From AFB Senior Site

Are you experiencing problems with your peripheral or side vision? Do you have to turn your head to see what's to your immediate right or left?[IMAGE]-->
It might be... Glaucoma
Glaucoma is a serious condition that involves an elevation in pressure inside the eye caused by a build-up of excess fluid. Left untreated, this pressure can impair vision by causing irreversible damage to the optic nerve and, eventually, blindness. Glaucoma results in peripheral vision loss, and is an especially dangerous eye condition because it frequently progresses without obvious symptoms. This is why it is often referred to as "the sneak thief of sight."
There is no cure for glaucoma, although it can be treated. The damage to the optic nerve from glaucoma cannot be reversed. However, lowering the pressure in the eye can prevent further damage to the optic nerve and further peripheral vision loss.
Still, early detection, appropriate and ongoing treatment, and the availability of specialized low vision and vision rehabilitation services can help people with glaucoma live productive and satisfying lives. Starting as early as age 35, a pressure check for glaucoma should be an essential part of your annual routine eye examination. A visual field test will detect peripheral vision loss.
Glaucoma at a Glance:
Affects more than 3 million people living in the United States.
Is the leading cause of blindness in African Americans, who should begin glaucoma tests as early as age 35.
Is caused by increased pressure in the eye due to a buildup of excess fluid.
Results in a loss of peripheral or side vision, which affects your ability to move about safely.
May also affect reading, as loss of visual field may result in being able to read only one word at a time.
Can cause irreversible damage to the optic nerve if left undetected and untreated.
Is particularly dangerous to your vision because there are usually no noticeable symptoms at first.
Possible Signs of Glaucoma:
There are various types of glaucoma that can occur and progress without obvious symptoms or signs. Open-angle glaucoma is the most common, and symptoms are slow to develop. As this types of glaucoma progresses, you may notice that your side, or peripheral, vision is failing, causing you to miss objects out of the side and corner of your eye.
If you are suddenly experiencing the following symptoms, you may have angle-closure glaucoma and should seek immediate treatment:
Blurred vision
Nausea
Headaches
Halos around bright lights
For More Information:
National Eye Institute. Eye Disease Simulations. See what a photo looks like to people with a variety of eye conditions. Includes information in Spanish.
http://www.nei.nih.gov/photo/sims/index.asp
Vision Simulator. An interactive tool that demonstrates progressive vision loss.
http://www.visionsimulator.com/default.asp-->
National Eye Institute. Eye health information.
National Eye Institute. Eye health information in Spanish.
The Glaucoma Foundation
Glaucoma Support Groups.
American Academy of Ophthalmology. Glaucoma information in Spanish.
Association of International Glaucoma Patient Organizations
Prevent Blindness America. The Glaucoma Learning Center.
Glaucoma Research Foundation.
American Glaucoma Society.
MedlinePlus. Glaucoma.

10 Useful Tips for your next visual field test

Most of us take 2 or 3 visual field tests a year. Each time we need to mentally try to recollect how we did it the previous time.
Here for the first time a properly documented step-by-step procedure is laid out for us.

Thanks to Dr. Leonard Yip who has taken the time and trouble to document the "10 Useful Tips for your next visual field test."
Very few will realize that they need to take proper rest before the test. If our response is not a split second from a cue we would often give the reply a pass (now we know we still have time upon seeing the light - a few seconds to respond). What is little known is that you can stop the VF machine if you feel uncomfortable.

For the 10 TIPS click the title bar of this posting

Neuroprotection and Glaucoma: Questions and Answers from Dr. Moses Chao

For quite some years we've been hearing about neuroprotection. Some glaucoma eyedrops are even said to have neuroprotective properties - so is the effective protection of the optic nerves anywhere near and available?

What is neuroprotection and how does it apply to glaucoma treatment?

