Medications
Most medications used to treat glaucoma are delivered as eyedrops and are aimed at lowering your IOP. These drugs are effective in preserving vision, but must be taken for life.
Until recently, miotics were the first choice of most doctors for glaucoma. These drugs, which include pilocarpine (Pilocarpine) and adrenaline-related compounds, work well in reducing IOP (in fact, some doctors still recommend them), but they have to be taken several times a day, anyou d some patients can have a hard time keeping up with the regimen. For this reason many doctors have moved on to newer classes of drugs, which are easier to use.
The most commonly prescribed of the new generation of glaucoma eyedrop medications are beta-blockers, which reduce the amount of fluid your eye produces. (If you have high blood pressure, you may already be familiar with beta-blockers, as they're often taken orally to control hypertension.) The oldest and most often prescribed beta-blocker eyedrop is timolol (Timoptol), but newer ones, including betaxolol (Betoptic), are just as effective.
If a beta-blocker fails to sufficiently lower your IOP, your doctor may decide to add a carbonic anhydrase inhibitor (CAI) , which also reduces the intraocular pressure by cutting down on fluid production.
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MAXIMISING YOUR EYEDROPS
The way in which you administer your eyedrops can make a big difference in how effective they are. In fact, with the right technique you can acutally increase the amount of medication you absorb by 50%. The best method is called tear duct occlusion. Here's how to do it:
Wash your hands with soap and water. If you're using ointment and eyedrops, apply the ointment first.
Lie down. Press the tip of your middle finger to the inside corner of your eye. Use your index finger to pull the lid down, forming a pouch.
Look up. Release a drop of medication into the pouch (don't touch your eye with the dropper).
Close your eye for a minute, maintaining pressure at the corner of your eye to prevent the drops from leaking into your nose. Wipe your closed eyelid dry with a tissue. Wall about 5 minutes before administering a second drop.
Note: some eyedrops may cause burning or stinging, an effect that's probably not due to the drug itself but to the antibacterial preservatives in the solution. 'The feeling can be used to your advantage: it lets you know that the drops actually got into your eye.
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You'll probably be given eyedrops containing dorzolamide (Trusopt) and brinzolamide (Azopt) or sometimes an oral form such as acetazolamide (Diamox), but this is rarely used now because of its side effects.
Other doctors make alpha-2 adrenergic agonists their first choice over beta-blockers (or they may combine one with a beta blocker). These drugs not only decrease fluid production, but also increase the fluid outflow through the evoscleral drainage pathway. Research has shown that at least one of the drugs, briomonidine (Alphagan), is more effective for regular use than certain beta-blockers. Finally, topical prostaglandin agonsits have also proven extremely effective in reducing IOP (anywhere from 45 to 71 percent in one study). These not only increase fluid outflow but also improve blood flow to the eye. Among those available are latanoprost (Xalatan) and travoprost (Travatan).
Procedures
If medications don't control your glaucoma the way your doctor would like them to, or if you have side effects from the drugs, which are making your life difficult, you may need to turn to surgical procedures to get relief. Surgery, however, doesn't cure glaucoma. More than 50 percent of surgical patients will have to start taking glaucoma medications within a couple of years of their procedure. Here are the most common types of surgical interventions:
Laser trabeculoplasty involves burning 80 to little holes in the drainage area of the eye. It takes about 15 minutes, is performed on an outpatient basis and causes little or no pain. It's very effective in lowering IOP, but you'll still need to take eyedrop medications (at lower doses) every day, and you may need more surgery or new medications within two to five years.
>I've heard there's a connection between galucoma and Alzheimer's. True?
No-one is sure exactly what causes glaucoma, but researchers have come across some tantalising and fascinating clues. One is called beta amyloid build-up. Beta amyloid is a sticky protein that forms clumps or patches in the brains of victims of Alzheimer's disease, where it wreaks havoc on cells and contributes to all the familiar symptoms of the disease, such as memory loss and dementia. Recently, researchers have found similar clumps in the retianas of rats with glaucoma. Could it be that beta amyloid also clogs the drainage vessels in the eyes of humans? The research isn't yet conclusive, but the answer may prove helpful both to people with Alzheimer's and to those who have glaucoma.
Filtration surgery (trabeculectomy) involves creating an opening with a flap in the sclera (the white of the eye), which allows aqueous humour to drain out and be reabosrbed by the body. About half the patients who undergo this procedure no longer need medication, and 40 percent of the remaining patients experience better control of their condition. For some reason, filtration surgery seems to be more successful with Caucasians than other racial groups.
