All of these measurements, benchmarks, images and data collected are important. Yet each case is individual. “I am treating a human being, not a number,” says Dr. Shakeel Shareef, a glaucoma specialist with UR Medicine’s Flaum Eye Institute in Rochester. (See sidebar for more about Dr. Shareef and promising new glaucoma treatment options.)
Back to me in 1994; Dr. Hicks (now retired) prescribed Timolol eye drops for me, a beta-blocker that decreases fluid production inside the eye. It brought my pressure readings down in both eyes to 18 and kept them stable.
Two years later, things were still fine, even when my husband, Brian, and I had our son Robbie, because it was safe to take Timolol during my pregnancy. (If I were taking Xalatan, another glaucoma medication, I probably would be switched to something else. Xalatan has shown an increased occurrence of fetal damage in animals.)
2003 was a significant year. Dr. Hwang downgraded my diagnosis to ocular hypertension (OcHTN). He switched me to Xalatan, which lowers pressures by increasing aqueous humor outflow from the eye. The same medications to treat glaucoma are also used for OcHTN, and OcHTN can progress into glaucoma at any time.
I’ve been on Xalatan or its generic form, Latanoprost, ever since. Xalatan has a potential side effect for green-eyed people like me: It can darken the iris and change eye color. Without fail, whenever I see Dr. Hwang, he’s kind enough to remark that I have managed to keep my “beautiful green eyes.” I’ll admit I was worried about that, but I’ll take brown eyes over blind eyes any day.
I have taken various eye drops through the years and now take two: One reduces aqueous fluid production and the other helps fluid flow better through the drainage angle. My pressures remain stable for a time period and then they may creep up.
In 2004, my diagnosis reverted back to primary open-angle glaucoma, where it remains. I recently asked Dr. Hwang why, since my visual field tests have shown no indication of vision loss.
He says that the visual field test was the gold standard for clinical glaucoma diagnosis, but thinking on that began to change with newer diagnostics.
“At the time, if you did not have the characteristic visual field defects, then you technically did not have glaucoma,” Dr. Hwang explained to me. “Your visual field has always been considered normal. Your OCT, however, shows [retinal] thinning, which is now considered an early sign of glaucoma.”
In 2011, my pressures were creeping up again; my right eye was 28 and my left was 23. We tried Combigan drops but I couldn’t tolerate the stinging, burning and irritation. A glaucoma specialist joined the practice and, as I alternated between him and Dr. Hwang, it was suggested that we try a laser treatment called Selective Laser Trabeculoplasty (SLT) to bring my pressures down.
The pamphlet I read reassured me that this non-invasive procedure “allows the drain to work more efficiently” and “there is rarely discomfort.”
It did bring my pressures down, both to 16. But my eyes hurt and tears were streaming down my face. This might be why I’ve forgotten the name of the specialist, who has since moved on.
The laser’s effect on pressures lasts about three to five years, and repeat procedures can be less effective. Also, as the disease progresses, the tissues are less responsive to the treatment. That’s why timing on whether, or when, to use laser is a judgement call.
Taking medications regularly makes an obvious and huge difference in slowing the progression of glaucoma. But first, people have to understand how vital it is to visit an eye doctor regularly.