Is “Pre-Glaucoma” the new “Fibromyalgia” — an invented medical label meant to scare via “diagnosis” without medical certainty? Is “Pre-Glaucoma” a new insurance power naming scheme invented to earn easy money for doctors by giving them the means to get paid by checking off a box on a form? 

Friday, I visited the eye doctor. I was stunned to hear how many patients in the waiting area were there to watch a Glaucoma video because their eye exam revealed them to be “Pre-Glaucomic.” Since there’s no such thing as a coincidence, I began to wonder again about the relationship between medical diagnoses and back-end insurance money.

There were too many people there of varying Race, age and ethnicity to believe the four MDs in that office were not in some incredible — and probably improbable — way skewing a random sample into a fanciful “pre-diagnosis” of “Pre-Glaucoma.” I’ve had elevated eye pressure in one eye for at least 15 years. I have super-thick corneas so that can play a role in providing a higher pressure than normal.

Every time I get an in-depth eye exam, the elevated pressure initially concerns my doctor until he reads through my history again and sees that pressure, for me at least, is in the normal range. On Friday, my doctor told me my eye had the same pressure as before but he was labeling it “Pre-Glaucoma” this time. I watched him tick it off on my insurance sheet. When I asked him what changed in his evaluation of my eye and why was I now on “Glaucoma watch” when previously I only had “elevated pressure,” he gave me an odd look as if he didn’t understand my question.

I wanted to know what had changed other than the labeling. I was told nothing changed. All the numbers were the same. “We just have more intensive diagnostic equipment now and we can see things earlier than we could before.” Okay, that made sense to me. Technology always presses us forward; but why the “Pre-Glaucoma” label now? Don’t you either have Glaucoma or not have Glaucoma? Is it possible to be “Pre-Pregnant” or “Pre-HIV positive” or is there a disconnect going on in the usage of the “pre-” diagnosis label?

I was told the history of the eye and other factors pointed to putting me on Glaucoma watch and “elevated pressure” and “Pre-Glaucoma” mean the same thing. “We have to keep an eye on your eyes,” I was told without a glint of humor or an ounce of compassion, “and we’ll do it again in six months.”

Am I too narrowly parsing words? Is there a danger being labeled “Pre-Glaucoma” on an insurance form that might somehow come back to bite you later as a no-longer-covered pre-existing condition even though you don’t actually have the disease? How can we fight back to save ourselves from the slapping on of these medical labels that have no real meaning or certainty in healing or positive effect in the best interest of our continued diagnoses?

29 Comments

  1. The cynic in me would say that this is all to do with *risk assessment* on behalf of the insurance companies. I suspect although nothing has in fact changed your premium may – and not downwards, or come back to bite you in the manner you described.

  2. Hi Nicola!
    I agree! I’m just not sure what’s in it for the doctor. A slightly higher payment for such a “pre-diagnosis?”
    I understand Glaucoma can be a long-term health concern — and that can mean a lot of doctor visit payments and medicine fees for insurance companies — but why would the MDs play along?

  3. In the UK our Doctors can earn more by carrying out extra health tests on behalf of the government ( who provide our healthcare from our taxes and National Insurance contributions).
    They get extra for providing family planning services, cervical smears, asthma and diabetic clinics, flu jabs etc etc. The government is looking to expand this type of service as it keeps healthcare local, and keeps us out of the hospitals and the pressure off the hospitals.
    I can only think that your MD’s would get an extra “incentive” or kickback in one form or another.

  4. Hey Nicola —
    Thanks for explaining how this sort of thing works in the UK. Very interesting to see how closely medicine and money are wed in the world.
    I guess one can never have too much money. My doctor’s office is incredibly successful and busy and they get all sorts of money from insurance companies, but if you can squeeze out another dollar or two for a pseudo diagnosis or two, then I guess you’re a bit better off in the end.
    I’ve never been one to get into a system to game it, but I realize I am not like most people.
    😀

  5. Sure does. And companies pay for that new relationship and so do we in higher payments and not covered conditions. It’s some big cycle, huh? A racket, as my father would say. I hope we get some kind of national health coverage so we don’t have to get stuck playing these name games with the people we look to for health help.