Closed-angle glaucoma
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Unlike the more common open-angle glaucoma, closed-angle glaucoma is a true medical emergency. How do you know if you might have it? Look for the following symptoms: severe, sudden pain (usually in one eye), nausea and/or vomiting, blurred vision or rainbow-coloured halos around lights.
Closed-angle glaucoma often begins as a structural deformity in your eye, which creates an unusually narrow drainage angle between the iris and the cornea. Anything that cause a sudden dilation of your pupil--including anithistamines and antipressants, darkness or emotional stress--can close off the angle, and with it, circulation of the aqueous humour. This causes intraocular pressure (IOP) to shoot up to dangerous levels. If something isn't done immediately to bring the pressure backdown, you can lose your eyesight in as little as a few hours. Get to a hospital. There, the doctors will likely treat you with powerful IOP-reducing drugs and laser iridotomy, a procedure that makes a hole in the iris. Filtration surgery may be necessary if permanent damage has occured.
Unfourtunately, closed-angled glaucoma is likely to be a twice-in-a-lifetime event. If you experience it in one eye, you're at high risk for having the same problem occur in the other eye within 10 years of the first attack. So, if narrow angles are found, preventive laser iridotomies should be done.
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Drainage tube implantation involves placing silicone tubes (or shunts) in the eye to create an artificial drainage pathway. It works best for patients with glaucoma caused by swelling of the iris and for children born with abnormalities in the trabecular meshwork.
PROMISING DEVELOPMENTS
In addition, try to limit coffee and other fluids. Some studies have shown that caffeine can boost your IOP for several hours. And other studies have found that drinking a litre or more of liquid within a short period of time (about half an hour) can raise IOP. Drink plenty of fluids to keep yourself hydrated, but do so by taking small amounts throughout the day.
Most medications used to treat glaucoma are delivered as eyedrops and are aimed at lowering your IOP. These drugs are effective in preserving vision, but must be taken for life.
Until recently, miotics were the first choice of most doctors for glaucoma. These drugs, which include pilocarpine (Pilocarpine) and adrenaline-related compounds, work well in reducing IOP (in fact, some doctors still recommend them), but they have to be taken several times a day, anyou d some patients can have a hard time keeping up with the regimen. For this reason many doctors have moved on to newer classes of drugs, which are easier to use.
The most commonly prescribed of the new generation of glaucoma eyedrop medications are beta-blockers, which reduce the amount of fluid your eye produces. (If you have high blood pressure, you may already be familiar with beta-blockers, as they're often taken orally to control hypertension.) The oldest and most often prescribed beta-blocker eyedrop is timolol (Timoptol), but newer ones, including betaxolol (Betoptic), are just as effective.
If a beta-blocker fails to sufficiently lower your IOP, your doctor may decide to add a carbonic anhydrase inhibitor (CAI) , which also reduces the intraocular pressure by cutting down on fluid production.
-----------------------------------------------------------------------------------------------------------------------------------------
MAXIMISING YOUR EYEDROPS
The way in which you administer your eyedrops can make a big difference in how effective they are. In fact, with the right technique you can acutally increase the amount of medication you absorb by 50%. The best method is called tear duct occlusion. Here's how to do it:
Wash your hands with soap and water. If you're using ointment and eyedrops, apply the ointment first.
Lie down. Press the tip of your middle finger to the inside corner of your eye. Use your index finger to pull the lid down, forming a pouch.
Look up. Release a drop of medication into the pouch (don't touch your eye with the dropper).
Close your eye for a minute, maintaining pressure at the corner of your eye to prevent the drops from leaking into your nose. Wipe your closed eyelid dry with a tissue. Wall about 5 minutes before administering a second drop.
Note: some eyedrops may cause burning or stinging, an effect that's probably not due to the drug itself but to the antibacterial preservatives in the solution. 'The feeling can be used to your advantage: it lets you know that the drops actually got into your eye.
--------------------------------------------------------------------------------------------------------------------------------------------
You'll probably be given eyedrops containing dorzolamide (Trusopt) and brinzolamide (Azopt) or sometimes an oral form such as acetazolamide (Diamox), but this is rarely used now because of its side effects.
Other doctors make alpha-2 adrenergic agonists their first choice over beta-blockers (or they may combine one with a beta blocker). These drugs not only decrease fluid production, but also increase the fluid outflow through the evoscleral drainage pathway. Research has shown that at least one of the drugs, briomonidine (Alphagan), is more effective for regular use than certain beta-blockers. Finally, topical prostaglandin agonsits have also proven extremely effective in reducing IOP (anywhere from 45 to 71 percent in one study). These not only increase fluid outflow but also improve blood flow to the eye. Among those available are latanoprost (Xalatan) and travoprost (Travatan).