Neuroprotection is a broad term to cover any therapeutic strategy to prevent nerve cells called neurons from dying, and it usually involves an intervention, either a drug or treatment. There is significant amount of scientific work that is currently going on in this area, but much more research is needed to identify the best pathways to target for neuroprotection. - Dr. Moses Chao, Glaucoma Research Foundation

FOR MORE INFORMATION VISIT THE LINK BELOW:

http://www.glaucoma.org/treating/neuroprotection.html

A Guide to Sunglasses from GRF

A Guide to Sunglasses
Glaucoma can make eyes highly sensitive to light and glare, with some glaucoma medications exacerbating the problem even further. Sunglasses are an easy solution that makes life more comfortable when outdoors, while also providing critical protection from the sun’s damaging ultraviolet (UV) rays.
Long-term exposure to UV rays can damage the eye’s surface as well as its internal structures, sometimes contributing to cataracts (clouding of the lens) and macular degeneration (breakdown of the macula). Ophthalmologists and optometrists now recommend wearing sunglasses and a brimmed hat whenever you’re in the sun long enough to get a suntan or a sunburn, especially if you live at a high elevation or near the equator.
The good news is that sunglasses don’t have to be expensive to protect your eyes and they can often be found at the local drugstore. Unfortunately, a high price is not always a guarantee of high quality and protection. Part of the difficulty is that standards and labeling regarding UV protection are voluntary, not mandatory—and can be confusing.
Here are some things to keep in mind when shopping for sunglasses:http://www.glaucoma.org/living/a_guide_to_sung.html

inaugural SNEC Glaucoma Patient Support Group Meeting

GLAUCOMA PATIENT SUPPORT GROUP MEETING


Talk on
Importance of Eye Drop Compliance in Glaucoma Care
(in English)

The Singapore National Eye Centre (SNEC) Glaucoma Patient Support Group is a non-profit, self-help group which aims to help patients and their families cope with glaucoma. Through regular meetings and activities, it will help patients achieve a more holistic approach to the management of glaucoma thereby leading to improvement in their quality of life.

As a start, we have organised a meeting on 26th May 2007 with a theme on “importance of eye drop compliance in glaucoma care”. This theme was chosen because we feel strongly that eye drop compliance is a small but crucial step to achieving better care. Hence, it is important that patient and their families understand what medication compliance is all about.

We sincerely hope that you and / or your family members will join us for this get-together.

Saturday, 26 May 2007

9.30am – 11.00am * Auditorium – Level 4, SNEC

Registration is FREE

For catering purpose, please confirm your attendance with
SNEC Public Relations Department
Tel: 6322 8370 / 74 / 94 or Email: meet@snec.com.sg

TTSH Glaucoma Forum - 28th April 2007

Microglia important in glaucoma

From Glaucoma Research Foundation
Microglia important in glaucoma
The fate of ganglion cells is also controlled by other cells within the retina. The nervous system, including the retina, is thought to be the only place in the body that is not subject to surveillance by the immune system. To search for and deal with signs of trouble, the nervous system uses special cells named microglia. Recent evidence suggests that, while microglia are usually beneficial, in diseases of the nervous system they often end up doing more harm than good. The molecular profile of glaucoma that the CFC published in 2006 had strongly hinted that microglia might be important players in glaucoma. This year the CFC obtained strong evidence that microglia are involved both early in the disease, perhaps contributing to the slow progressive atrophy of retinal ganglion cells, as well as late in the disease, perhaps mediating the spread of the disease from focal to widespread. Needless to say, we viewed microglia as an important therapeutic target.

New Technology at National University Hospital detects glaucoma, 3 to 6 years, ahead of its actual manifestation

Channel 8 10 O'clock News :Dr Jovina See, Head of Glaucoma Service at NUH, was interviewed in Chinese and discussed the new HRT Equipment and new state-of-the-art technology which are able to detect the initial on-set of glaucoma as early as 3 to 6 years ahead of its manifestation.

Alpha-C Sharing Session on 14th April 2007

Don't Fall Victim to the Silent Sneak Thief of Sight

GLAUCOMA CARE: LOOKING BACK, LOOKING AHEAD - A PATIENT'S HOPE
DON’T FALL VICTIM TO THE SILENT SNEAK THIEF OF SIGHT
by Sam Fong, Alpha-C Support Group, Glaucoma Society (Singapore)

We cannot ignore this well-known glaucoma statistic. For every one person diagnosed with glaucoma there is another person unsuspectingly suffering silently with the disease. Glaucoma is the silent sneak thief of sight. It is a leading cause of irreversible blindness.

