Living with Glaucoma
Although a diagnosis of glaucoma is not life threatening, it can bring about lifestyle changes and fears for the future. Significant vision loss at the time of diagnosis may affect driving, employment and independence. With early detection and treatment, glaucoma can be managed and loss of vision need not occur.
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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.
Driving with glaucoma - this depends on the amount of vision loss your glaucoma has caused. Fitness to drive for a private car licence requires a best corrected visual acuity of 6/12 or better, with both eyes open. In addition there needs to be at least 120 degrees of visual field free of glaucoma defects with at least 10 degrees free of defects above the horizon. If either of these criteria are not met, a restricted licence may still be possible. Note that licensing requirements vary between states.
Images courtesy of Dr. Anne Hoste
Sleeping positions - 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. There is not one specific position that is the best but it is important to avoid sleeping in positions where physical pressure or strain is put on the eyes. If an individual’s glaucoma is well controlled with no sign of deterioration, the goal of treatment has been achieved and there is no need to look to other lifestyle modifications such as altering sleeping position.
Sleep apnoea - numerous studies have demonstrated a higher rate of glaucoma in patients with sleep apnoea. Patients with sleep apnoea are advised to have an eye test to screen for glaucoma.
Wind instruments - musicians who play a high resistance wind instrument (eg trumpet, oboe) experience a transient increase in eye pressure and are slightly more likely to experience peripheral vision loss. This appears to be related to both the resistance of the instrument and the number of hours spent playing it.
Neck ties - 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. A study has indicated that tight neck ties can contribute to the risk of glaucoma. While the research is not definitive it is suggested that if you be able to easily slide a finger between the neck and collar then the tie should not have alter the pressure in the eye.
Air travel with glaucoma - generally, flying has no effect on someone with glaucoma, other than a temporary elevation in intraocular pressure (IOP). Following a trabeculectomy there is no increased risk with flying – this also applies to any laser procedure. The only issue with flying is if a procedure has resulted in the retention of air or gas in the eye, mainly pertaining to vitreoretinal surgery. Make sure to ask your ophthalmologist if you have any specific concerns.
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. 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.
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.
Yoga - some yoga positions may impact eye pressure in people with glaucoma. People with glaucoma may have increased eye pressure when doing head down positions, such as “downward dog”. Damage to the optic nerve occurs in people with glaucoma and one of the known causes is elevated fluid pressure inside the eye.
Swimming - swimming goggles have also been linked to increased eye pressure. It is recommended that goggles with small widths be avoided, and to choose those goggles with a horizontal diameter of greater than 55 mm. If you swim with goggles, ensure they fit snugly to the bones around your eyes and do not apply pressure to the eyeballs themselves.
Weight Lifting - 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.
Sexual activity from a glaucoma perspective, in a word yes - just don't hang head down for prolonged periods!
Dry eye syndrome, commonly worsened by topical glaucoma medications (especially preserved medications), contributes to the overall burden of glaucoma. Dry eye syndrome can be improved by eyelid hygiene, warmth and massage, topical lubricants (ideally preservative free) and sometimes altering the topical drop regimen.
Cataracts in patients with glaucoma
Cataract, frequently found among glaucoma patients is readily treatable by surgery.
A cataract is the process by which your natural focusing lens changes from being transparent to being cloudy.
Glaucoma is usually asymptomatic: it is called the "sneak thief of sight". By contrast, cataracts often do have symptoms that may impact on your quality of life. The symptoms of cataracts, vary with the type and location of the lens opacity you have. Commonly patients complain of decreased central vision. This is noticed especially when driving and looking out into the distance.
Glaucoma treatment in pregnancy
You may need to stop or adjust medications for glaucoma when you are pregnant.
All glaucoma patients who need treatment with drops need to consider, with their ophthalmologist, the possible benefits and potential side effects of any medication. When glaucoma affects a woman who is pregnant, breast-feeding, or considering having a baby, there are additional considerations in the strategies needed for safe treatment. Now there are two patients involved - the mother and the baby - and the ways in which a baby’s tissues and organs react to drugs may be quite different from those in adults.
As we are all aware, drugs can have harmful effects on the development of a baby’s organ systems. The earlier in pregnancy the drugs are used, the more frequent and more severe the problems can be. But even later in pregnancy, or after birth if the infant is being breast-fed, drugs can have unwanted effects.
When eye drops are instilled, some is absorbed into the general circulation, and travels all over the body. It can pass through the placenta and reach high concentrations in the baby’s blood too. If a baby is being breast-fed, it can pass into the milk, and thus get into the baby’s circulation as well.
To read more about how glaucoma can affect pregnancy, please read the following article:
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, even though this is only temporary. So a little red wine almost every day is not a bad idea. Your liver will not like too much however!
Caffeine - for most individuals caffeine does not affect the pressure in the eye. There is however increasing evidence that blood flow can be a factor in glaucoma and this can be influenced by caffeine intake. It is recommended if you do have problems with your blood pressure or experience migraines then excessive caffeine intake should be avoided.
Vitamin B3 has been shown in experiments to reduce eye pressure. While human trials have yet to be conducted, there is hope that adding Vitamin B3 to existing treatments may be beneficial.
Alternative therapies such as homeopathic and holistic have not been tested for effectiveness against glaucoma. It is advised to stay with valid treatments that have been proven to be effective and safe.
Marijuana/Cannabis lowers eye pressure but the effect is temporary (3-4 hours). The mood-altering effects of marijuana must be weighed up against this beneficial yet temporary effect, as do the various chemicals within marijuana cigarettes that can cause lung and potentially brain disease. In addition, it can lower blood pressure which can decrease blood supply to the optic nerve, potentially exacerbating increasing risk. As there is no concrete evidence for its role in altering the course of glaucoma, marijuana use as a glaucoma treatment is advised against.
Living with low vision
Low vision is defined as visual impairment that cannot be corrected by treatment or tools including glasses, contact lenses or surgery.
With poorer vision comes an increasing fear of blindness, social withdrawal and other limitations. Depression, associated with chronic disease and disability, is more common in patients with advanced glaucoma, and is associated with reduced quality of life.
If you are experiencing depression or anxiety due to your experience with vision loss, please speak to your doctor or health care professional.
Resources to assist those with low vision include:
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Some of the information on this page can be found in the article “Living with glaucoma”