Primary Open-Angle Glaucoma (cont.)
The goal of medical treatment is to reduce the pressure before it causes glaucomatous loss of vision. Medical treatment is always initiated for those people who are believed to be at the greatest risk for developing glaucoma (see When To Seek Medical Care) and for those with signs of optic nerve damage.
How your ophthalmologist chooses to treat you is highly individualized. Depending on your particular situation, you may be treated with medications or just observed.
No consensus exists on what is the appropriate medical treatment for preventing or delaying the damage due to primary open-angle glaucoma when a person only has elevated intraocular pressure and no other signs of primary open-angle glaucoma.
To date, no one has been able to conclusively determine which people will develop damage if left untreated as opposed to those who will not sustain damage even if not treated. Your eye doctor will discuss the pros and cons of medical treatment versus observation with you.
- Some ophthalmologists treat all elevated intraocular pressures of higher than 21 mm Hg with topical medicines. Some do not medically treat unless there is evidence of optic nerve damage. Most ophthalmologists treat if pressures are consistently higher than 28-30 mm Hg because of the high risk of optic nerve damage.
- If you are experiencing symptoms like halos, blurred vision, or pain or if your intraocular pressure has recently increased and then continues to increase on subsequent visits, your ophthalmologist will most likely start medical treatment.
Your intraocular pressure is evaluated periodically. One guideline to how often your intraocular pressure is checked is shown below.
- If your intraocular pressure is 28 mm Hg or higher, you are treated with medicines. After 1 month of taking the drug, you have a follow-up visit with your ophthalmologist to see if the medicine is lowering the pressure and that there are no side effects. If the drug is working, then follow-up visits are scheduled every 3-4 months.
- If your intraocular pressure is 26-27 mm Hg, the pressure is rechecked in 2-3 weeks after your initial visit. On your second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then follow-up visits are scheduled every 3-4 months. If the pressure is lower on your second visit, then the length of time between follow-up visits is longer and is determined by your ophthalmologist. At least once a year, visual field testing is done and your optic nerve is examined.
- If your intraocular pressure is 22-25 mm Hg, the pressure is rechecked in 2-3 months. At the second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then your next visit is in 6 months and includes visual field testing and an optic nerve examination. Testing is repeated at least yearly.
Follow-up visits may also be scheduled for the following reasons:
- If a visual field defect shows up during a visual field test, repeat (possibly multiple) examinations are performed during future office visits. An ophthalmologist closely monitors a visual field defect because it may be a sign of early primary open-angle glaucoma.
- A gonioscopy is performed at least once every 1-2 years if your intraocular pressure significantly increases or if you are being treated with miotics (a type of glaucoma medication).
- More fundus photographs (which are pictures of the back of your eye) are taken if the optic nerve/optic disc changes in appearance.
Francisco Talavera, PharmD, PhD
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