We are committed to inform our patients thoroughly about their condition. A well informed patient will benefit from that knowledge and, over time, will be much better off because of it. With that in mind, we have gathered here for you important information about your type of glaucoma (POAG).

A special note to patients for whom we have prescribed timoptic  or Timoptic- XE:

Timoptic-XE is absorbed into blood circulation. Because it is a “Beta blocker” type of drug, it may cause problems in patients with lung and heart conditions.

If you have now, or have had in the past, or should you develop in the future asthma, COPD (chronic obstructive lung disease), chronic bronchitis, emphysema or heart problems, let us know. Also, remind your family doctor that you are using beta blocker drops for glaucoma.

The complete name of your eye condition is Chronic Primary Open Angle Glaucoma (POAG).This chronic form is usually painless. Rarely, when the pressure within the eye increases markedly, eye pain may develop. When this happens, it must be evaluated promptly. Call us immediately and tell receptionist you have to be seen because you have glaucoma and eye pain.

To understand the loss of vision in glaucoma, you must be aware of the two main types of vision – central vision and peripheral vision. Central vision is the sharp vision you use to read. As you read this letter with your central vision, you are also aware of the room around you. You are aware of the room, and of the rest of the world around you, because you are using your side (peripheral) vision. In glaucoma, you lose your side vision while the reading vision stays sharp. This is why you would not notice vision loss until the loss is very great. To give you an idea of what the loss side vision is like: If you lost your side vision, and you were driving across an intersection, you would be able to read the license plate of the car in front of you but you would not see the bus coming at you from the side. Remember, by the time you notice vision loss, the loss is far advanced. It is too late to do anything about it. The damage cannot be reversed. I cannot emphasize it too strongly – follow recommendations faithfully!

To protect the nerve, the pressure inside the eye has to be brought down to a point where no damage to the nerve will occur. This point varies from patient to patient. Even when the pressure is lowered to what appears to be a reasonable level, in some predisposed people glaucoma may progress. Monitoring of the nerve appearance and of its function must continue, regardless of the pressure achieved

The first step in monitoring is the periodic eye pressure check. If the pressure is higher than “normal” or desirable, the treatment will need to be changed. On the other hand, a finding of “normal” pressure only means that it is normal at that particular time. It does not give us assurance that it is at the desirable levels at all times, day and night (there is variation in pressure during the day and night). To detect progressive nerve damage, periodic eye exams are needed in addition to pressure checks. The nerve head has to be carefully examined and its appearance compared against nerve photographs taken during previous eye exams.

A Nerve Fiber Analysis test (OCT test) may be done in order to obtain a baseline picture against which later tests will be compared. If there is progression of nerve loss on subsequent tests, treatment will be adjusted. The OCT test is currently among the most sensitive tests available for detection and follow up of glaucoma. It is positive early, before the nerve changes appearance, before the Visual Fields test becomes positive and long before you have significant vision loss.

The OCT test measures how many nerve fibers still remain. The Visual Fields test checks the nerve function. These tests measure different aspects of glaucoma damage and both types are necessary for the best glaucoma care.

At each visit you will be told when to come back for another eye exam. Write that date in your calendar. For your 6 month visit we will send you a reminder to schedule your exam. If, for any reason, you do not get a reminder please check your calendar and call us for an appointment anyway.

There is some association between diabetes and glaucoma. It may be prudent to have your doctor check you for diabetes.

Glaucoma tends to run in families. Brothers and sisters of glaucoma patients are 20 times more likely to develop glaucoma than people without family history of glaucoma. Children of glaucoma patients have an almost 10 times greater chance of developing glaucoma.

Your blood relatives should be checked for glaucoma. Measuring the eye pressure is a common screening test for glaucoma, but is not enough. For a variety of reasons it misses up to one half of glaucoma cases. It may be fine for people who are not at high risk for glaucoma (do not have family members with glaucoma). Glaucoma patient relatives need periodic exams with detailed evaluation of the nerve, possibly including the OCT test.

Glaucoma is a lifetime condition. Over time the cost of drugs is high. You will often pay less for drops if you shop around. If cost is a major problem, you may consider laser treatment. Selective Laser Trabeculoplasty (SLT) is a well established, painless, in-office procedure. It is commonly done on patients who do not respond well to eye drops, have problems administering them, tend to forget to use them, cannot tolerate them, or are otherwise unable to comply with eye drops treatment for any reason. Some pregnant women choose the laser procedure to avoid the use of medications during pregnancy. Initially, laser controls the pressure in 4 of 5 patients. The effect may fade with time but, one year after laser surgery, the pressure still remains under control in about one half of patients. SLT surgery is covered by medical insurance and Medicare.

To instill eye drops:

1. Wash hands
2. Invert the closed bottle and shake once
3. Sit down, lean back, tilt your head back, look up toward your forehead
4. With index finger pull down lower lid to make a pocket for the drop
5. Hold bottle over the eye between thumb and index finger of the other hand. May rest one finger or thumb against bridge of nose or brow. Do not touch the tip of the bottle with lid or finger.
6. Squeeze a single drop (extra drops won’t hurt but are wasted)
7. Press your index finger to the inner corner of the eye for 20-30 seconds to block the tear duct and prevent medication from draining away.

If you are using more than one kind of drops wait at least 2 minutes between drops (to avoid the second drop washing out the first drop).

To prevent contaminating the solution in the bottle do not allow the tip to touch the eye, hand or any other object. This is critical if you also have an eye infection

Soft contact lenses absorb, and are stained by the benzalkonium preservative found in most glaucoma drops. Remove lenses before instilling glaucoma drops. Wait at least 15 minutes before reinserting the lenses.

Cold remedies containing Pseudoephedrine, Phenylephrine or Neo-Synephrin; anti-histaminics Chlorpheniramine, Diphenhydramine or Benadryl and overactive bladder remedies such as Detrol often carry a warning telling you not to use them if you have glaucoma. These warnings do not apply to your type of glaucoma. You can safely use them for a week or two; beyond that, monitoring may be needed.

Steroids (cortisone, hydrocortisone, prednisolone, etc.) tend to increase eye pressure.

If you need to use steroids for longer than 2 weeks, your eye pressure has to be monitored during use. This includes use of steroid-containing eye drops, steroid pills, and steroid creams over large areas of the body. Use of steroid creams for small skin lesions is unlikely to cause increased pressure. If you are taking steroids now, do not discontinue them – just tell us about it and come in for a re-evaluation. Steroid use for less than 2 weeks generally does not require special monitoring of eye pressures.

By following our recommendations, and faithfully complying with monitoring requirements, the chances of preserving your vision are excellent. Because chronic glaucoma has no symptoms, and people are not able to detect loss of vision, some patients are tempted to lower their guard. That’s a big mistake – don’t make it!

I trust that I have anticipated and answered most of your questions. If not, please let me know.

Thank you for choosing Southland Eye Clinic for your eye care.