Treatment Options
Frequently Asked Questions
Is there a cure for open angle glaucoma?
Unfortunately, there is no cure for glaucoma. Open angle glaucoma represents the vast majority of glaucoma that affects patients in the United States. However, there are treatments that can reduce or even halt the progression of the disease. These treatments include topical medications, laser surgery, and surgery to increase the rate of fluid drainage from the eye. Which treatment is best depends on the individual patient, as well as the type and severity of their glaucoma.
What are some of the new medications used to reduce the fluid in the eye and eliminate the side effects, such as blurred vision, caused by glaucoma drugs?
Blurred vision from glaucoma drugs is caused primarily by miotics (pilocarpine and carbachol). The blurred vision occurs primarily in younger people who are still capable of accommodation (refocusing from distance to near) and in older people with cataracts. The blurred vision is due partly to constriction of the pupil (miosis) and induced accommodation, which makes the eye more nearsighted. Pilocarpine ocuserts, a tiny disc impregnated with pilocarpine and worn under the eyelid for several days at a time, produces a steady flow of the drug with minimal side effects.
If I think the medication I'm using is causing side effects, should I stop using it for a while to see if there is an improvement? What medication should be used to treat the glaucoma during this time?
Most patients can safely suspend a medication suspected of producing unpleasant side effects for approximately one to two weeks. Your ophthalmologist may suggest that you return sooner based upon the amount of damage to your optic nerve and the level of your intraocular pressure. Depending upon the particular class of medication, it may take one to four weeks to be completely rid of the drug's effect.
I have been using pilocarpine to control my IOP for years. The time it takes for my pupils to return to their normal size has slowly increased from about 50 minutes to more than three hours. During the recovery period, I cannot see well. Is this long recovery period to be expected? Is there any harm to being on pilocarpine for so long? Is there a recommended replacement for pilocarpine?
There are three new types of ocular antihypertensive medications that have been introduced within the last several years: dorzolamide (Trusopt), latanoprost (Xalatan) and brimonidine (Alphagan). Although each has specific benefits and side effects, they do not reduce pupil size and generally do not produce the same degree of visual diminution or blurring as does pilocarpine. Your complaint is a commonly reported side effect of pilocarpine therapy and you may consider discussing these newer medications with your physician. Alternatively, you could try a different pilocarpine delivery system such as an ointment (Pilogel) or slow-release disc (ocusert).
What are some of the side effects of using Xalatan?
The most common side effects of latanoprost (Xalatan) are stinging and burning related to corneal irritation, conjunctival injection (redness) and, in some patients, a darkening of the iris color. Your complaints may represent either a side effect or allergic reaction to this medication. Both of these are unlikely to disappear on their own. Latanoprost allergy or intolerance is not uncommon and may occur in as many as 5 percent of patients who are currently using other classes of antiglaucomatous medication. As always, call your doctor if you have an adverse reaction to any medication.
What are other medication choices?
Diamox sequels have the least side effects when taken at bedtime. Alphagan is another medication you might want to discuss with your eye doctor.
What are the most common side effects of eye drops used to control glaucoma?
All medications can have side effects, though not all medications cause side effects in all people. If you have side effects with one medication, it makes sense to try a different one. There are a number of different classes of medications marketed now for treatment of glaucoma. The only way to tell if a medication is causing side effects is to stop the medication and see if they go away, then start the medication again to see if the side effects return, then repeat this process once again. Sometimes, it is the preservative in the medications rather than the medications themselves that cause the side effects. In such cases, it is possible to get preservative-free medication.
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What's the best treatment for glaucoma: surgery or medication?
Quality of life is an important factor in the treatment of any chronic ailment. It is important to make a decision as to whether you want to live with significant side effects. You should first consider whether there is a way to eliminate the side effects of the medications you are taking. Talking with your ophthalmologist is the best approach to identifying possible ways to resolve the problem of medication side effects.
If you are still suffering from intolerable side effects, or if your glaucoma is uncontrolled, then surgery may be an option.
Glaucoma surgery is safer and more effective than ever. Routine trabeculectomy for uncomplicated open-angle glaucoma, when performed as an initial surgical procedure in a patient who has not had previous intraocular surgery, is highly effective. The chance of complications or surgical failure increases with previous intraocular surgery, complicated glaucoma, having to redo the operation for glaucoma and severe near-sightedness.
What are ocuserts? How are they used and how do they help my glaucoma?
Ocuserts are plastic membranes about one-third the size of a contact lens. They are inserted into the eye and worn under the upper or lower lid where they cannot be seen. They contain pilocarpine, which is released slowly into the eye, and need to be changed every five days. The benefits of Ocuserts are that they eliminate the need for using pilocatpine four times a day; they provide a constant therapeutic effect of the medication while reducing the side effects of blurred or fluctuating vision; they are well tolerated by patients under the age of 40; and they reduce fluctuation of intraocular pressure, which occurs with pilocarpine drops.
Why do some people with glaucoma and high pressure respond to as little as one eye drop while another person with a lower pressure needs to take three or four drops?
The extent or seriousness of glaucoma damage to the eye cannot not be judged by the intraocular pressure alone or the number of glaucoma medications required to control it, but rather should be defined by the amount of damage to the optic nerve and visual field. This is an important point. Glaucoma is a disease characterized by progressive injury to the nerve; this results in loss of vision that can be detected on a visual field test.
The response to glaucoma medications varies among individuals. Some individuals respond nicely to a single agent; others may require multiple medications to control their disease and prevent further vision damage. The desired intraocular pressure is chosen by the treating physician and based upon the extent of the glaucoma damage, the intraocular pressure at which the damage occurred and other factors.
What preservative-free glaucoma medications are available?
Pilocarpine is available without preservatives. Preservative-free preparation is also available for timolol maleate.
Would alpha-2 agonists and/or prostaglandin analogs be better choices than Timolol?
Your therapy should be changed if your glaucoma is unstable or you are having side effects. Prostaglandin analogues are extremely effective medications and can be use as an alternative.
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