Singapore has about 40,000 glaucoma sufferers, but only half have been detected and are receiving treatment. The burden of seeking a chance, early-stage prognosis of this virtually symptom-less (asymptomatic) disease rests with the sufferer. Glaucoma is defined by the slow progressive loss of visual field together with characteristic signs of damage to the optic nerve. By the time that the sufferer realizes that he has visual-function defects; glaucoma would have reached a fairly advanced stage, with optic nerve damage and extensive visual field loss.

As a patient with this condition, my hope is for our Health Care Authority to help us retain as much of our vision for as long as possible. Early detection and compliance to medication give us the best opportunities to preserve our sight. At present, there is no recommendation that primary health-care clinicians routinely screen for intraocular hypertension or glaucoma. But if we assume that there are an estimated 20,000 undetected glaucoma sufferers in Singapore, not to mention those suffering from other (undetected) degenerative eye conditions, then there may be a case for reconsidering the benefits of recommending routine screening.

For example, the 2002 Swedish study, Early Manifest Glaucoma Trial, concluded that with early detection the progression of the disease may be better managed and vision prolonged when treatment is started early. Educating the public, and specifically the patient, is paramount. Because there are no obvious early symptoms, unless the patient understands that early detection, diagnosis and treatment can make the difference, glaucoma will unfortunately remain “the silent sneak thief of sight.”

The good news is that the future holds great promise for the glaucoma patient. Medical research and technology continue to provide a better understanding of the disease and more precise tools for detection and monitoring. They provide:-

• A better understanding of the different types of glaucoma
• Improved detection methods
• More accurate, computerized visual field testing
• New and innovative laser and conventional surgical techniques

Once-a-day eye-drops such as the prostaglandin analogs for glaucoma introduced at the turn of this century and more combination-drops coming on stream will improve the problem of medication compliance through greater convenience to the patient. Improved and refined surgical techniques together with better understanding of pre- and post-operative care greatly reduced the risks of surgical failures.

From the patient’s perspective, we hope the future will bring more effective treatments for glaucoma than merely reducing Intra-ocular Pressure (IOP). We hope that breakthroughs in neuroprotection, which can safeguard the optic nerve, will not be too far away. Beyond that - Stem Cell Therapy for optic nerve regeneration may become a possibility. These will all enhance the prognosis of future patients to preserve their vision, if not “cure” their condition.

Is your IOP "good enough"?

Ask Dr Jovina See in Ask The Doctor

Is glaucoma eye-drops compliance that difficult?

Is glaucoma eye-drops compliance that difficult?

A patient's perspective

By Sam Fong, Alpha-C Support Group, Glaucoma Society (Singapore)

Far too many glaucoma patients have lost too much of their sight, much too early and unnecessarily, due to non-compliance on the use of their eye-drops. The correct use of eye-drops is surprising low even among the educated population. What are the reasons?

Eye-drops - a symptom reliever
We take our medicine by habit. Traditionally, eye-drops have been primarily seen as lubricants for dry eyes and to be used as and when required. Very few instructions are given to the user other than the drops should get into the eye. Even if it overflows the eye lids, it is acceptable. After the application, the user feels almost immediate relief from the discomfort. So, the feedback is that eye-drops produce good results and when eye is better, the drops are no longer required. It is also the same with pills. A 3-times-a-day medicine does not mean an 8-hourly cycle - you would often take it after breakfast, after lunch and after dinner, or at your leisure. In most common ailments, medication relieves the symptoms of pain or discomfort while the body's immune-system performs its own auto-healing process. Thus, you can get well, with or without medicine, albeit with a little more suffering along the way. Therefore, a patient's views of medicine are gathered through their common experiences. And, however you take your medicine, you usually do get well eventually!

