyze the tests and review the results when he sees you.

 

Consultation day with Dr. Schertzer

Upon arrival, please check-in at the front desk so that we know you have arrived. Our receptionist will verify your name, address, MSP number as well as the names of your referring and family doctors. Sorry, our waiting room has limited capacity. We have room for one person to accompany you.

While in the waiting room, you will can watch videos explaining glaucoma and other eye conditions. As patients have found these to be very educational, many of these videos are included in this website so that you can return to this site to review the information any time in the future.

If you are booked for a visual field test or HRT nerve scan, one of these will be performed then you will return to the waiting room until another ophthalmic technician, the glaucoma fellow or ophthalmology resident calls for you. An initial history will be taken and parts of your eye examination will also be performed. When seen by an ophthalmic technician, you will then return to the waiting room until Dr. Schertzer calls for you. Fellows or residents will perform the complete examination then call Dr. Schertzer to review the key elements of the history and physical and formulate a treatment plan.

The complete examination for glaucoma usually includes: visual acuity, tonometry (intraocular pressure), pachymetry, slit-lamp biomicroscopy, gonioscopy, and optic nerve examination by ophthalmoscopy. These clinical findings will be reviewed along with the ancillary test results to see if the findings are consistent with one another. Dr. Schertzer, and residents or fellows if present, will discuss the findings with you along with their assessment of your likelihood of having glaucoma or, if you have glaucoma, whether you are stable at this time. A plan will be discussed for your ongoing care and you should have time to ask questions to make sure you have a good understanding of the conclusions. If any treatments are recommended, be they medical, laser or surgical, the risks and benefits will be reviewed.

Within a few minutes of finishing with Dr. Schertzer, a full report will be faxed to your referring doctor and family doctor so that all members of your healthcare team can work with you. We do our best to maintain open communication with your other doctors, even when seeking a second opinion, but will always check with you first as to who should receive copies of your consultation report.

 

How long will all this take?

Although the total amount of “chair time” for the consultation is approximately 20 minutes, and we do not double-book patients, sometimes emergencies arise that can put our whole team behind by up to 1.5 hours.

If a couple of patients have serious issues, the schedule can be thrown off for everyone else for the rest of the day. We try to spend the time that is needed with each patient. Although these long delays are infrequent, when they do occur, some patients who have had to wait a long time understand that if they were the one having the problem, they know they would have gotten the extra time so they don’t mind the inconvenience sometimes.

If things seem to be running behind and you have to be somewhere else across town for another appointment, please let our staff know so that we can try to accommodate your needs or re-book you for another day.

 

What is the follow-up plan?

After your glaucoma consultation there are several possibilities for how you will be followed-up in the future. This depends on what we find.

If you do not have glaucoma and lack risk factors to put you at risk of developing glaucoma, then you will be followed-up by your referring doctor and we would gladly see you again in the future if circumstances change that may increase your glaucoma risk.

If you are a glaucoma suspect, then this means that you have some risk factors for glaucoma but not enough in the way of convincing findings that you have glaucoma. You will then be followed-up every 4-6 months for at least 3 visits to see if there is any sign of progression to glaucoma over the following 1-2 years.

If you have glaucoma, you will be followed on a regular basis and treated by medical, laser or surgery as needed.