Procedures
If medications don't control your glaucoma the way your doctor would like them to, or if you have side effects from the drugs, which are making your life difficult, you may need to turn to surgical procedures to get relief. Surgery, however, doesn't cure glaucoma. More than 50 percent of surgical patients will have to start taking glaucoma medications within a couple of years of their procedure. Here are the most common types of surgical interventions:
Laser trabeculoplasty involves burning 80 to little holes in the drainage area of the eye. It takes about 15 minutes, is performed on an outpatient basis and causes little or no pain. It's very effective in lowering IOP, but you'll still need to take eyedrop medications (at lower doses) every day, and you may need more surgery or new medications within two to five years.
>I've heard there's a connection between galucoma and Alzheimer's. True?
No-one is sure exactly what causes glaucoma, but researchers have come across some tantalising and fascinating clues. One is called beta amyloid build-up. Beta amyloid is a sticky protein that forms clumps or patches in the brains of victims of Alzheimer's disease, where it wreaks havoc on cells and contributes to all the familiar symptoms of the disease, such as memory loss and dementia. Recently, researchers have found similar clumps in the retianas of rats with glaucoma. Could it be that beta amyloid also clogs the drainage vessels in the eyes of humans? The research isn't yet conclusive, but the answer may prove helpful both to people with Alzheimer's and to those who have glaucoma.
Filtration surgery (trabeculectomy) involves creating an opening with a flap in the sclera (the white of the eye), which allows aqueous humour to drain out and be reabosrbed by the body. About half the patients who undergo this procedure no longer need medication, and 40 percent of the remaining patients experience better control of their condition. For some reason, filtration surgery seems to be more successful with Caucasians than other racial groups.
Closed-angle glaucoma
-----------------------------------------------------------------------------------------------------------------------------------------
Unlike the more common open-angle glaucoma, closed-angle glaucoma is a true medical emergency. How do you know if you might have it? Look for the following symptoms: severe, sudden pain (usually in one eye), nausea and/or vomiting, blurred vision or rainbow-coloured halos around lights.
Closed-angle glaucoma often begins as a structural deformity in your eye, which creates an unusually narrow drainage angle between the iris and the cornea. Anything that cause a sudden dilation of your pupil--including anithistamines and antipressants, darkness or emotional stress--can close off the angle, and with it, circulation of the aqueous humour. This causes intraocular pressure (IOP) to shoot up to dangerous levels. If something isn't done immediately to bring the pressure backdown, you can lose your eyesight in as little as a few hours. Get to a hospital. There, the doctors will likely treat you with powerful IOP-reducing drugs and laser iridotomy, a procedure that makes a hole in the iris. Filtration surgery may be necessary if permanent damage has occured.
Unfourtunately, closed-angled glaucoma is likely to be a twice-in-a-lifetime event. If you experience it in one eye, you're at high risk for having the same problem occur in the other eye within 10 years of the first attack. So, if narrow angles are found, preventive laser iridotomies should be done.
---------------------------------------------------------------------------------------------------------------------------------------
Drainage tube implantation involves placing silicone tubes (or shunts) in the eye to create an artificial drainage pathway. It works best for patients with glaucoma caused by swelling of the iris and for children born with abnormalities in the trabecular meshwork.
PROMISING DEVELOPMENTS
- A new technique for treating glaucoma, enzymatic sclerostomy may soon eliminate the need to cut the eye surface during surgery. The technique uses a 'biological knife', an enzyme that can be selectively activated on your eyeball to make areas more porous and to drain off more fluid. Experimentally tried on 15 patients, it reduced their IOPs by an average of 43%. The technique is still too technically difficult to perform on larger numbers of people, but researchers have high hopes for it.
- Other new options to conventional glaucoma surgery also hold great promise. These include goniocurettage, the scraping away of portions of the blocked out-flow tissues; pneumatic trabeculoplasty, which places a suction ring over the eye to lower IOP and improve drainage; and trabecular aspiration, in which a vaccum removes material that could be preventing outflow.
Lifestyle changes
Although your eye doctor will be your guide, there are some lifestyle changes you can make to help manage your condition. One is to exercise regularly. Glaucoma patients who do aerobic exercise, such as brisk walking, three times a week have been found to lower their IOP by as much as 20 percent. But remember, if you stop exercising, your IOP will go back up, so keep at it.In addition, try to limit coffee and other fluids. Some studies have shown that caffeine can boost your IOP for several hours. And other studies have found that drinking a litre or more of liquid within a short period of time (about half an hour) can raise IOP. Drink plenty of fluids to keep yourself hydrated, but do so by taking small amounts throughout the day.
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