Glaucoma Eye-drops - a pressure regulator
However, with glaucoma, it is not quite the same story. It is not a common experience and the normal technique does not apply. This is because, when you have glaucoma, your eye’s auto-regulation system has failed. Eye-drops are no longer a symptom-reliever but now acts as a regulator of intra-ocular pressures (IOP) in the eye. You can say it is like the pace-maker used to regulate the heart beat and stopping the pace-maker will cause the faulty heart to function erratically. So it is with the eye. When your application of IOP-lowering eye-drops are stopped or not regular, the unregulated glaucomatous eye pressure may fluctuate diurnally by as much as +10 mmHg from its low.

First, we need to try to understand how glaucoma is treated with the use of eye-drops. Currently, the only available treatment for glaucoma is by lowering the IOP. We can do this by taking medicine in the form of tablets, using eye-drops or by surgery where an alternate drainage path is created for AH (aqueous humor) outflow. It is quite obvious that tablet intake is probably the least effective means for lowering IOP in the eye because the medicine is not directly applied to the eye and that surgery is the most effective because it directly and physically creates a vent in the eye for pressure relief.

No feedback indication
What makes it difficult for the patient to understand the usefulness of the eye-drops is that the pressure in the eye is awfully low. Take a drinking straw and fill it with water to 150mm height and hold it against your arm and you will feel nothing; double it to 300mm water height and again you will feel nothing pressure-wise. This represents the limits of the range of pressures between 11 and 22mmHg. The eye-drops in most instances are trying to regulate the IOP in the patient*s eye within this range and to find a "safe" level required by the patient. And because the patient cannot feel the effects physically, the patient cannot appreciate the usefulness of the eye-drops. The process is unable to provide a system of positive feedback that can be measured by the patient. In the case of diabetes, the patient is able to measure daily his blood-sugar level and gauge his compliance but this is not quite the case with glaucoma. With glaucoma, the patient can only get the performance-feedback at his next clinic visit, which may be 5 to 6 months later.

There are various causes of non-compliance in the use of eye-drops. Broadly we may classify them into two groups:-

1) failing to take prescribed doses at recommended intervals
2) failing to dispense the correct dosage due to wrong techniques

Unclear Prescription Convention
It is traditional in medicine prescription to use the day to represent the interval of dosage and then specify the number of times they have to be taken, often before or after food. Thus this practice is also applied to glaucoma eye-drops - do you apply nightly, twice a day, three times a day, or four times a day? The day is taken as the yardstick. What then about the night? Does one sleep through it without medication? If the patient sleeps 10 hours a day, what happens to the 3 or 4 times a day dosage interval? It is possible in such instances that the eye-drops would have over-regulated the IOP during the wake-hours and under regulated the IOP during the sleep-hours. This can only lead to undesirable results for patients with "spiked-up" IOPs during the night.

If the traditional prescription methods are confusing, then change them. Perhaps it may be better to base the application times on a 24-hour day (inclusive of the night) - applying eye-drops 12 hourly, 8 hourly, or 6 hourly - instead of the 2x, 3x or 4x per day convention. In this way, the time of dosage each day will be the same and much easier to remember. This makes the exact dosage times clearer and helps the patient to be more disciplined. The patient will also have a better idea of the dosage interval and plan ahead. Thus, if adherence to a 6-hourly dosage schedule is not possible for the patient because his work, age, health etc, it would be better that the ophthalmologist prescribe eye-drops which have longer effectiveness. Studies show that greater compliance is seen with lower-dose frequency and falls sharply as the frequency is increased. With once-a-day dosage, 75% of patients use their drops regularly. But, the patients' compliance falls to 40% when the dosage ís increased to a 6-hourly schedule.
Consumption rates of common dosing schedules are around 80% when the drops are taken by patients who are on a once-a-day dose; and falls to 50% when patients are placed on 6-hourly dosages.
Though the consumption rate looks better, the time interval of application has often been compromised. Often non-compliance may be due to:-

• 1) Lack of planning
  2) Forgetfulness
  3) Change of daily schedule
  4) Confusion about instructions
  5) Cost of the medicine

Proper Instilment
However, getting the correct timing for dosing is only one aspect of compliance. The other, which is more difficult to manage, is getting the necessary dosage into the eye where it is required. Here, tablets have the advantage over eye-drops for compliance because the former can be counted but the latter is difficult to measure. An eye-drops dispensing bottle is designed to release one drop-size at a time into the eye. Most eyes are capable of receiving at least 0.8 of a drop-size. Three things can happen to a drop when instilled:-

