I Have Glaucoma – Now What?

Interviewer: Your eye doctor says you have glaucoma. Now what? We'll talk about that next on The Scope.

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Interviewer: Dr. Norm Zabriskie is a glaucoma expert at the Moran Eye Center. So Dr. Zabriskie, I've gotten the diagnosis. My optometrist told me that I have glaucoma. I want to take it seriously because I know it can make me blind and it's irreversible. What next?

Dr. Zabriskie: You bet. Well, treatment for glaucoma, first off, I think this is a very important point. For many years now, we didn't know for sure that our treatment was even that effective, and treatment consists fundamentally of lowering the eye pressure. Within the last 10 to 15 years, there have been multiple, very large, very well-designed and well-conducted studies both in the United States and in Europe and elsewhere, that in my opinion have fundamentally proven that lowering intraocular pressure, though not a cure, is absolutely beneficial in terms of either stopping or at least delaying the progression of glaucoma. So I am absolutely 100% an advocate of treatment which consists of lowering the intraocular pressure.

Interviewer: All right. But it's not a cure. It can only slow or stop . . .

Dr. Zabriskie: It's not a cure. It does not cure disease nor does it reverse damage that has been done. It just slows down or stops the progression. So then we look at, what are the options for lowering the intraocular pressure? And they really consist of three things. One is medicines which is usually topical medicines given in the form of eyedrops. The second is laser treatment, and the third is surgical treatment when required.
In the United States most of the time we would initiate treatment to lower intraocular pressure to treat glaucoma by initiating eyedrops. We have a number of different eyedrops to choose from with varying profiles of efficacy versus side effects, and we manage those drops. We usually start with one, an individual will try it for maybe a month or so, come back, we'll see if it lowered the pressure and also of course was well-tolerated by the patient. And depending on that result, we might add a second drop or feel like we're fine for right now, and we'll just follow it from that point forward.

Interviewer: Is that always the first thing that you try to do, the least invasive, the drops first?

Dr. Zabriskie: Yeah, in almost all instances we try drops first. Now there might be some circumstances where, say, laser was used first and we also have good literature, good studies that support the use of laser first. But if you just look at the practice trends in the United States, most of the time drops are initiated first. And part of the reason is that I think we have very good drops, very good medicines for treating glaucoma.
There's one class of drugs that was introduced . . . now, my goodness, it's been 15 to 20 years ago now, which in my opinion is just really an outstanding class of drugs not just in ophthalmology but in just all of medicine. When you look at their ease of application, they're just once a day, they have excellent 24 hour efficacy and they tend to be very well-tolerated, I mean, that is a drop class that is really revolutionized the treatment of glaucoma over the past 15 to 20 years and has been very, very effective. We have others that are also effective. So I would say that in most instances, really, in most instances a patient with glaucoma can be well-controlled with drops, and especially if the diagnosis is made early and we're catching it early, that patient tends to do very well in their lifetime. They're treated, yes. They require a lifetime of drops, but they do well. They see well.

Interviewer: And they get to see for the rest . . .

Dr. Zabriskie: They get to see.

Interviewer: I mean, that's a fair trade-off, right?

Dr. Zabriskie: And then things are well-maintained. Absolutely.

Interviewer: Even if I'm the kind of person hates putting drops in my eyes, that's kind of a good balance or payoff to . . .

Dr. Zabriskie: Absolutely, absolutely. Now if drops for whatever reason either prove ineffective or poorly tolerated, then we can moved on and a laser treatment that we have available to us, I think is also an excellent option. The laser is great in that it is non-invasive, okay, so we're not making surgical wound, we're using a laser to treat the eye. It tends to be quite effective. It doesn't last forever but we can oftentimes get several years of pressure lowering from a single laser treatment, and in some instances that laser can be repeated down the line which can give us yet another boost of pressure lowering. So I think laser is a very, very good option when needed.
Now beyond that, there does tend to be a group of patients who for whatever reason their disease is progressive despite our best efforts using drops and laser, and in that individual, surgical options are available. And there are several surgical options that are available to treat glaucoma, although I must emphasize again that even the surgery, all the surgery does is lower the pressure. It doesn't reverse any damage that has been done, I wish it did, but it doesn't. But we're grateful that we have these surgical options to lower the pressure and really quite effectively in this kind of more aggressive category of patients that are losing vision despite treatment with drops and laser.

Interviewer: But the important thing to remember is when you get a treatment, especially the drops, you've got to do it. Otherwise it doesn't do any good.

Dr. Zabriskie: That's exactly right. You have to take the drops everyday or it doesn't help, it doesn't work. And here's the thing. Why it can be difficult for a glaucoma patient to take their drops is that so often they are taking a medicine to treat a disease that is really not causing them any problems. They still see fine, they feel like they're doing fine, and yet I'm telling them, "You have glaucoma. Thankfully it's early and I need you to take this eye drop to keep it in this early phase."
That's a relationship that I have to build with the patient to have them realize, "Okay, I'm taking this drop every day and even though I don't really think I have a problem, I'm taking this drop every day to prevent what could be a significant problem down the line." And that's something that a glaucoma patient just has to kinda buy in to, that it's all about prevention, so I'm taking this medicine now to prevent the problem further down the line. That's a very important thing that a glaucoma patient has to accept.

Interviewer: So the important thing to remember here is that if you are diagnosed with glaucoma, there are some excellent treatments out there.

Dr. Zabriskie: There are.

Interviewer: Most likely starting with eye drops and moving on.

Dr. Zabriskie: Correct.

Interviewer: Any final thoughts for somebody that just had that diagnosis and they're a little frightened, scared?

Dr. Zabriskie: Absolutely. It is a scary diagnosis but my counsel is to realize that many, many, many patients, if not by far the majority of patients, if they take their drops or whatever treatment is recommended to them by their doctor and they're faithful about it and compliant about it, most of them do well. And they live the rest of their life with good vision and functioning very, very well.

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