How patients perceive their glaucoma matters
What I learned when a patient asked when she’d go blind
The other day, I had the pleasure of seeing one of my favorite glaucoma patients for an intraocular pressure (IOP) check and visual field study. She is an 86-year-old white female from rural Nebraska who found her way to Georgia many years ago with her late husband in an attempt to find carpentry work. She has no family here and is essentially independent, living alone, and still driving. Her medical history is remarkable for arterial hypertension and high cholesterol, and her systemic medications are Lipitor (atorvastatin calcium, Pfizer) and Tribenzor (olmesartan medoxomil/amlodipine/hydrochlorothiazide, Daiichi Sankyo).
I have been successfully treating her IOP with prostaglandin analog monotherapy for two years. She first presented with IOPs of 28 mm Hg in the right eye and 29 mm Hg in the left eye. After a diagnosis of early primary open-angle glaucoma, I set her target pressures to 18-21 mm Hg for both eyes, corresponding to about a 30 percent IOP reduction. She has consistently been at or below target since the initiation of therapy.
More from Dr. Casella: Drance hemorrhages and quarterly optic disc evaluation
The big question
She had just started the Tribenzor and asked me if I thought it could affect her glaucoma. I told her that amlodipine, being a calcium channel blocker, was actually helping by opening up the blood vessels feeding her optic nerves. At the completion of the examination, I was getting ready to walk her up to the front when she stopped me and said she had a very serious question. We both sat down, and she asked me how long she had before she went blind because her mother went blind from glaucoma before seeking ophthalmic care. My mind immediately went back to my fourth year at University of Alabama at Birmingham School of Optometry in the ocular disease clinic when a patient asked me the very same thing. I froze up at the time because I didn’t really know how to handle such a blunt and potentially life-altering question.
My attending, Dr. Nowakowski, who was in the room, sensed the feeling of tension in the air and immediately jumped in by emphatically saying, “No. We’re not going to let that happen.” He then went on to briefly say that the patient was doing everything she needed to do with her drops and to simply continue being compliant. I could literally see the relief appear on the patient’s face. I felt relieved, as well, and I never forgot about that short 10-second conversation.