1) some over-flow the rim of the eye
2) some gets drain out through the tear duct
3) some gets absorbed by the eye - the only useful portion

Depends on Patient, his Patience and Persistence
The objective is to allow as little of (1) and (2) to happen and as much of (3), which is the only useful portion of the eye-drop, to take place. The eye-drop must get to the eye to do its job. How much of the drop is going to be effective depends on the patient, his patience and his persistence. Too little of (3) would result in partial compliance or lack of efficacy. How much of the drop should do useful work i.e. (3) is a chicken-and-egg issue. The test is, if by maximizing the usefulness of the drop will maximize the IOP lowering, the maximum usefulness should logically be targeted. It saves money, it gives less side effects.

Consider a Case Study. Let us say that a control patient needs a 35% IOP reduction to reach the target pressure. Assuming that, with this patient, the prescribed eye-drop is capable of lowering the IOP by 40% if optimal efficacy is practiced but only 20% was obtained due to poor but consistent application. As a result, on examination of the optic nerves and visual field results, the ophthalmologist prescribes to add on another eye-drop so as to lower the IOP further by another 20% and the target IOP was met. Note that this could actually be achieved with the first drop if there was good compliance. Thus, with good compliance, it is possible to reach the target pressure with less cost, a less frequent dosing regime and less side effects. Trying to get everyone to achieve the maximum benefit from the drop may not be practical but some good practices may yield better results than haphazard applications.

Some Good Techniques for Good Compliance
Let us consider some of the better techniques adopted for good compliance. In a workshop study of 20 patients some good practices were introduced and the performance gauged after the next visit. The results of the initial visit and subsequent visit are tabled: The results showed that with proper instructions and practice, the procedures could be taught and learnt by patients.
Let us try to understand how each of these steps helps to improve the procedure of application. Getting the eye-drops properly absorbed by the eye requires time and it varies with different eye-drops and from person to person. Generally, 5 minutes would be sufficient but with the carbonic anhydrase inhibitors (CAI) they might take as much as 10 minutes because of their more waxy and viscous nature. Keeping still for 5 minutes in the tilted head back and the eye gently closed position will keep the drop at optimum instilment mode. Closing the eye gently without blinking and squeezing will improve the dosage. The action of blinking will cause fluid to drain down the tear ducts and together with some of the medicine. Applied pressure-lacrimal puntae, a procedure of applying slight pressure to the inner corner of the eye with the finger, will physically close the tear duct blocking drainage through this channel temporarily. The patient should try to apply drops to one eye at a time instead of both eyes simultaneously if difficulties are experienced in preventing over-flowing. A delay of 1 or 2 minutes between instilment of drops to each eye often helps. Similarly, if more than 1 drop is instilled to the same eye at close interval, a minimum of 5 to 10 minutes between applications will ensure that the second drop does not wash out the first drop.

Even the most conscientious patient forgets or misses the time to take a medication occasionally. But, immediately upon realizing it, he should take the medicine as soon as possible unless the time is so close to the next scheduled medication, that he should skip the dose and carry on according to his normal schedule.

One must safeguard against the folly of being fully compliant just before the next clinic review with the objective of obtaining good IOP readings, with the hope that the ophthalmologist would not increase the dosage of eye-drops and thus save cost. This will not work, as the optic nerves and visual field results will reveal the long-term consistency or inconsistency of eye-drops compliance. But it is only when the patient understands the importance of being consistent, that the patient would want to be compliant.

Conclusion
Finally, the patient should remember that the IOP-lowering eye-drop acts as an IOP regulator. In order that it can function in this role, the interval of application should be regular, as prescribed, and consistently maintained over long periods of time. The ability to apply each dose with maximum effectiveness to the eye will enable maximum benefit to be obtained from each drop and avoid additional medicine. By being compliant the benefits to the patient are:-

1. It will require less eye-drop dosage
2. It will have fewer side-effects
3. It will save you money
4. Most importantly, it will save your SIGHT!

Am I at risk for glaucoma?

.

.

Am I at RISK for GLAUCOMA?

