Frequently Asked Questions

Yes, everybody is at risk of developing glaucoma. 2-3% of Australians will be affected by glaucoma in their lifetime. Some people have a higher risk, particularly those who:

• have a family history of glaucoma
• are over the age of 40
• have diabetes or migraines
• are short or long sighted
• take certain medications such as cortisone (steroids) or anti-cholinergic drugs 
• have had eye surgery or an eye injury

If you have a direct family member with glaucoma (parent, sibling, or child), you are at an increased risk of developing glaucoma yourself. This is because, in many cases, glaucoma is an inherited (genetic) disease that is passed on within families. Regular visits to your eyecare practitioner are recommended.

For those already diagnosed, once your treatment is effective and your glaucoma is stable then your eye care practitioner will recommend how often you should be reviewed. You may need to have a greater number of appointments when you first go onto medications, when your medications are changed, or if your glaucoma is not stable. Your eyecare practitioner  will advise you of the frequency of visits that is most suitable for your case.

If you have never been checked for glaucoma then you should go to your optometrist and start being checked by the age of 35 years. Early detection through regular and comprehensive eye exams is the key to protecting your vision from damage caused by glaucoma.

You will need to get a referral to see an eye specialist. A referral will allow you to claim benefits from Medicare for the consultation and some of the tests done on the day. Referrals can be obtained from your optometrist, GP or a current specialist. Please note that referrals do expire. We would advise you to discuss the possibility of getting an indefinite referral. 

Click here find an ophthalmologist (eye specialist) near you.

Your eyecare practitioner will usually have recommended a course of treatment - eye drops are the most common form of treatment although laser procedures and surgery can also be performed. Eye drops are to be instilled every day and, depending on the eye drops prescribed, the dosage will be one (or more) drop(s) each day. In some cases, more than one type of eye drop will be prescribed.

It is important to follow the treatment plan and appointment schedule that has been recommended by your eyecare practitioner. This is because glaucoma is a life-long and often progressive condition, and appropriate and timely treatment can prevent vision loss.

Glaucoma can be present in one eye (unilateral) or in both eyes (bilateral).
 
If you have glaucoma in one eye, both your eyes will be tested at your eye appointments to monitor the affected and the non-affected eye. Your eye care professional will treat glaucoma for the one eye, however, it is also common for early preventative treatment to start in the other eye. 
 
If you have glaucoma in both eyes it is also possible to have glaucoma that is worse in one eye compared to the other and to receive different treatments for each eye. 
 

Eye drops only work when they are being used correctly – if you stop using them then your eye pressure (otherwise known as the intraocular pressure, or IOP) will increase again. Hence it is important to use your eye drops every day to prevent significant fluctuations in the IOP. There is some evidence to suggest that fluctuations in IOP may be as harmful to the optic nerve as consistently high IOP. Using the drops at the same time each day prevents significant fluctuations in a 24 hour period.  

Additionally, having a fixed daily routine generally helps patients to remember to use their eye drops each day. Nonetheless, if you are a little late with using your eye drops on a certain, it is still better to use the drops later than not at all.

There is growing evidence that factors other than high eye pressure may predispose a person to glaucoma damage. Eye pressure is important in glaucoma because it is the only reliably modifiable factor in the management of the disease, however it does not explain why glaucoma develops in all patients. Although, blood pressure has received significant attention in glaucoma, its relationship to glaucoma is not entirely understood.

Low Blood Pressure
Studies have consistently reported that low blood pressure is a risk factor for glaucoma. If blood pressure is low then the pressure delivery blood into the eye (known as the ocular perfusion pressure) is weaker. This leads to poor delivery of oxygen and nutrients to the optic nerve and potentially contributes to injury. This can occur in patients who normally have low blood pressure, but also in those who are over treated for their high blood pressure.

Ocular perfusion pressure is also lower at night when it is natural for blood pressure to dip. Thus, injury to the optic nerve could be occurring overnight and over a lifetime this could result in significant glaucoma damage without treatment.

High blood pressure
Studies tell us that high blood pressure can also result in higher eye pressure, possibly because of increased fluid production and/or altered fluid drainage. However, the effect of blood pressure on eye pressure is very small, with 10 mmHg (millimetres of mercury) increase in blood pressure only increasing eye pressure by 0.26 mmHg.

