Glaucoma

Disclaimer

Dr. Shawn Cohen, MDCM, FRCSC, DABO Assistant Professor of Ophthalmology, McGill University Montreal, Quebec, Canada

• I was diagnosed as a glaucoma suspect patient. What does this mean?
• Is it possible to develop glaucoma without having high pressure in my eye?
• I am curious to know if smoking and drinking alcohol can have a negative impact on glaucoma.
• Dear Doctor, why do I need to administer my eye drops every day and sometimes even several times per day?
• My doctor told me that I am amongst the few patients allergic to preservative contained in most glaucoma eye drop medications. What can be done?

Question:
I was diagnosed as a glaucoma suspect patient. What does this mean?

Answer:
The term glaucoma suspect means that you have not yet been convicted of having glaucoma! It means that either the optic nerve looks like it might one day develop glaucoma or that the nerve appears normal but the eye pressure was measured to be greater than the accepted upper limit of normal, which is 21 millimeters of mercury. Therefore, it is of the utmost importance that your ophthalmologist, at least once per year, examines you in order to rule out any development of early damage of the optic nerve so that medical therapy can be started when required.

  
Question:
Is it possible to develop glaucoma without having high pressure in my eye?

Answer:
The answer to your question is YES. Unfortunately, for some people, glaucoma develops with little or no elevation of pressure in the eye. This condition is referred to as either Normal or Low-Tension Glaucoma. Nevertheless, lowering the eye pressure remains the treatment of choice for this condition as it has been proven to prevent the glaucoma from worsening.

  
Question:
I am curious to know if smoking and drinking alcohol can have a negative impact on glaucoma.

Answer:
Contrary to popular belief, smoking and alcohol may play a role in eye diseases, including glaucoma. Alcohol changes the fluid balances of the body and the eye and can lead to erratic and misleading changes in the eye pressure. Smoking has been shown to increase the risk of cataracts and worsen forms of macular degeneration, both of which can lead to loss of vision and therefore worsen any existing loss in a patient who has already lost some vision from their glaucoma. Smoking produces toxic products that might cause damage to the optic nerve tissue and its circulation. Unfortunately, smoking and alcohol can also affect a person’s general health in many ways.

  
Question:
Dear Doctor, why do I need to administer my eye drops every day and sometimes even several times per day?

Answer:
Studies have shown that the more time your eye pressure spends at the desired target measurement, established by your ophthalmologist using well-studied guidelines based on your own degree of glaucoma severity, the less likely the glaucoma is to worsen. Forgetting to take your drops or skipping some drops will cause the eye pressure to rise above a level that is safe for your optic nerve. Over time, this could lead to damage that could even lead to blindness. While some eye drop medications control very well the eye pressure consistently over a 24-hour period and can thus be used once daily, others need to be taken more often as their effects are not as long lasting. For these reasons, eye drops need to be taken exactly as prescribed every day.

  
Question:
My doctor told me that I am amongst the few patients allergic to preservative contained in most glaucoma eye drop medications. What can be done?

Answer:
Approximately 6% of the population might be allergic to the preservative contained in most eye drop solutions, including artificial tears as well as medications for glaucoma and other eye conditions. Preservatives are included in eye drop bottles that are to be used for periods exceeding one day as they prevent bacteria from growing in the bottle. Fortunately, newer agents exist which either use a newer and different preservative or are prepared in such a way as to not have any preservative. These preservative-free drops are packaged into tiny tubes, called minims, that have enough drops to last one day and then they are discarded and a new minim is used on the next day. Laser treatment and surgery for glaucoma remain solutions proven effective in ensuring that the eye pressure is kept at its target level.

  

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