  6. I’m not sure there is a way out of it, Anne. It keeps getting worse and worse and never better. People suffer. The middle class crumbles under these heavy health penalties. It will take some strong governing to put the stops on these runaway healthcare costs and to centralize them as part of our inalienable rights to health and prosperity.

  7. This is interesting if unconvincing and vague:

    What is Pre-Glaucoma
    Q: An optometrist recently said I was “pre-glaucoma.” What does this mean and what should I do about it? Thank you.
    A: This is another way of saying that you are a glaucoma suspect. Briefly, a glaucoma suspect is someone who might have glaucoma but it’s too early to tell. This term includes patients with ocular hypertension (persons with elevated intraocular pressure but no detectable disc or visual field damage), and patients with large cup/disc ratios and normal visual fields who may or may not have early normal-tension glaucoma. Since you have been diagnosed as a glaucoma suspect, it is important that you see your eye care specialist regularly to monitor your condition so that you do not experience any loss of vision.

    http://www.glaucoma.net/gany/ask/ask8.html

  8. This, too, is interesting — the title of the page is “Pre-glaucoma medication study”–

    Question:
    I have a history of elevated eye pressure but my eye doctor still hasn’t diagnosed glaucoma. Even without this diagnosis, would it make sense to start taking glaucoma medications?
    Answer:
    A definitive diagnosis of glaucoma usually requires any combination of elevated eye pressure, changes in optic nerve head or a loss of visual field. If you just have elevated pressures, your eye doctor may assign a diagnosis of glaucoma suspect. Depending on the pressure measurements, family history and a patient’s overall health, a doctor may begin prescribing anti-glaucoma medications for glaucoma-suspect patients. …

    http://www.midwesteyecare.com/talkinghealth/owhq&a53.htm

  9. Businesses are starting to shift their health-care burdens onto the government when they stop providing health coverage for people who are eligible for medicare benefits.
    This is coming at a time when the medical profession is getting more aggressive in combating illnesses and dispensing more medications.
    I’ve noticed that medical care guidelines have been getting tougher over the years. Blood pressures that used to be considered borderline a few years ago are now considered hypertensive.
    Pre-hypertensive is anyone with a BP over 120.
    New guidelines adopted a few years ago mandate that hypertension be treated aggressively.

    “We have thought of blood pressures under 140/90 mm Hg as being okay,” says Daniel W. Jones, M.D., the American Heart Association representative on the JNC VII committee and the incoming dean of the school of medicine at the University of Mississippi Medical Center in Jackson. Jones is currently the executive associate dean.
    “The evidence is now clear that those in the prehypertension range are at higher risk than those with lower blood pressures and are much more likely to move into the hypertension range where medication is required. But lifestyle changes can help those with prehypertension.”
    The new prehypertension category focuses physician, patient and public attention on blood pressure in these ranges to motivate them to adopt health-promoting lifestyles. …
    Most hypertensive patients will require two or more antihypertensive medications to achieve goal blood pressure …
    “Using more than one drug to treat most patients will be key to improving blood pressure control rates. Patients and physicians need to begin the drug treatment process with an open mind to using as much medication as necessary to achieve goal blood pressure,” Jones says.

    Maybe the new medical guidelines for glaucoma are similar the new hypertension guidelines.
    Medical professionals might be trying to catch cases earlier before any damage is done. Maybe it’s better to attack the problem before it becomes a problem.
    Our scientists might have improved the state of medicine to the point that “borderline” cases of the past that might not have warranted treatment are the new battlefronts for advanced treatments designed to head off illness. Maybe we are better at predicting who will suffer the effects of illness than we were just a few years ago.
    Just think what might happen when genetic testing can be done to determine our risks for future illnesses.
    When we end up with government health care — I’m convinced it is inevitable because of the increasing costs that can’t be supported by anyone who pays for health insurance — I just hope that we aren’t cut off from preventative health care.
    I also hope that they don’t cut back on certain services — such as dental care.
    To illustrate the point, I turn to the social commentary of The Simpsons:

    At “Painless Dentistry”, the solitary lamp turns Ralph’s exam into an interrogation. When he admits that he doesn’t brush his teeth, Ralph is shown “The Big Book of British Smiles”, depicting assorted Brits with crooked teeth.
    The picture of Prince Charles pushes Ralph over the edge.