In addition to this, high blood pressure can also damage to the retina (the sensory tissue at the back of the eye) and its blood vessels. This might mean that the blood vessels in the eye are less able to cope with fluctuations in ocular perfusion pressure.

Tell your care team about your blood pressure.
It is important for your eye care practitioner to know your medical conditions, including your blood pressure medications. A commonly used glaucoma medication is a beta-blocker eye drop. Oral beta-blockers used to treat high blood pressure can also decrease heart rate. Therefore, use of both an oral beta-blocker and a beta-blocker in eye drop form could potentially have unwanted side effects.

Overall, it is best to avoid very high or very low blood pressure. There is ongoing research to better understand the relationship between blood pressure and glaucoma so that doctors can better guide their glaucoma patients.

While glaucoma cannot be cured it can be controlled with treatment (eye drops, laser,or surgery) to prevent or slow down further loss of vision. If a person with glaucoma does not receive treatment then their optic nerve may become progressively damaged resulting in loss of vision.  Damaged vision due to glaucoma is irreversible and left untreated can progress to blindness.

This depends on the amount of vision loss from glaucoma. There are currently guidelines in place which specify the amount of central and peripheral vision a person must have in order to hold a drivers licence. More information on Assessing Fitness To Drive can be found here.

If you have any concerns about your suitability to drive then you should discuss this further with your eyecare practitioner.

Find more information about driving with glaucoma in the following two articles:

• Maintaining safe driving habits

Unfortunately, vision lost to optic nerve damage from glaucoma cannot be restored, it is permanent and irreversible. The aim of treatment is to reduce the risk of further glaucoma damage. Your doctor has made a recommendation as part of your glaucoma treatment plan to try and preserve the current level of vision.

The five essential reasons for leaving home are to purchase food and essential household goods, to exercise within a close vicinity, for caregiving purpose, to work or provide education that cannot be done from home and also to receive a COVID vaccine in a nearby facility. 

Pharmacies fit into two categories. Pharmacies are an essential service for healthcare needs and some pharmacies can also now supply and administer the COVID vaccination. Pharmacies have remained open during these lockdown periods.  The 24-hour pharmacies in Melbourne remain open around the clock, even after curfew for emergencies.

Pharmacies are still receiving deliveries most days of the week, except maybe on the weekends. Therefore, there are regular supplies, which means that there is no need to stockpile medications. Pharmacies can legally only provide a customer with one month's supply of medication, to reduce any risks of shortages within the community.

If the pharmacy is a COVID close contact location, the deep clean process that needs to occur may result in the pharmacy only closing for one to two days at the most, as it is an essential service. This process involves spraying a fine mist into the air and requires a minimum of 12 hours to settle, before someone can enter the premises. A pharmacy would be a destination that would be on the high priority list for a deep clean. This is to ensure that the business can reopen promptly to continue to provide health care to the community. 

In order to prevent any delays in receiving medication, it would be ideal for individuals to collect their medication one-week prior to it running out. This ensures there is plenty of time to replenish the stock or organise a new prescription if it is needed. There are plenty of reminder services that can be utilised or this can be marked on a calendar. Most pharmacies will have an app to help remind customers to collect their prescriptions and the pharmacists can also provide information to customers regarding what app to utilise.  You can also set up an alarm to alert you as to when your next prescription is due to be collected. 

Another pharmacy can be called, if a customer cannot access their usual one because it is closed. They can provide what is called an emergency supply of medication. The patient would need to bring with them the old package of the medication, so that the pharmacist can provide them with the correct drug and also inform them of the accurate directions for use. If a new prescription can be organised for another pharmacy that would be the preferred option. A Telehealth appointment or phone consult with the appropriate health practitioner would need to be booked, so that another script can be written. This new script can either be mailed or sent via an electronic prescription to the new pharmacy.

A compounding pharmacy is basically a pharmacy that specialises in producing something that is not available commercially. The pharmacists working there are specifically trained to produce these compounded items. 

If the compounding pharmacy were closed for a deep clean it would be ideal for the patient to refer to their prescribing doctor for a short-term solution. Hopefully, they have not run out of the compounded medication to the extent that there is no supply left. Alternatively, another compounding pharmacy could be contacted.  There are however even fewer sterile compounding pharmacies that can produce drugs, such as eye drops. Therefore, the best option would be to contact the prescribing doctor in the short term.

