Written by Clin Assoc Prof Ivan Goldberg, Ophthalmologist and Head, Glaucoma Unit at Sydney Eye Hospital
Some common questions from those living with glaucoma
Often, Glaucoma Australia is asked about the advisability of various daily activities when one has glaucoma and about how drops fit in. This article attempts to provide some guidelines.
Almost anything you might want to do will not affect your glaucoma adversely.
Using your eyes is not harmful and they do not need to be "rested". Reading, writing, sewing, computer work and similar activities all encourage your eyes to focus up close. Focusing like this exercises the muscles inside your eyes as well as those around your eyes. Working the muscles inside your eyes helps the drain in each eye to work more effectively. Aqueous fluid can drain back to the blood stream more easily, encouraging the eye pressure to fall. If your eyes become tired with prolonged concentration, you can rest them periodically - but please don't worry that you have done them any harm. Similarly, longer distance viewing such as driving, watching TV or going to the movies does not harm your eyes.
What about physical activity? Keeping your weight down and being physically fit helps to prevent health problems e.g. heart attacks and diabetes, and is important for your overall well-being. How pleasant to know, therefore, that these same measures also help you to protect yourself from glaucoma.
This help is in two forms: firstly, any measures which maintain the health of all blood vessels (such as avoiding smoking, ensuring normal blood pressure and cholesterol levels, controlling diabetes and body weight) will enhance the blood vessel nourishment of the optic nerve fibres; and secondly, physical activity actually reduces eye pressure directly for a few hours at least.
Is sex safe? From a glaucoma perspective, in a word yes - just don't hang head down for prolonged periods! Blood vessel health and thus visual health is also promoted by avoiding obesity, and remaining as physically fit as possible. Exercise to the limits of your comfort and ability is highly recommended. As mentioned above, a bonus is the added slight reduction in eye pressure exercise produces for some hours. The only exercises to be avoided are those in which your head is held below your waist - such a posture increases eye pressure. Yoga lovers take note.
Is diet or food choice a problem for glaucoma patients? No specific foods are particularly good or bad for glaucoma treatment. Because optic nerves health depends in part on healthy blood vessels, food that helps to maintain blood vessel health is likely to promote visual health: reduced saturated fats and increased intake of vegetables and fruit are desirable. Red wine also helps to provide extra anti-oxidants and the alcohol content tends to reduce eye pressure, albeit temporarily. So a little red wine almost every day is not a bad idea. Your liver will not like too much however!
A common concern is a group of medications taken orally which contain a specific precaution for glaucoma patients in their consumer information sheets - many anti-cold and flu as well as anti-allergy agents (like antihistamines) and some antidepressants. These cautions apply in particular to people with a risk of angle-closure glaucoma, which is less common than the open-angle glaucomas. If you have had a laser peripheral iridectomy for a tendency to angle-closure, or combined mechanism-glaucoma, then the medications should be safe for you. If in doubt, check with your ophthalmologist.
Many patients complain about glare or increased sensitivity to light. Usually such problems relate to cataracts, or corneal scarring and not to glaucoma itself. However some drops used to treat glaucoma, such as pilocarpine, make the pupil small. If there is a mild cataract, the symptoms the cataract provokes can be exaggerated by these drops. Please discuss this further with your ophthalmologist. Another useful tip: avoid heavy rubbing of your eyes. Such a manoeuvre raises eye pressures and may contribute to further optic nerve damage. Similarly, there is some evidence that sleeping with physical pressure on an eye can accelerate glaucomatous damage. Perhaps try to avoid sleeping face down, and to consciously avoid any pressure on one or both eyes from the pillows or bedding.
Some specific comments for specific activities:
If you do weight lifting, try to breathe in as you lift the weights: don't hold your breath. This avoids strain, avoids increasing the pressure in the veins of your head and neck and thus avoids increasing the pressure in your eyes. For the same reason, select more repetitions with lighter weights rather than fewer lifts with heavier weights. If you swim with goggles, ensure they fit snugly to the bones around your eyes and do not apply pressure to the eyeballs themselves. If you wear closed collars (with ties for example) be careful not to have them too tight as this increases pressure in the veins of your head and neck and thus increases eye pressure too.
What about the timing of your drops? Each medication has a well-defined duration of action, and therefore each medication has an optimal frequency of use daily and optional schedule for timing during the day. For example, while bimatoprost ("Lumigan"), latanoprost ("Xalatan"), tafluprost ("Saflutan") and travoprost ("Travatan") are each needed once daily, timolol ("Timoptol", "Tenopt", "Optimol") or 1-bunolol ("Betagan") may be used once or twice daily, and if once daily are probably most effective if used on waking.
Betaxolol ("Betoptic", "Betoquin"), brimonidine ("Alphagan" and "Alphagan P") and dorzolamide ("Trusopt") and brinzolamide ("Azopt") are required twice daily, and are best instilled about 12 hourly. However, glaucoma patients are human beings who happen to have glaucoma. You have a lifestyle with demands on your time and normal needs. Becoming a slave to an eye drop program is not necessary. If drops are instilled occasionally at sub-optimal times or frequencies, disaster is not the immediate result. Aim to use your drops at the ideal times for your medication, fitting this in most conveniently with your lifestyle and daily activities. While trying to maintain this regimen do not despair if on the odd day you deviate somewhat. This includes travel across time zones. When you fly into the wide blue yonder use your drops in the air as you would have back at your origin and then simply switch to your usual times at your destination.
To make drop taking less inconvenient, there are several fixed combinations available, which mean two drops can be instilled with one drop from one dispenser. "Azarga" is brinzolamide plus timolol, "Combigan" is brimonidine plus timolol, "Cosopt" is dorzolamide plus timolol, "Duotrav" is travoprost plus timolol, "Ganfort" is bimatoprost plus timolol, "Simbrinza" is brinzolamide plus brimonidine and "Xalacom" is latanoprost plus timolol. Having these choices means if three or even four drugs are needed to gain eye pressure control, they can be obtained with only two dispensers.
For further information please talk with your ophthalmologist.
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