What is Glaucoma?

UIC Pharmacy Blog Topic:  Glaucoma.

What is glaucoma?

-        Glaucoma is defined as a multi-factorial, complex eye disease with specific characteristics such as optic nerve (nerve inside the eye) damage and visual field loss.There are about 2.2 million Americans with glaucoma but only half are aware of their disease. While increased pressure inside the eye (called intraocular pressure or IOP) is usually present, even patients with normal range IOP can develop glaucoma.

Why is it important to diagnosis glaucoma early?

-        Glaucoma is important to be diagnosed early because it may not have any symptoms. Anyone can have glaucoma and only an eye exam by a physician can tell you whether you are at risk for or have glaucoma. If left untreated, glaucoma may lead to reading impairment, and it is possible that the condition may lead to irreversible partial or even complete vision loss.

What causes glaucoma?

-        Glaucoma can be caused by many different factors. It is known that inheritance is a significant cause of glaucoma, and having a family member with glaucoma increases your risk. Some medications and disease states may also cause glaucoma. For example, steroids can cause glaucoma and conditions such as diabetes, blood pressure abnormalities, heart diseases, eye injuries, and inflammation in the eye can all lead to glaucoma. In addition, some over-the-counter (OTC) drugs can also affect glaucoma. Be sure to ask your pharmacists about the safety of OTCs medications if you have glaucoma.  

What are some other risk factors for glaucoma?

-        Age over 60

-        Race (e.g., African-Americans, Latinos)

-        Increased IOP

-        Those who are severely nearsighted

-        Those with a thin cornea

-        Not having an eye examination

What types of glaucoma are there? Are there any signs and symptoms?

-        The 2 most common types of glaucoma are open-angle glaucoma and closed-angle glaucoma (also called angle-closure glaucoma, narrow-angle glaucoma, or acute glaucoma). Open-angle glaucoma is the most common form and is a slowly progressing disease. Typically, there are no signs or symptoms that patients feel. The patient may feel that there is a small loss at the side of the vision initially (peripheral vision), but until a significant amount of vision is lost, it is unlikely that patients will realize they have glaucoma. Also, this type of glaucoma may/may not have IOP elevation.

-        On the other hand, closed-angle glaucoma is a very serious disease that needs immediate medical attention. The damage to the optic nerve occurs quickly and the symptoms are very noticeable. This type of glaucoma is associated with blurred and cloudy vision, eye pain, headache, nausea and vomiting, and sudden sight loss. Also IOP is generally markedly elevated in closed-angle glaucoma.

Is glaucoma treatable?

-        Unfortunately, there is no treatment for vision that is already lost. The goal of therapy is to slow or prevent further vision loss by using medications or performing surgeries.

ü  Pharmacologic treatments vary and include medication classes such as the cholinergic agonists (e.g., Isopto Carpine, Isopto Carbachol); prostaglandin analogs (e.g., Xalatan, Lumigan);  α₂-agonists (e.g., Iopidine, Alphagan) ; β-antagonists (e.g., Betimol, Timoptic, Betoptic); carbonic anhydrase inhibitors (e.g., Trusopt, Azopt); and combination agents (e.g., Cospot, Combigan). 

ü  The physician may start prostaglandin analogs as a first-line treatment because of their convenience and minimal side effects. β-antagonists are usually the next most commonly used treatments. If your physician decides that you are not a candidate for these 2 treatments, your physician may choose to use either a carbonic anhydrase inhibitor or α₂-agonist as a first-line option.  Any of these drug classes can be used as additive, second, or third-line agents as well. To make it more convenient, the physician may prescribe a combination product especially when you need more than 1 medication.

ü  Surgery can also be performed either at the same time with drug therapy or when drug therapy does not respond well. Ask your physician about further surgical information.

Can I prevent glaucoma?

-        Yes! You can prevent damage from glaucoma by having regular eye exams. The Glaucoma Research Foundation recommends an eye exam for glaucoma every 2 to 4 years before age 40, 1 to 3 years from age 40 to 54, 1 to 2 years from age 55 to 64, and 6 months to 1 year after age 65. If you are at high risk for glaucoma, an eye exam should be performed every 1 to 2 years after age 35. Keep in mind that the earlier the diagnosis and treatment, the better the prevention from damaging the eye. Studies have also shown that moderate routine exercise can lower IOP. Some of the recommended exercises include walking or jogging at least 3 times weekly. If you are involved in dynamic physical activity, wear protective eyewear to prevent eye injuries since it can put you at a higher risk for developing glaucoma. 

Proper use of eye drops

-        What is the best way to put my eye drop medications into my eye?

                        i.         Wash and dry your hands.

                       ii.         Shake if a suspension, and open the cap.

                     iii.         Tilt your head backward and use your index finger to pull down the outer part of the eyelid gently to form a pocket for a drop.

                      iv.         Make sure that the tip of the dropper does not touch anything, and place the tip of the dropper near the pocket and then look up to drop into the pocket.

                       v.         Let your finger go and gently close eye to increase the availability of the drug into the eye. Do not close tightly as this may push drug out of the eye.

                      vi.         While eyes are closed, gently press the inner side of the eye with your finger. This will minimize the drugs going to other parts of the body.

                    vii.         Close the bottle and store as directed.

-        Why is it important to not touch the tip of the dropper?

ü  Contacting the tip of the dropper with the eye or any other material may contaminate the medication with bacteria, and this may result in a serious eye infection.

-        I have more than 1 eye drop medication. Can I put them in at the same time?

ü  No. Our eye only holds a small amount of fluid at one time. Therefore when more than 1 drop or other medications are needed to be dropped into the eye, wait more than 5 minutes to administer (10 minutes desired).

-        Can I wear contact lenses with my glaucoma eye drop medications?

ü  Many of the glaucoma eye drop medications have preservatives, such as benzalkonium chloride, and they may be absorbed by soft contact lenses. When dropping medication into your eyes, remove contact lens and the lens can generally be reinserted after 15 minutes. However, there are some drugs that interact with contact lens and it is not recommended to wear contact lens when you are on glaucoma eye drop medication therapy. Ask your pharmacist for more details.

Where can I learn more about glaucoma?

-        American Academy of Ophthalmologists: http://www.aao.org

-        Glaucoma Research Foundation: http://www.glaucoma.org

Prepared by: Min-sik Shin, UIC PharmD Candidate, Class of 2012

UIC Pharmacy