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    9 things glaucoma patients want to know


    7. What if I miss a dose?

    Instilling eye drops consistently reduces the likelihood of pressure fluctuation (diurnal variation). Experts found that 67 percent of peak IOP occurs outside of typical office hours.20 Inconsistent use of drops will vary IOP and has been proven to be detrimental to glaucoma.21

    Everyone is human, and staying compliant with the drops is important. Instill the drops as soon as patients remember, even if it seems like they are doubling up within a few hours.

    8. How do you get glaucoma?

    Glaucoma is not contagious. It develops from many different risk factors.

    As mentioned earlier, high IOP is the number-one risk factor for disease progression. Other risk factors include thin corneas, sleep apnea, history of eye injury, family history, and African American or Hispanic race.

    About 50 percent of glaucoma cases are thought to be genetic.22 If a parent has glaucoma, children are five times more likely to develop glaucoma. If a sibling has glaucoma, there is a 10 times greater risk for disease.23

    Many risk factors cannot be controlled; however, some can. The controllable risk factors include: smoking, lack of exercise, diabetes, and high blood pressure.24

    Related: Medically managing glaucoma

    9. What resources are available for patients with impaired vision?

    Some patients with glaucoma and other ocular disease will lose vision no matter how compliant they are with treatments. Taking advantage of available resources can improve quality of life even if treatment cannot prevent vision loss.

    For veterans, the Department of Veterans Affairs (VA) has the most resources available for visually impaired individuals. They offer many low vision devices which may assist in daily living activities. For example, devices can magnify text, help a patient write a check, and sound an alarm when to stop pouring hot beverages to avoid burns.

    In addition to devices, the VA offers services to improve the household, such as helping people to cook for themselves.

    Low vision devices and services may be available at other clinics or institutions. Most optometry schools offer these services as well as non-profit institutions such as Lighthouse for the Blind.

    Transportation can be a big concern when someone becomes visually impaired. These individuals lose independence and may become depressed. Many cities have public transportation, for which visually impaired people are often offered a discount or free use. Some cities may offer free ride service for disable individuals. Uber, a ride hailing service similar to taxis, recently integrated a voiceover app which helps visually impaired people hail a ride.

    Related: How oral and dental hygiene plays a role in glaucoma

    Many resources offer entertainment. Audiobooks are loaned for free or a small fee at libraries. News outlets such as National Public Radio (NPR) are available, and many cities transcribe local newspaper to audio. Community centers may offer recreational programs such as bowling, yoga, and ball sports.

    Other resources may be available in different local areas.

    Wrapping up

    It is rare patients come without questions, and what better source for them to trust than their eyecare team. Take opportunities to help educate patients—this will help to reassure patients as well as build patient confidence you and in the practice.

    Work with colleagues and doctors to keep patients as informed as possible.



    1. Fingeret, Murray. Optometric Clinical Practice Guideline. Care of the Patient with Open Angle Glaucoma. American Optometric Association. Available at: https://www.aoa.org/documents/optometrists/CPG-9.pdf. Accessed 2/25/18.

    2. Keltner JL, Johnson CA, Cello KE, Bandermann SE, Fan J, Levine RA, Kass MA, Gordon MO; Ocular Hypertension Treatment Study Group. Visual field quality control in the Ocular Hypertension Treatment Study (OHTS). J Glaucoma. 2007 Dec;16(8):665-9.

    3. Centers for Disease Control and Prevention. Blindness and Vision Impairment. Available at: https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Blindness.html. Accessed 2/25/18.

    4. Grant WM, Burke JF Jr. Why do some people go blind from glaucoma? Ophthalmology. 1982 Sep;89(9):991-8.

    5. Hattenhauer MG, Johnson DH, Ing HH, Herman DC, Hodge DO, Yawn BP, Butterfield LC, Gray DT. The probability of blindness from open-angle glaucoma. Ophthalmology. 1998 Nov;105(11):2099-104.

    6. Malihi M, Moura Filho ER, Hodge DO, Sit AJ. Long-term trends in glaucoma-related blindness in Olmsted County, Minnesota. Ophthalmology. 2014;121:134.

    7. National eye institute’s Visual Functioning Questionnaire (NEI-VFQ-25), Assessment of function related to vision (AFREV), and Compressed Assessment.of ability Related to Vision (CAARV).

    8. Ekici F, Loh R, Waisbourd M, Sun Y, Martinez P, Nayak N, Wizov SS, Hegarty S, Hark LA, Spaeth GL.Relationships between measures of the ability to perform vision-related activities, vision-related quality of life, and clinical findings in patients with Glaucoma. JAMA Ophthalmol. 2015 Dec;133(12):1377-85.

    9. Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E; Early Manifest Glaucoma Trial Group. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003 Jan;121(1):48-56.

    10. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS Investigators. Am J Ophthalmol. 2000 Oct;130(4):429-40.

    11. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol. 1998 Oct;126(4):487-97.

    12.The Glaucoma Laser Trial (GLT). 2. Results of argon laser trabeculoplasty versus topical medicines. The Glaucoma Laser Trial Research Group. Ophthalmology. 1990 Nov;97(11):1403-13.

    13. Waisbourd M, Katz LJ. Selective laser trabeculoplasty as a first-line therapy: a review. Can J Ophthalmol. 2014 Dec;49(6):519-22.

    14. The Advanced Glaucoma Intervention Study (AGIS): 4. Comparison of treatment outcomes within race. Seven-year results. Ophthalmology. 1998 Jul;105(7):1146-64.

    15. Migdal C, Gregory W, Hitchings R. Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology. 1994 Oct;101(10):1651-6; discussion 1657.

    16. Green K. Marijuana smoking vs cannabinoids for glaucoma therapy. Arch Ophthalmol. 1998 Nov;116(11):1433-7.

    14. 17. Graham IDP. Cannabis and Health. Orlando, FL:Academic Press Inc; 1976.

    18. Rosenkrantz H, Fleischman RW. Effects of cannabis on lungs. In: Nahas GG, Paton WDM eds. Marihuana: Bilolgical Effects. Elmsford, NY:Pergamon Press Inc;1979:279-299.

    19. Dewey WL. Cannabinoid pharmacology. Parmoacol Reb. 1986 Jun;38(2):151-78.

    20. Mosaed S, Liu JH, Weinreb RN. Correlation between office and peak nocturnal intraocular pressures in healthy subjects and glaucoma patients. Am J Ophthalmol. 2005 Feb;139(2):320-4.

    21. Gross RL, Peace JH, Smith SE, Walters TR, Dubiner HB, Weiss MJ, Ochsner KI. Duration of IOP reduction with travoprost BAK-free solution. J Glaucoma. 2008 Apr-May;17(3):217-22.

    22. Wolfs RC, Klaver CC, Ramrattan RS, van Duijn CM, Hofman A, de Jong PT. Genetic risk of primary open-angle glaucoma. Population-based familial aggregation study. Arch Ophthalmol. 1998 Dec;116(12):1640-5.

    23. Leske MC, Connell AM, Schachat AP, Hyman L. The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol. 1994 Jun;112(6):821-9.

    24. Bonomi L, Marchini G, Marraffa M, Bernardi P, Morbio R, Varotto A. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000 Jul;107(7):1287-93.

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    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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