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    9 things glaucoma patients want to know


    4. I lowered my blood pressure, so is my eye pressure low?

    Blood supply to the eye comes from the carotid artery which runs along the neck. The internal portion of this supplies the ophthalmic artery which delivers most of the eye’s blood. Some of this blood supply goes to make aqueous humor from the ciliary body—think water from the faucet.

    Low blood pressure yields low aqueous production; however, homeostasis (the body’s equalizer) keeps the body regulated. When a person exercises, his blood pressure will rise, and so might his IOP. The body is able to compensate for this and return eye pressure to its usual level.

    In a patient with chronic high blood pressure, this could lead to decreased circulation or poor blood supply to the eye. This lack of blood supply to the eye can cause glaucoma, even with normal IOP.

    Blood pressure does play a role in glaucoma, but it does not directly correlate with an individual’s eye pressure.

    5. What are the best treatments for glaucoma?

    At this time, the main goal with treating glaucoma is decreasing IOP. Most major glaucoma studies have proven that by lowering the IOP, this will delay or prevent glaucomatous progression or conversion; even in patients with normal tension glaucoma.2,9-11 IOP can be lowered with topical drop medication, laser treatment, and surgical procedures.

    Topical medications are considered first line of treatment in the United States. They show good efficacy by lowering IOP 20 to 30 percent. There is a variable side effect profile with drops, but most patients tolerate them well. One downfall with instilling drops is patient compliance. Like anything else that must be performed up to several times a day, people forget. Missing a dose could cause IOP to spike.

    Related: How MIGS are changing glaucoma treatment

    Laser procedures to decrease IOP are roughly equivalent in safety and efficacy to medication with one drug. Many studies report that selective laser trabeculoplasty has few side effects, eliminates many compliance concerns, and saves money.12 Arguably laser could be used first line for many glaucomas.7,13 IOP decrease is similar to that of medications, and some studies report it lasts 30 months and up to 5 years.14,15 One challenge with laser is some patients are afraid of a laser procedure and will opt for other treatments.

    Many surgical procedures are available now. Some are more invasive than others, but all involve opening the eye. Minimally invasive glaucoma surgery (MIGS) has gained popularity over the past few years. These procedures use a microscopic-sized tool and tiny incisions to help lower IOP. While these procedures reduce the incidence of complications, they may not be as effective as more invasive procedures such as trabeculectomy and shunts. MIGS are options for patients with mild to moderate glaucoma.

    The idea behind all glaucoma surgeries is to create a channel for fluid to drain from the inside of the eye to underneath the outer membrane of the eye (i.e., conjunctiva). With the exception of MIGS, glaucoma surgeries are typically reserved for severe glaucoma cases where other therapies have failed.

    6. Can I use marijuana to treat my glaucoma?

    Marijuana does lower IOP.16 Unfortunately, IOP sits at therapeutic range for three to four hours, and not everyone —only 60 percent of individuals—experience a pressure reduction. This means patients would need to dose themselves almost every 4 hours, even while asleep.

    Regarding smoking marijuana vs. consuming edibles, the long-term toxic effects have been well studied.17,18 Studies found that drug absorption is maximum with smoking, and both smoking and edibles yield euphoric effects.19

    There has been development of aqueous-based solutions for topical administration to the eye. A study reported the solution retains IOP-reducing activity without euphoric effects.16

    Marijuana alone cannot compete with other available treatments at this time. Marijuana may offer many health benefits and great potential, but more research is needed to capture therapeutic components without side effects.

    Will Smith, OD
    Will Smith, OD, is in practice in Jacksonville, FL. He earned his Doctorate of Optometry at the University of Alabaman-Birmingham School ...


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