If a person happens to wake up with any COVID related symptoms or feels unwell it is best to get a COVID test and not enter a pharmacy or any other facility. Pharmacies can still serve customers from their car or home, if they phone to inform them of the situation. It is essential that a person with symptoms does not enter a pharmacy, because this can put someone at risk of contracting the the virus and also result in the pharmacy needing to close for a deep clean, if they are a confirmed positive case. 

If testing positive for COVID it would be best for the customer to collect prescriptions i.e. eye drops, by utilising their local pharmacy’s delivery services.

Almost all pharmacies now have this service set up, with either no charge or a small fee, depending on the distance involved and the time of the day that the service is being requested. 

Some pharmacies may also choose to use a postal service, however the time taken for the postal services to deliver the medication needs to be taken into consideration.  Australia Post and courier services are working really hard, but they are also working within the restrictions and therefore there are likely to be delays. However, rest assured that a person will not be penalised for entering a pharmacy to access a health related services outside of curfew hours.

Vaccinations are the latest service that pharmacies have been able to provide, in some areas of some states, and it is a gradual rollout. Most likely a patient will have at least one pharmacy within their area that is providing the COVID vaccination. 

Findapharmacy.com.au is a website that contains a full list of pharmacies that are providing the COVID vaccine. To book a vaccine appointment, an online booking platform can be used or the pharmacy should be called in advance, to ensure they can prepare the vaccination. The vaccinating pharmacists have been required to complete the compulsory training modules to be able to administer the vaccine. There are also strict storage and handling requirements for the vaccines, to ensure patient safety.

When a patient goes to the pharmacy they'll be asked to complete a questionnaire. The form will ask whether they have any known allergies, take other medications and have any coexisting medical conditions. The pharmacist would therefore be alerted of any glaucoma. As the vaccine is reasonably new it is always a good idea to gather as much information as possible to determine if later on it can affect certain conditions.

There is still a lot of research being done, so it is difficult to say if it will cause a raise in IOP. It would definitely be a good idea to inform the pharmacist of the glaucoma diagnosis and it would be ideal to get an eye pressure test done beforehand. The commencement of the new medication could also be delayed, if it is occurring in conjunction with receiving the COVID vaccine. Therefore, this would help to distinguish if the raise in IOP was due to the medication or the vaccination.

An electronic prescription is a digital version of a paper script. It is in the form of a QR code, which is sent via an SMS or email by your doctor. If a patient takes more than one prescription each medicine will have its own QR code. Therefore, if a customer has multiple medications/prescriptions it means they may have multiple phone messages or emails. The pharmacy receives the digital script and can also organise for the medication to be delivered later the same day, as long as they are provided with the script within a timely manner. If the doctor has written repeats the pharmacy can send these to the customer almost instantaneously, in the form of a QR code. This new code or token then becomes what is used for the next repeat prescription.

If a person has multiple prescriptions, active script lists have just been initiated in some pharmacies nationwide. This is the alternative to having electronic scripts.
It combines all of a customer’s prescription into one digital list, which is stored as an electronic file in the cloud. The pharmacy can access all their prescriptions and dispense medication from this list when needed. The benefits of having an active script list is that the customer is not reliant on their phone, having mobile data and managing multiple QR codes. To get a greater understanding of the active script lists, access the Australian Digital Health Agency website, which provides informational videos on how electronic scripts and active lists work in depth.

Absolutely, the pharmacist would be more than happy to assist any customer with this. If a GP, prescriber or the customer gives consent for the prescription to be sent directly to the pharmacist, this can be done. Therefore, the use of a phone would not be needed. Pharmacists would now be well aware of how the electronic prescription process works and they would be able to assist with the set up of this. 

No, not all doctors or pharmacies use e-script. This is because there is currently a lot of extra work that is involved in setting up e-prescriptions for the doctor and the pharmacist. A lot of this organisation and set up would have to be done in their own time and health professionals are often really busy with their appointments and patients.

Going forwards there will likely be a gradual rollout. This ensures that the utilisation of electronic scripts is implemented legally. Moreover, this ensures that all staff working at the medical clinics receives proper training on how to use and implement them. 

