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GLAUCOMA
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Compliance with Glaucoma Treatment
Glaucoma treatment is directed at lowering eye pressure
to prevent optic nerve damage and loss of vision. Initially,
this is accomplished in most glaucoma patients through the
use of one or more eye drops. However, it is not enough
for your eye doctor simply to prescribe these drops. In
partnership with your eye doctor, the best possible medications
for you need to be identified. As important, you need to
use the recommended eye drops! Unless eye drops are used
correctly, they will not be effective and glaucoma can worsen.
Did you know that as many as one half of all glaucoma patients
fail to take their eye drops correctly? For some, this means
forgetting one or more doses of an eye drop. Others may
remember to take them, but do so incorrectly. In this case,
the eye drop may not be placed properly on the eye or may
be washed out by excessive blinking or tears.
Taking an eye drop at the wrong time is also incorrect,
and can lead to worsening of glaucoma. If the interval between
taking the same eye drop is either too short or too long,
its effectiveness will be reduced. For example, an eye drop
which is taken too close to another may actually wash the
first one from the outside of the eye and reduce its effectiveness.
Using more than one eye drop for each eye is another way
in which eye drops often are used incorrectly. Some patients
are under the mistaken impression that two or more drops
at a time may be more effective than one. In fact, if a
single eye drop is administered correctly, then using more
than one may cause a drug overdose with consequent side
effects.
Compliance is the act of following the recommendations of
your doctor. After all, an eye drop or any other drug will
not work unless you use it correctly!
Failure to comply with your doctor’s recommendations
is not unique to glaucoma. In fact, it is widespread and
occurs throughout medicine and with virtually all diseases.
In fact, it is often a reason why medical treatment of a
health-related problem is not successful. For several reasons,
however, the glaucoma patient is particularly likely to
comply poorly with their doctor’s recommendations
as follows:
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Characteristics
of glaucoma leading to poor compliance |
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Asymptomatic disease (no symptoms)Chronic
disease requiring long-term therapy may require use
of several medications. |
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Expense of treatment |
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Inconvenience of treatment |
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Benefit of treatment not apparent |
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Local side effects of treatment |
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Systemic (body) side effects of
treatment |
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Glaucoma is Largely Asymptomatic
An individual is often unaware that they have glaucoma until
late in the course of the disease. In the most common type
of chronic glaucoma, it is the rule, rather than the exception,
that there is no pain, redness or change in vision until the
optic nerve is significantly damaged. Hence, many patients
cannot be persuaded to undergo treatment, and even may deny
the need for it.
Glaucoma is Chronic and Often
Requires Lifelong Treatment
The most common types of glaucoma are chronic and require
lifelong treatment. After being diagnosed with glaucoma, effective
treatment requires the use of several medications in many
instances. Use of these medications is often inconvenient
and can be costly for many patients.
The Benefit of Glaucoma Treatment is Not Apparent
Treatment of many diseases is associated with measurable improvement
by a patient. For example, a patient with an infection who
is treated with an antibiotic often knows within hours after
initial treatment that there is some improvement. In other
words, it may be clear very soon that the infection is being
treated successfully and that they are better. As a result,
they are highly motivated to continue the treatment recommended
by their doctor until it has been completed.
In contrast, an important goal of glaucoma treatment is to
prevent further vision loss. Most of the time, a treated glaucoma
patient cannot tell whether or not they have been treated
successfully. Even if treatment is effective, their vision
is most often not improved.
Treatment with any drop will only lower eye pressure temporarily.
Depending on the drop, the effective duration is between four
and 24 hours. However, some patients only take eye drops before
seeing their eye doctor. And others are only compliant using
their eye drops immediately after seeing their eye doctor.
Therefore, failure to use eye drops at the recommended regular
intervals throughout the entire time between appointments
is an important reason why glaucoma can continue to worsen
in some patients.
Glaucoma Medications have
Side Effects
Each of the medications used as an eye drop to treat glaucoma
has the potential for having side effects. These side effects
may be serious, or they may be barely noticeable, and limited
only to a treated eye, for example, and result in decreased
vision, discomfort, or redness.
Some eye drops get absorbed into the blood, and can affect
heart rate, blood pressure, breathing and even mental function.
Either local side effects of the eye or general ones which
affect other parts of the body can cause a patient to purposefully
miss one or more doses of the eye drop. They may believe that
avoiding their use as prescribed by their doctor will make
them feel better.
What Can be done to Improve
Compliance?
Education is perhaps the most important single means for improving
compliance. A patient who is educated about the nature of
glaucoma and its treatment is most likely to be a better patient,
and correctly use their eye drops (Table2). You should understand
that glaucoma is largely asymptomatic (has no symptoms) and
that the benefits of treatment are not appreciated most of
the time.
Both you and your eye doctor should enlist the support and
cooperation of friends and relatives. Educating them about
the effects of glaucoma and its treatment, as well as the
importance of taking medications as directed, is often useful.
For example, a spouse may assist you in using the eye drops
so that they are properly placed and so that only one drop
of a medication is given.
Reducing side effects from eye drops is important for their
safe use and can improve compliance. Depending on the eye
drops which are being used, this can be achieved in several
different ways.
Perhaps most importantly, you should learn how to use your
medications correctly. You should know how to gently close
your eyelids and block your tear ducts for at least two minutes
following eye drop administration. These simple maneuvers
will increase the amount of drug that is absorbed into the
eye and considerably reduce the amount that is absorbed undesirably
into the blood.
A simple schedule for administering your eye drops also is
useful. For example, many, but not all, types of beta-blocker
eye drops are as effective at lowering eye pressure when given
twice daily in the morning and evening. Besides being easier
to remember, once daily use of a beta-blocker eye drop may
cause fewer side effects than twice daily use.
A schedule of eye drop use also may be simplified by relating
the time of administration to routine daily events such as
awakening in the morning and going to sleep in the evening
for twice daily use. For three times daily use, one may consider
using the eye drop at lunchtime, as well. And for four times
daily use, a simplified schedule may involve use at breakfast,
lunch, dinner and bedtime.
Finally, when using more than one eye drop medication at a
certain time, it is necessary to wait at least five minutes
in between the use of the different drops. This allows the
first eye drop to be absorbed into the eye before the second
eye drop is given.
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Keys
to understanding glaucoma |
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In glaucoma, the optic nerve fibers
are damaged and then die. |
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Once the nerve fibers are damaged
they do not recover. |
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Damaged nerve fibers lead to loss
of vision |
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Eye pressure which is too high is
a leading cause of optic nerve fiber damage |
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The eye pressure
lowering effect of an eye drop is between 4 and 24
hours. Therefore, eye drops need to be used everyday
and some drops need to be taken several times a day
to consistently lower eye pressure. |
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You may not be aware of any vision
problem until glaucoma is very advanced. |
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The benefit of eye drop treatment
may not be apparent, and some eye drops may even make
your vision worse. |
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Education about glaucoma and its
treatment is critical for patients, family, and friends.
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Summary
Listening to and following your eye doctor’s recommendations
not only improves the likelihood of successful treatment,
but allows them to determine whether the eye drops are beneficial
or additional ones are needed. You should ask your eye doctor
about any possible side effects from recommended treatment,
and report them if they occur. Also, you should ask your eye
doctor to observe your use of an eye drop so that they might
determine whether it is being administered correctly. In particular,
learn how to block your tear ducts after using an eye drop
and remember to do this to minimize side effects throughout
the body.
Don’t be afraid to discuss these issues with your eye
doctor, as they are committed to provide you with the best
possible chance for successful treatment of your glaucoma!
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