  10. Excellent point, Chris! What used to be normal is now considered “pre-something” — probably in part so doctors can prevent lawsuits in the future concerning protection from the accusation: “Why didn’t you tell me then what I have now?”
    I think that’s a dangerous thing. Scaring people before they have something is just as bad as pre-treating a condition that may or may not exist later.
    Hypertension is another one of those strange things. Pressure goes up and down all day long and some people are naturally more sensitive to any changes out of their ordinary day and that can lead to elevated levels. Unfortunately the only way you can test for Hypertension without involving them mind is to insert pressure tubes that are watertight — unfortunately that is not very practical and quite impossible, so we rely on the antiquated world of pressure cuffs and stethoscopes.
    It’s really quite mad we don’t have a better way to invisibly test for hypertension across the days and nights. One reading in a doctor’s office doesn’t give a very good random sample and even home testing skews the results in a non-normal setting.
    I don’t know if you watch “The Carters” on E! television or not but I happened up on an episode this weekend as Nick Carter explained why they brush their teeth 11 days apart: Brushing three times a day “rubs off all the enamel” and “makes you see the dentist more.” It was like getting medical advice from a family of cave people who’d been living in the dark since 1910.

  11. Hi Chris!
    Akismet caught you again for some reason! I’m glad you said something because I normally just blindly click on the Akismet “Delete” button because there’s too much junk I don’t want to read sitting there…
    Saw your updated homepage! Love the photo montage of your new basement. Looks fab! Love Imus on the monitor, too! He’s such a wacko!
    😀

  12. You folks just do not get the big picture! Pre-diagnosis (ie: No diagnosis) is another way the medical profession protects their behinds! If they difinetly diagnose something, and they are wrong, they open themselves up to the vultures (attornies)! Yes, the medical profession needs regulation, but lawyers need a complete “about face”! Of coures, this will never ever hapen because we keep putting them in law making positions! DA!

  13. Hi David,
    I’m going to remember Nick Carter’s dental treatment plan when he appears on Capitol Hill to testify for or against some proposed legislation. 🙂
    I’ll also remember to not get to close to any member of that family, if the chance ever arises, without offering them some strong breath mints to mask the byproducts of rotten teeth.
    I wonder if they also avoid bathing regularly as it can remove essential oils from the body and also cause one to lose the benefits of projecting a strong olfactory essence that captures and encapsulates raw alpha-male qualities?
    Alpha-male animals in the wild don’t bathe regularly, so it must be unnatural for humans to do so. 😉

  14. I don’t know why The Carters made their reality show, Chris. It only shows how backwards and insulted and stupid they are… same thing with Ms. Spears and her new Ex-hubby. Her show revealed her to be the same sort of vapid star and not at all what her image makers made her out to be… what disappointments all around!
    From the looks of them on their show… the Carters don’t often bathe or comb their hair or change their clothes… they live in a mansion… they behave like The Beverly Hillbillies!
    http://www.imdb.com/title/tt0055662/

  15. Hi David,
    That’s the problem with art developed by corporate committees.
    It seems all of the stars who have reality shows have come through the committee system where corporate types made all of the decisions and made the person the star. The star didn’t have to make any decisions (or any of the artwork?) themselves because there were committees and others available to do the heavy lifting.
    It’s too bad that the struggling artist spending lots of time on the road traveling from dive to dive will never make it big, but someone who “has a look” — but no brains or even any common sense — gets to be a role model for future generations.
    Of course, the money and fame is fleeting with these people and the ones who end up getting rich are the corporate types that pull the puppet strings.
    When relatively smart musicians get rolled and end up losing money after pulling in millions, I hate to even think what might be happening to the money that is being pulled in by these people who portray themselves as not being able to figure out how to tie their shoes or cope with the easiest of routine tasks.
    Or, are they players in a morality tale that warns against becoming a wastrel? In reality, could they be anti-wastrels?