More information on the active script list:

The active script list is designed for anyone who is on multiple prescriptions i.e. more than three medications. The active script list itself would be set up by a nominated pharmacy. The idea is that if the patient is away, any pharmacy can dispense the medication from the active script list. The list is electronic and is stored in the cloud. The patient must provide the pharmacy with their name, potentially their Medicare number, a date of birth and also a form of identity. If the customer then consents, either one or multiple prescriptions would be dispensed from the list. If the doctor has provided repeats it will work the same way. The repeats will sit in the active script list and when the patient runs out a doctor can then prescribe a new list. Again, to get a greater understanding of the active script lists, log on to the Australian Digital Health Agency website, which has really good informational videos about them. As the active script list is stored in the cloud and cannot actually be seen, the website provides a visual way of looking at how they work and makes it easier to understand.

Yes, a paper prescription can be emailed to the pharmacist. However, some states still do require a physical copy in which case it could be mailed or dropped in at the pharmacy when the patient is next there. Legally the pharmacy needs to receive the original script to dispense the appropriate medication.

Most pharmacies will have a delivery service and there may be some banner groups that will have a click and collect service available. A legal prescription would need to be provided so it can be dispensed. There would be an arrangement for these pharmacies to access the prescription from the customer. It would just depend on which pharmacy was located within your area that provides this service.

In February 2021 the healthcare sector shifted to a compulsory active ingredient prescribing legislation. This means familiar brands will be referred to by their generic or drug names. If a customer wishes to continue using the same brand they just need to inform the pharmacist. This shift in legislation was a requirement to align Australian prescribing standards with international standards. It was also implemented to empower patients to have a better understanding of the active ingredients in their medications.

The pharmacist can be asked if there are any questions or queries. The pharmacist may use the generic or brand name that the patient is familiar with, or provide a list that has the active ingredients and also the corresponding brand that the patient can refer to.

If you are a person living with glaucoma under the age of 50 years, it is recommended by ATAGI to have the Pfizer vaccine and for persons over the age of 50 years, both Pfizer and AstraZeneca are considered safe.  If you get the COVID vaccine and you have glaucoma, there shouldn't be any issues.

It is still in the early stages, so the benefits are going to outweigh any risks and we need to use this time to actually report any side effects to the drug companies.

If you're in any doubt, please consult your GP or healthcare professional ahead of time.

Every Australian will eventually be eligible for this vaccination as they gradually roll it out in each State or Territory. These vaccinations are relatively new, and in Australia we have been supplied with the Pfizer and AstraZeneca COVID vaccines. 

There appears to be a small risk of thrombosis with thrombocytopenia in people 50 years and over, but this risk appears to be lower than in younger people. Cases overseas have been reported at all ages.

People who are considering vaccination with the AstraZeneca COVID-19 vaccine should be aware of this potential complication as part of providing informed consent.

The COVID-19 AstraZeneca vaccine can be used in adults aged under 50 years where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits.

To find out when you'll be eligible for yours, it is recommended that you visit the Department of Health website and have a look at their COVID eligibility checker. It's a very simple tool where you just pop in a few of your details answer a few simple questions and it gives you an estimation of when you may be eligible for yours.

You can do this eligibility test for yourself and also on behalf of someone else.

The process will roll out in stages according to your State or Territory and as well as going to the GP, other immunisers that are able to administer the vaccines are nurse and pharmacist immunisers. 

Before health professionals are able to administer the COVID vaccine, they must undergo compulsory training. It is fairly intensive training, so be rest assured that your health professional will be very informed about the COVID vaccine, when you're ready to receive yours.

You can find out where you can book in for a COVID-19 vaccine by going online to health.gov.au where you can find a list of GP-led respiratory clinic locations around Australia.  Some private GP clinics have also had small allocations and it is worth enquiring to see if you are eligible to receive these. 

If you've had a vaccination for the flu at your local pharmacy, the process will be very similar. When you arrive at your pharmacy your allocated time, you'll be asked to complete a pre-questionnaire and consent form, this will also give you the opportunity to disclose all your medications, and allow an adequate assessment of your suitability. 

