FEAR OF BLINDNESS FROM GLAUCOMA

A reader diagnosed with glaucoma expresses his fear of blindness to Ophthalmologist Carolina Valdivia, MD.

A 68 year old man from Egypt writes:

Hello Dr. Valdivia. I have been diagnosed with glaucoma and my doctor has prescribed Cosopt eye drops. I taking them twice per day. I would like to know if Cosopt eye drops are sufficient to stop optic nerve damage. I feel overwhelmed by a fear of blindness.

Thank you for the wonderful work that you are doing.

Thank you for your question and for your interest in glaucoma-eye-info.com.

Carolina Valdivia, MD Like you, many people diagnosed with glaucoma have a fear of blindness. These feelings are normal and you should not be embarrassed about having them.

Believe it or not, a fear of blindness actually can help you. This is because patients that are not concerned about their glaucoma, tend to be less adherent to medication regimens. Irregular taking of medications can be disastrous for glaucoma patients. If they continue being non-adherent to medication regimens, their fear of blindness eventually can become a reality. Fortunately, this does not have to be your future. Adherence is key to successful treatment.

Of course, for those patients that are adhering to their medication regimens, the next logical concern is if their prescribed medicine will be effective in preventing further optic nerve damage and forestall becoming blind. Your question relates to this issue. Unfortunately, it is very difficult for me to give you a specific answer without having examined you myself and knowing your patient history, along with the results of special tests. However, I can give you information about Cosopt eye drops and controlling high intraocular pressure.

Cosopt eye drops are designed to lower eye pressure to a normal range and to sustain it within that range to prevent optic nerve damage. However, it is important to understand that a normal eye pressure is one that does not cause damage to YOUR optic nerve. Each case of glaucoma has its own unique characteristics. A medication that is effective for one person, may not be as effective for someone else. This is why your ophthalmologist will monitor your eye pressure and the condition of your optic nerve regularly.

A single type of eye drops may not always be effective at its recommended dosage in controlling high intraocular pressure. Sometimes it requires the addition of a second medication to the treatment regimen in order to prevent optic nerve damage and forestall becoming blind.

When an ophthalmologist prescribes a second medication to control high intraocular pressure, patients often interpret this as meaning that their glaucoma is getting worse. Consequently, their fear of blindness increases. Rather than agonize in silence, a much better strategy is to ask your ophthalmologist directly if your glaucoma has worsened and share your fear of blindness with him or her. Your ophthalmologist can give you answers and can help you to work through your fear of blindness.

Cosopt ophthalmic solution is a combination of two glaucoma medications: Timolol and Dorzolamide. It functions to reduce high intraocular pressure by decreasing the production of fluid inside the eye called aqueous humor. Extensive tests on Cosopt eye drops have demonstrated that it is very effective in reducing high intraocular pressure in patients with certain types of glaucoma. Whether they produce excellent results in you primarily depends on these factors.

The type of glaucoma that you have.
How high your eye pressure was before you started taking the Cosopt eye drops.
The approximate period of time that your eye pressure had been elevated before you were diagnosed.
The amount of previous optic nerve damage.
Your adherence to the prescribed medication regimen.
Your correct administration of the Cosopt eye drops.

Although I cannot know the third item on the list for certain, it can be estimated by reviewing the results of the last eye examination in which your eye pressure was normal and computing the number of months that have passed between that exam and your diagnosis of glaucoma. This, along with the amount of previous optic nerve damage, in some instances can make it more of a challenge to reduce high intraocular pressure to levels where further loss of optic nerve fibers is prevented. The reason for this is that intact optic nerve fibers still may be partially damaged from prolonged previous exposure to high intraocular pressure. These nerve fibers can be more susceptible to further damage, even from pressures that are 16-20 mmHg. Thus, Cosopt eye drops in certain cases can be very effective in reducing high intraocular pressure, but an additional medication is required to reduce it even more in order to ensure that optic nerve damage is prevented.

For this reason, a person with glaucoma should be under continued care by an ophthalmologist. Special tests, such as optical coherence tomography (OCT) and perimetry should be performed annually. Speak with your ophthalmologist. She or he will be able to tell you what your ideal eye pressure should be and inform you about the success of Cosopt eye drops in reaching this target pressure.

Carolina Valdivia, MD

REFERENCE:

Bendel RE and Juzych MS. Principles and Complications of Medical Therapy of Glaucoma. In: Zimmerman TJ and Kooner KS. Clinical Pathways in Glaucoma. New York:Thieme, 2001:427-456.

A number of visitors have written to me asking for recommendations pertaining to eye-care products and books for obtaining more information. I have joined with Amazon.com to create a dependable resource for books and products. You can find these materials at the Eye-Care Store.

My goal in answering your questions is to provide you with information, clear up misconceptions, and to explain options so that you can have an informed conversation with your doctor. However, under no circumstances should my response to your question be considered a substitute for ongoing consultation and examination with your doctor. Since I have not examined you, I only can speak in terms of generalities, whereas your doctor has sufficient clinical details to evaluate your case specifically.

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