.

.

• If you are 55 or older, you should get an eye exam at least once every two years.
• If you have diabetes or other health problems, you may need to see an eye doctor more often.
• A dilated eye exam will allow your doctor to check for glaucoma.

ASK YOURSELF THESE QUESTIONS :

• Have I had an eye injury or eye surgery, even as a child?
• Am I very near-sighted?
• Have I taken steriods on a long-term basis?
• Most importantly: have I had an eye exam recently?
• Am I 40 years of age or older?
• Did my parents, grandparents or great-grandparents lose their sight? What was the cause of their vision loss?
• Do I have diabetes?

SEE: Wills Glaucoma Service : Chat Highlights: Glaucoma Risk Factors and Their Significance

http://www.wills-glaucoma.org/supportgroup/20030625.php

Risk Factors for Glaucoma:

http://www.wills-glaucoma.org/risks.htm

How to use your eye drops

Alpha-CARE for U

Speed up the treatment, spread the word - compliance, compliance, compliance ......

How to use your eye drops

Some General Information

1. Use your drops as instructed by the doctor.


2. Read the label carefully and put the drops in at the times stated by the doctor/nurse. It is important to put your drops in at the same time each day.


3. Keep your drops in a cool, clean place (some drops may need to be kept in the fridge)


4. Remember to take your drops with you if you go out and, in particular, when you go on holiday.


5. Do not let your drops run out. Get a new bottle from your doctor in good time.


6. Always get a new bottle after 28 days even if you have some left


7. Do not stop using the drops unless your ophthalmologist tells you to do so


8. Some eye drops can affect your heart rate and/or breathing. Inform your doctor if you are using eye drops

If you experience any discomfort when using the eye drops please contact your eye doctor

--ooOOoo--

How to put your eye drops in

1. Wash your hands


2. Position yourself comfortably (stand, sit or lie)


3. Tilt your head back so you are looking up at the ceiling
4. Gently pull down the lower eyelid


5. Hold the bottle directly over the eye – you may find it helpful to use the bridge of your nose to rest the bottle on


6. Do not allow the dropper tip to touch the eye


7. Squeeze a drop into the pocket inside the lower lid – do not worry if more than one drop goes into your eye or it runs down your cheek


8. Close the eye and apply slight pressure to the inner corner of the eye for 2 to 3 minutes. This will prevent the drops from running down the tear duct into the back of the throat and will increase the benefit of the medication


9. If you use more than one drop in the same eye, allow about 5 minutes between each medication
   
   Please speak to your doctor or clinic nurses if you are having problems putting your drops in as they may be able to help.

--ooOOoo--

Also see : Is eye-drops compliance that difficult? http://alphacian.blogspot.com/2007/02/is-eye-drops-compliance-that-difficult.html

Glaucoma - Ask the Expert

In conjunction with Glaucoma Awareness Month - January 2007

Ask the Expert

January 18, 2007: Thursday, FOX Morning Show with Dr. George L. Spaeth, a Wills Glaucoma Service physician. (Video - 262 Kbps 02:19 mintues)

Now that I've been told I have glaucoma, what can I expect?

Now that I've been told I have glaucoma, what can I expect?

By George L. Spaeth

"Now that I've been told I have glaucoma, what can I expect? " This question has to enter the mind of every person who has just learned that he or she has glaucoma. It may be a sufficiently frightening question that the person never speaks it aloud. But it's the sort of question that most physicians dread, because it asks for projections that are extremely difficult to make. It asks the ophthalmologist to "play God," and, while physicians may be respected for their knowledge, they are usually aware that they have no unique ability to see into the future. Nevertheless the question is the right one for patients to ask, and it is an essential one for the ophthalmologist to address with a patient.

The first thing that a person who has been told that he or she has glaucoma ought to do is to ask the doctor what he or she means by the word "glaucoma." The word "glaucoma" is still used in so many different ways, and it means so many different things to different people, that the question about what it means for the person to have glaucoma can't really be addressed at all until there's some agreement on what the word "glaucoma" means.

