Saturday, March 6, 2010

glaucoma

Question
Hello

Generally, what should be the target eye-pressure for the treatment of glaucoma (not normal-tension glaucoma)?

I know that normal eye-pressure of a healthy person may be from 12 to 21 mmHg. I know that exact target eye-pressure for the treatment of glaucoma is that pressure at which progression of visual field loss stops. But it takes about one year to perform a series of 3 to 5 tests of perimetry to evaluate the progression of visual field loss. But patient needs proper medicines as soon as possible. I am diagnosed primary open angle glaucoma. I am using two medicines (Beta Adrenergic Receptor Blocking Agent+Prostagalandin Analog). My eye-pressure is reduced from 37 to 17 mmHg. Is it better that I use three medicines (+Alpha-2 Adrenergic Agonist), so that my eye-pressure reduce to 12 mmHg?

Best regards,

Allen.  


Answer
Target pressure is determined on an individual basis for each patient, depending upon various factors.  Some doctors begin with a general plan that the pressure should be reduced by a percentage equal to the initial pressure. So in your case, 37% less than 37 mmHG is 23 mm Hg.  I think that is most likely too high for a target pressure, so we would have to look at other factors.  



One of the other factors, for example, is age.  If you are 85 years old, then a pressure of 17, or maybe even 23 is acceptable because the damage from glaucoma is slow enough that you will not outlive your vision.  If however you are 25 years old, then I would say the pressure would need to be much lower, say maybe 12, because your doctors would have to plan on fighting that disease for another 75 years!  



Assuming you are neither 25 nor 85 but somewhere in between, if they have your pressure down to 17, they are most likely within a good range for you.  I would trust what these doctors are doing for you and wait for your year of tests to be up before your meds are adjusted.  Glaucoma damage is slow as I said earlier.  If they have it mostly under control, that is the goal and the details can be adjusted as further testing brings in more data for you.