Taking Control of Glaucoma

Taking control of glaucoma: The importance of adherence to glaucoma treatment

Glaucoma is known as the “silent thief of sight”: people with glaucoma usually have no symptoms. The only intervention that has been proven to reduce the risk of vision loss in glaucoma is lowering the eye pressure. The most common way to lower eye pressure is with eye drop medications. Glaucoma treatments do not improve vision, but they do to help prevent vision loss from happening.

What does it mean to be “compliant”?

Adherence (the newer term that is replacing “compliance”) with glaucoma treatment usually means taking your eye drops everyday and at the right times and coming to your glaucoma check ups. Your doctor needs to check your eye pressure regularly, as well as look at your optic nerves and measure your visual fields, to monitor your disease.

Why is it difficult to take eye drops everyday?

Some people with glaucoma only need 1 or 2 eye drops everyday to control their glaucoma, but some may need as many as 4 glaucoma medications, taken multiple times throughout the day. Imagine using 2 eye drops in the morning, 1 eye drop at noon, 1 at dinnertime, and 2 more in the evening, and doing this everyday for years and years, to help protect your sight. It is easy to see how people could miss some drops. Reasons can include forgetting them (or falling asleep before that bedtime drop), the cost of the medications, the side effects from the eye drops, and many others.

Why is adherence important for glaucoma patients?

In one word: blindness. The eye drops lower the eye pressure, which helps protect the eye from loosing vision from glaucoma. If a patient does not put in their eye drops, then the eye pressure will not be as low as it needs to be during that time and eye can be damaged. The damage from glaucoma is not reversible, so prevention is the goal.

What can you do?

If you have glaucoma and you take eye drops, use them everyday and as close to the right time as possible. Also, see your doctor for your glaucoma check-ups. Ask about your eye pressure readings, your optic nerve appearance, and your visual fields, so that you know what’s going on with your disease. If you are having any trouble getting your drops in (for example, increased cost due to change in insurance, always forgetting the morning drop, red eyes drawing attention at work), then tell your doctor about it, so you can make changes in your treatment plan.

Friends and family members can help, too. If someone you care about has glaucoma, think about asking them if they need any help with their drops. Some ways you might help: look at videos to see eye drop techniques, put in the drops for them, provide gentle reminders, or go with them to doctor’s visits to be a “second set of ears” on instructions and recommendations.

Taking eye drops for glaucoma is not easy, but it does work. Most people who are treated for glaucoma do not go blind. Take control of your disease, by taking your eye drops and going to your glaucoma check-ups.

For more information about glaucoma and treatment, visit www.nei.nih.gov/health/glaucoma.

1/29/15

Jullia A. Rosdahl, MD, PhD
National Eye Health Education Program Glaucoma Subcommittee
Duke Eye Center, Duke University

Coffee and Glaucoma: “1-2 cups of coffee is probably fine, but…”

10/2/14

The Relationship Of Coffee And Glaucoma

Research shows that drinking caffeinated beverages, especially coffee, causes eye pressure to go up, even just one cup of coffee. The effect is highest in glaucoma patients and people at risk for glaucoma. However, eye pressure goes up only a small amount, so it is probably not a significant risk.

In some people, though, too much coffee may be causing damage. In people at risk for exfoliation glaucoma (a type of open angle glaucoma where some flake-like deposits are seen on the lens of the eye), drinking three or more cups of caffeinated coffee was associated with an increased risk of developing exfoliation glaucoma. The effect was strongest in women with a family history of glaucoma. This study doesn’t show that coffee causes glaucoma, but does suggest that drinking three or more cups of caffeinated coffee might not be good for your eyes.

One group of scientists applied caffeine eye drops directly on to healthy eyes, and they did not see any increase in eye pressure. This suggests that caffeine doesn’t appear to have a direct effect.

How can you best protect your eyes? Consider going decaffeinated or limit your caffeine consumption. If you are at higher risk for glaucoma or have been diagnosed, be sure to have regular comprehensive dilated eye exams, use medications as directed and see your eye care provider as scheduled.
For more information about glaucoma, visit www.nei.nih.gov/glaucoma.

References
The effect of caffeine on intraocular pressure: a systemic review and meta-analysis. Li M, Wang M, Guo W, Wang J, Sun X. Graefes Arch Clin Exp Ophthalmol 2011. 249(3):435-42.

Effect of caffeine on the intraocular pressure in patients with primary open angle glaucoma. Chandra P, Gaur A, Varma S. Clin Ophthalmol 2011. 5:1623-9.

The relationship between caffeine and coffee consumption and exfoliation glaucoma or glaucoma suspect: a prospective study in two cohorts. Pasquale LR, Wiggs JL, Willett WC, Kang JH. Invest Ophthalmol Vis Sci 2012. 53(10):6427-33.

