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    The dangers of starting and stopping glaucoma treatment

    Keeping patients committed to prescribed treatment is key to success


    Restarting treatment

    At the follow-up visit and the next several visits over the course of several years, his IOPs remained well controlled in the mid-teens in each eye. He did not return for over two years. He explained to me that he had lost his job and his insurance at the time. He found another job shortly thereafter with insurance benefits but explained to me that he had been busy and had put off coming back.

    I welcomed him back and documented my advice to him that glaucoma can lead to blindness if left untreated. I also documented that he expressed understanding of that possibility and agreed to resume treatment. His IOPs were high that day, and I performed a comprehensive eye exam and took photographs of his optic nerve heads. Upon review and comparison to previous photos, his optic nerve heads were unchanged.

    Related: How alcohol consumption correlates with glaucoma

    Six weeks later, his IOPs were back down in the mid-teens. I performed subsequent visual field and SD-OCT studies and found no progression. He was concerned that he had damaged his eyes by ignoring the apparent need for therapy for several years, and he was relieved that I could find no additional glaucomatous damage to his eyes.

    At that point, he said, “Do you think I need to keep taking this stuff?”

    Success with continuation

    By asking that question, he gave me a great opportunity to discuss the nature of glaucoma progression to the best of our current knowledge. I explained to him that glaucoma is a progressive disease, but it can take years to determine the mere presence of progression—not to mention the progression rate. I also explained that glaucoma is a slow disease and that time is typically on one’s side with comparison to many other diseases.

    I explained that, with him at age 52 and in relative good health, I was not concerned about him having visual problems from glaucoma in the next month or even the next year, but his high IOPs were putting many of those potential years of good vision in jeopardy.

    My usual speech is, “If you were 105 years old, I would turn you loose and tell you to have a nice life, but you are not. It is my job to ensure that those years are filled with healthy eyes and good vision, and that’s the only reason I am here.”

    He saw my point, smiled, and agreed to continue treatment. He has a follow-up visit scheduled for this fall. I hope he shows up.

    Read more from Dr. Casella here

    Benjamin P. Casella, OD, FAAO
    Dr. Casella, a 2007 graduate of University of Alabama at Birmingham School of Optometry, practices in Augusta, GA, with his father in ...


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