Expect the Unexpected
The first thing that the patient with glaucoma should expect is the unexpected. Some types of glaucoma seem so serious that the physician worries that the affected person is likely to go blind. Other glaucomas seem quite mild, and the doctor may wonder if any treatment is necessary at all. But the patient with what appears to be a serious glaucoma may respond wonderfully to treatment and not have any further significant visual loss, while the one with the seemingly mild glaucoma may end up visually incapacitated because glaucoma in this case proves very resistant to all sorts of treatments.

Does this mean that the individual affected with glaucoma can't make any plans? No. While unexpected things are routine, the changes that occur in most people with glaucoma, once the initial diagnosis has been made and the initial treatment started, usually occur slowly over a period of many years. If the patient is alert and the physician is alert, the different directions in which the glaucoma is going can be spotted, and new and more appropriate projections made.

For example, the first patient mentioned above needs to be counseled at the start that there's a reasonable chance that he will lose his vision due to glaucoma. But as soon as it becomes apparent that the response to treatment is better than expected, a new counseling session is necessary in which the patient comes to understand that he's doing very well and the outlook for the future is far more favorable than had initially been considered. In a similar vein, when it becomes apparent to the physician that the second patient is not responding well to therapy, it's essential to share that information with the patient so the patient have a more accurate idea of where he or she can expect to be 20 years later.

Remain Vigilant
Except for a few types of glaucoma, the tendency for glaucoma to cause continuing damage remains with the person for the rest of the person's life. Thus, the person must not think that he or she is "cured" and stop being vigilant. There's a great difference between being vigilant and being a hypochondriac. To be vigilant means to be alert to warning signs and to exercise appropriate "preventive maintenance." To take care of a car properly does not require that the owner spend an hour a day inspecting the car. It does mean that periodically the car needs to be checked to make sure that the operating systems are working appropriately and that, if they don't seem to be working properly, that they are checked out promptly.

Warning signs that should alert the patient to call the doctor are symptoms of any kind that make the patient wonder if everything is OK. Of course, the most worrisome symptom is any sense that visual function is worse in any way. These symptoms would include:

• a sense that it's harder to get around, an increasing sense of clumsiness



• loss of depth perception



• more difficulty seeing at night



• less ability to distinguish between colors



• haziness of vision that is not corrected by glasses



• a perception that there are certain areas in the person's visual field that are getting worse



• pain in the eyes, especially when it's associated with smoky or misty vision or with rings around lights



• pain or fatigue after close work or when going into dark places such as restaurants or movie theaters



• achy eyes, that feel as though they have some pressure in them, especially when such aches occur repeatedly



• colored haloes around single lights such as street lamps



• a fluctuating sharpness of vision.

It's appropriate for the person to test each eye individually periodically. This need not be time-consuming or threatening. One way, for example, is on the first of each month for the person to check each eye individually to see if there's been a change in the smallest print that the person can read, and to check each eye to see if there's a change in the sense of the visual field, i.e., the awareness of all the things that surround a person. If one uses the same printed material each time to check vision, it becomes immediately apparent if the vision is becoming worse. If one looks at the same general scene, such as at a specific picture on the far side of the wall, then major changes in the visual field are easy to appreciate on repeated testing.

There are, of course, a wide variety of other visual symptoms that indicate that something might be wrong, such as "seeing double" or marked problems with glare. These symptoms, however, usually point to concerns other than glaucoma.

It's also important for the person to be vigilant regarding his or her general health. A person's general health has a profound effect on his or her glaucoma, and the glaucoma can have a profound effect on general health. Changes in the person's sense of well-being, the person's sense of energy, level of general fatigue, stress, and important events in the individual's life should be noted and relayed to the physician.

Prepare for Battle or Be Wary of Treatment?
Eyes that have far-advanced damage have demonstrated that the person's glaucomatous disease is the type that causes damage. Eyes that don't have much damage have demonstrated that they have the type of condition in which damage is much less likely to occur. The person, then, who at a relatively young age is found to have far-advanced glaucoma damage has to be prepared for a real battle. On the other hand, the person who's really doing quite well and isn't showing signs of progressive deterioration is more likely to be damaged by methods used to prevent further damage than he or she is likely to be damaged by the glaucomatous process itself.

