Monday, February 12, 2007

Section 12-A: Using Glaucoma Medications Regularly

The Doctor-Patient Relationship

The most important controllable factor in glaucoma management is adherence to prescribed medications. A good doctor-patient relationship fosters knowledge of the disease process and greater likelihood of adhering with a recommended regimen. The more patients know about their disease process, the more likely they are to adhere to treatment. It is the eye care providers’ responsibility to inform patients of their diagnosis and its implications. A common misconception is that blindness is the inevitable result of glaucoma. While there is a possibility of blindness in glaucoma, it is not necessarily inevitable. With proper diagnosis and early intervention, most patients retain functional vision with limited visual disability. Asking the doctor questions and better understanding of the disease are part of effective treatment.

Understanding Goals of Treatment

Since glaucoma is a chronic condition, once treatment is initiated it is often continued throughout a patient’s lifetime. The goal of medications is to prevent a further decline of vision by lowering the intraocular pressure (IOP). This goal is sometimes not obvious to patients because instead of restoring previously lost vision, it aims toward preventing further vision loss. The presumed lack of direct benefit hinders adherence with glaucoma medications. When patients see no direct benefit from taking medications, they may be less inclined to take them as prescribed. In addition, the vision loss from glaucoma tends to occur slowly over time and there are usually no acute symptoms. Patients do not notice the vision loss that occurs over a long time period and fail to see this as being a result of not taking their glaucoma medications. Although the immediate benefit is not obvious, it is important to realize that taking daily eye drops is decreasing the likelihood of vision loss from glaucoma.

Worsening Glaucoma with Missed Doses

Missed doses of medications can cause vision loss as much as not taking glaucoma medications altogether. The fluctuations in IOP can be equally detrimental to the optic nerve. A study which used electronically monitored medication bottles revealed that only 83% of timolol doses were taken as prescribed. The IOP measured the day of the exam can be misleading since most patients take their eye medications shortly prior to the examination. Unfortunately, there is no available physiologic parameter which allows the eye doctor to know what the average IOP has been between visits. Glaucoma can worsen when doses are repeatedly missed despite a good measurement at the doctor’s office. The fluctuations of IOP can be detrimental to the optic nerve.

A Team Approach to Battling Glaucoma

The treatment of glaucoma is a battle which must be fought by both the eye doctor and patient. It is very difficult, if not impossible, for an eye doctor to control glaucoma without the full participation of the patient. It is the patient who is responsible for the day-to-day treatment of glaucoma. The patient should be aware of the benefits and side effects of the recommended medications as well as the disease itself. A well-informed patient is more likely to adhere to a long-term medical treatment of glaucoma.

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