Effects of caffeinated coffee consumption on intraocular pressure, ocular perfusion pressure, and ocular pulse amplitude: a randomized controlled trial. Jiwani AZ, Rhee DJ, Brauner SC, et al. Eye 2012 26(8):1122-30.

Jullia A. Rosdahl, MD, PhD
National Eye Health Education Program Glaucoma Subcommittee
Duke Eye Center, Duke University

Genetics and Glaucoma: Why don’t we have a genetic test for glaucoma?

9/25/14

We have known for a long time that there is a genetic component to glaucoma, since having a family history of glaucoma is one of the most important risk factors for developing the disease. Glaucoma is actually a group of diseases, including some starting at birth or in childhood, as well as the more common types that happen in adults, such as primary open angle glaucoma.

In some of the glaucomas of childhood, scientists can trace the cause to a single gene. For example, mutations in the gene for myocillin can cause juvenile-onset open angle glaucoma. And there are genetic tests available for some of these genes. These genetic tests, however, are helpful only for a subset of glaucoma patients. For most glaucoma patients, these tests don’t give us the answers we need.

In the types of glaucoma that happen in adults, both environmental factors and genetic factors contribute to whether or not someone develops the disease. This complex interplay of factors makes testing only one gene or a handful of genes not as helpful. For diseases like adult-onset open angle glaucoma, instead of having just one gene that is mutated and causing the disease, there are many genes involved. All these genes contain tiny differences, some potentially helpful and some potentially harmful. It is an individual’s mix of genes combined with the lifetime of complex environmental exposures, that determines whether he or she will get the disease. In the future, genetic tests that incorporate this group of genes will help doctors, patients, and families better understand their susceptibilities, and hopefully lead to prevention of vision loss from glaucoma.

Genetic testing has the potential to offer a lot of benefits, but is not without risk and unintended consequences. Genetic counselors are trained to help patients, families, and doctors navigate these areas.

For more information about glaucoma, visit www.nei.nih.gov/glaucoma.

References:
Genetics of primary glaucoma. AO Khan. Current Opinion in Ophthalmology. 2011. 22(5):347-55

Jullia A. Rosdahl, MD, PhD
National Eye Health Education Program Glaucoma Subcommittee
Duke Eye Center, Duke University

Lasers for Glaucoma

7/10/14

Many people have heard of Laser Vision Correction, where special lasers are used to change the shape of the cornea to help a person see without the need for glasses or contact lenses. Lasers can also be used to treat glaucoma. There are different types of glaucoma, and they all can cause irreversible blindness; early diagnosis and treatments aimed at lowering eye pressure can help prevent blindness from glaucoma. Laser treatments for glaucoma do not improve vision, but they can help prevent vision loss.

There are 3 main ways that lasers are used to treat glaucoma.

Laser Peripheral Iridotomy
Laser peripheral iridotomy involves making a hole in the iris, or colored part of the eye, to prevent angle closure glaucoma. Angle closure glaucoma happens when the drain of the eye is blocked by the iris. This type of glaucoma can come on very quickly, called “acute angle closure glaucoma”, or more slowly, called “chronic angle closure glaucoma”. When it comes on quickly, people will often have symptoms like eye pain and redness, blurry vision, and even nausea; the chronic form can have few or no symptoms. This laser can help prevent vision loss from angle closure glaucoma.

Laser Trabeculoplasty
Laser trabeculoplasty is used to treat open angle glaucoma. In open angle glaucoma, the drain of the eye is open, but not working well enough to keep the eye pressure controlled. During this procedure, the laser is focused on the drainage tissue itself (called the trabecular meshwork); it helps the drain to function better to lower the eye pressure. This laser procedure may be repeated after the effect wears off. This is not a cure for glaucoma; the disease still needs to be monitored regularly.

Gonio - lasers for glaucoma — Credit: Michael P. Kelly, FOPS Duke University Eye Center

Cyclophotocoagulation
Laser peripheral iridotomy and laser trabeculoplasty are both office-based procedures; cyclophotocoagulation, where lasers are used to treat the ciliary body (the part of the eye that makes the fluid), are frequently done in the operating room. Cyclophotocoagulation involves “coagulating” the ciliary body with a laser. After the procedure, the ciliary body makes less fluid, thereby lowering the eye pressure.

Laser treatments, along with eye medications and surgeries, are important components of the care of glaucoma patients. Early diagnosis and treatment can help prevent blindness from glaucoma. A comprehensive dilated eye exam by your eye care provider is the first step.

To learn more about glaucoma, visit www.nei.nih.gov/glaucoma.

Jullia A. Rosdahl, MD, PhD
National Eye Health Education Program Glaucoma Subcommittee
Duke Eye Center, Duke University

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