  16. Hi Chris!
    From a monetary POV, today’s stars are much better protected than they were 30 years ago. Ms. Spears has hundreds of millions of dollars and she could happily live ever-after and go away from us all and want for nothing and wish for no desire. But she won’t…
    The problem is today’s stars are filled with “yes-people” — who confirm, for a salary, a car and accessibility, the star’s genius and relevance — and their job is to deny nothing and only reinforce good things.
    That skews reality for the star: See Tom Cruise, Ms. Spears, The Carters, Danny Bonaduce, K-Fed, Sly Stallone — and they think they are smarter and more talented than they really are in the end.

  17. I think you’re right.
    I was flipping through the television sometime this weekend and saw on one of the Spanish channels that K-Fed is going to wrestle the Marine guy, John Cena, on New Years Day.
    I only caught a part of the speech because I was flipping around and stopped when I heard the translator say something about K-Fed in Spanish.
    Yahoo Answers has a thread speculating on the effect K-Fed’s divorce papers might have on the wrestling match.
    The B and C stars must keep moving like sharks or else they will perish in a sea of more and more B and C stars.
    Of course, sometimes the viewers can win in these situations.
    Two of the women — New York and Pumpkin — from VH1’s Flavor of Love starring Public Enemy’s Flava Flav were distributing pictures of themselves kissing in an effort to get some publicity. What made the kissing pictures ironic is that they have gotten into a “cat fight” on the show with one spitting on the other.
    Anything for publicity. 🙂

  18. Didn’t K-Fed recently get bodyslammed by a wrestler? This match in January must be the next unnatural step in the K-Fed de-evolution.
    I am a big fan of FLAVOR OF LOVE — yes, BOTH SEASONS! — and that news source has it wrong! It’s “Punkin'” not “Pumpkin!”
    😀
    I can’t wait for NY to star in her own “The Flavorette” series. I think she’s funnier picking apart women than men. We’ll see if she flies or not.

  19. Didn’t K-Fed recently get bodyslammed by a wrestler? This match in January must be the next unnatural step in the K-Fed de-evolution.
    I am a big fan of FLAVOR OF LOVE — yes, BOTH SEASONS! — and that news source has it wrong! It’s “Punkin'” not “Pumpkin!”
    😀
    I can’t wait for NY to star in her own “The Flavorette” series. I think she’s funnier picking apart women than men. We’ll see if she flies or not.

  20. Hi David,
    TMZ has the K-Fed footage. Unfortunately, I can’t watch the video just yet until I update some plug ins.
    Reality TV World doesn’t have anything about “Flavorette” yet. Maybe there will be some leaks as it gets closer to air-time.
    I did notice that “Real World” is planning a 19th season. Pretty soon, kids who were born around the time the first “Real World” aired in 1992 will be having their own kids — if they haven’t already starting doing so already. 😉
    It’s somewhat sad that after being on the first “Real World,” Jersey City’s own, Heather B. Gardner, only has a less-than-60-word write up on Wikipedia …

  21. Chris! Count yourself lucky you can’t see the K-Fed!
    😀
    I think they were calling it “The Flavorette” but then on the reunion show for “Flavor of Love 2” they said it was titled something like “Can Love Find New York” or something awful like that. “The Flavorette” is a much better title!
    The first season of the “Real World” was the best season. No one knew what it was. The kids on the show didn’t know what it was. It was truly original and fascinating. Heather was always a bit of a brute, wasn’t she? Not much to like there.
    The “Big Girl” on “Flavor of Love 2” was also from Jersey City! Now she was fun!