Value Your Own Assessment of What You're Feeling
The person with glaucoma has to realize that the system of medical care which has come to be considered to be the best medical care is based on science, and science is based on unbiased, objective measurements which are analyzed in an unbiased, objective way. This means that the concerns of patients, which are never objective, and are always biased, are always considered with skepticism by the scientist. But in fact every individual person is unique and different from every other person. The patient wants a physician to be scientific, objective, and knowledgeable, but the patient must be prepared to do battle with physicians who don't appear to value what the patient feels about himself or herself. For example, when a patient says to the doctor that he's getting worse, by definition the patient is getting worse. The doctor may not be able to find manifestations of that deterioration but that doesn't mean the deterioration isn't occurring. The glaucoma patient, then, must pay a great deal of attention to his own sense of well-being and must be prepared to communicate that convincingly to his or her physician.

Be Ready for Repeated Optic Disc and Visual Field Assessments
The two most important tests done on the glaucoma patient are evaluation of the optic disc and visual field. Patients need to be prepared to have serial, repeated tests of these two functions. The patient also must be prepared for the huge amount of variability that exists between testing sessions and must not conclude that he or she is either getting worse or stable just on the basis of an apparent change in a photograph or on a visual field. The determination of whether a test really does represent a deterioration or an improvement is frequently an extraordinarily difficult determination and should not be made lightly by either the physician or the patient.

Be Prepared to Make Trade-Offs
The person who has a serious glaucoma, in which the optic nerve already has become damaged must realize that he or she is going to have to make trade-offs. Using drops is a nuisance; the vision is temporarily blurred, it's not comfortable to have to leave a meeting to go into the bathroom to use one's drops, it's a nuisance to make sure that one always has one's drop with one, etc. But if one has the type of glaucoma that is going to get worse, and the glaucoma is being controlled with medications, either one uses the drops or the glaucoma gets worse.

The two most important tests done on the glaucoma patient are evaluation of the optic disc and visual field. Patients need to be prepared to have serial, repeated tests of these two functions. The patient also must be prepared for the huge amount of variability that exists between testing sessions and must not conclude that he or she is either getting worse or stable just on the basis of an apparent change in a photograph or on a visual field. The determination of whether a test really does represent a deterioration or an improvement is frequently an extraordinarily difficult determination and should not be made lightly by either the physician or the patient.

Similarly, when glaucoma surgery is done, the eye is not returned to normal. The pressure may be controlled by the surgery, but the surgery usually substitutes one problem of less magnitude for the greater problem of losing vision. It is essential that the patient understand that there will be such trade-offs and it is the job of the patient and physician together to decide how to prioritize the problems so that the patient is most likely to accomplish those things which are of most importance to the patient.

Source: Wills Glaucoma Service

Glaucoma - Interview in Malay

It is worth repeating the Radio Interview conducted in July 2006 with SNEC Ophthalmologist, Dr Hoh Sek Tien, on Glaucoma in Malay

http://www.ab-glaucoma-sin.org/media/RSI/11jul2006.html

Kata orang ya, mata adalah jendela kita untuk melihat dunia. Dengan matalah, kita lihat keindahan alam sekitar dan telatah manusia ya? Setuju, saudara?

Lifestyle & Glaucoma - Wills Glaucoma

• P: Nine months ago I started a walking routine, usually 45 to 50 minutes a day. After five months of that exercise, my blood pressure had dropped low enough that I no longer needed medicine to control it. My cholesterol also dropped. Further, I lost 17 pounds. The best news, however, is that at my last checkup my IOPs were10 mm Hg. My glaucoma specialist said that my visual field is stable. Since I have not changed glaucoma medication, I attribute the decrease in IOPs to walking. My IOPs have never been that low.
  Dr. Rick Wilson: You are a good example: I see that all the time. In fact, when my son was born 21 years ago, I was found to have seriously high blood pressure. I started swimming four times a week and lost 15 pounds. I have never had to take medicine for high blood pressure as it dropped significantly.
  
  

You don't use it, you lose it!

To access Chat Highlights : http://www.willsglaucoma.org/supportgroup/20070103.htm

Glaucoma - Is there a cure?