The vaccine itself is an intramuscular injection, which means it's going to be given in your upper deltoid in your upper arm. You may experience redness or pain after getting the vaccine.

Your pharmacist will then ask you to stay behind for observation for about 15 minutes and if no obvious adverse effects, you'll be issued with a COVID certificate or record as evidence that you have received the vaccination. This record will also be on the Australian immunisation register for you to view.

If you are intending to receive the flu vaccination it is recommended to have the COVID and flu vaccines two weeks apart. If in doubt just check with your GP or your pharmacist and they'll be able to advise you.

The answer is absolutely yes! It's recommended that you still continue to use any other medications prescribed at the usual times, as there are no potential drug interactions between the COVID vaccine and your glaucoma eye drop medication.

If you happen to be initiating a new glaucoma eye drop and you get the COVID vaccine around the same time, it's going to be difficult to distinguish which one caused the side effects. It is recommended that you organise a follow-up consult with your prescribing doctor to monitor this. It’s also a very good idea to keep any notes or a diary of how you're feeling so then you can report everything back to your doctor.

Yes steroid eye drops you can obviously still continue to use as well when you get the COVID vaccine. With steroid eye drops however, unless your eye specialist or prescribing doctor has prescribed them permanently it should always be reviewed. Steroid eye drops are not something that we ordinarily suggest you use every day without medical monitoring.

It is not advised that you get the COVID vaccination if you're pregnant. There aren't actually any conclusive studies and although they have actually not indicated that there are any risks, it is best to speak with your GP or pharmacist to actually discuss other options.

If you are currently breastfeeding, it is advised that you monitor for any side effects within yourself and your newborn. 

It is unknown if it does, but it is unlikely to as glaucoma is an eye pressure condition and COVID is more a respiratory condition. So it's not expected that there will be any direct or indirect link at this stage.

There hasn't been any conclusive studies to do with eye-related side effects. It's something that we need to be aware of, and perhaps this time next year they'll report of some.

A requirement of the health professional administering the vaccine is to check the Australian immunization register before they actually administer it to you.

There is also an electronic record of any of the vaccines that you may have received in the past. And if you're wondering how you can access this, you can actually download it on the MyGov app and it will all be listed.

Because the eyeball is filled with fluid it has an “intraocular pressure” which is determined by how much fluid is inside the eye. The range of pressure we describe as “normal” is anywhere between 10 and 21 mmHg (eye pressure is measured in millimetres of mercury just like blood pressure).  High eye pressure is caused by an imbalance between the production and drainage of the fluid in the eye (aqueous humour) so that the fluid tends to build up.  Loss of vision from glaucoma occurs when the eye pressure becomes too high for an individual eye and damages the optic nerve.

Not necessarily. Increased eye pressure (also termed ocular hypertension), means you are at risk but not all instances of increased eye pressure lead to glaucoma.  You may be classed as a glaucoma suspect.  A person has glaucoma if there is damage to the optic nerve. Increased eye pressure is a significant risk for the development of glaucoma.

The level of eye pressure at which there is progressive damage to an optic nerve varies between people, not everyone with high eye pressure develops the disease, although ocular hypertension is the most important risk factor for glaucoma.

Yes.  Some individuals with “high” pressures do not develop nerve damage, while others with “normal” pressures develop progressive nerve damage.  In low-tension or normal-tension glaucoma the optic nerve is damaged even though the pressure in the eye is not very high.

Deciding what level of eye pressure is acceptable for an individual is complex. Your specialist will assess a range of factors, including the eye pressures prior to treatment, how much optic nerve damage is already present and whether the damage is getting worse. These factors are then balanced against any possible risks or side effects associated with an increase in treatment.

Your target pressure range may change with time and it is more important that you talk to your doctor about the process of decision making in your particular situation, rather than being too focused on one particular number.

Although eye pressure does change with posture, there is as yet no strong evidence that a particular sleeping position should be adopted by glaucoma patients.  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 sleep position.  Adopting a new sleeping position may affect the quality of a night’s sleep and as yet there is insufficient evidence to recommend any change for glaucoma patients.

It is thought that the eye pressure goes up when we lie down and interestingly in some cases of normal pressure glaucoma the more severely affected eye seems to be on the side that the individual tends to sleep on - but this is not always the case, and as yet there is no firm evidence to guide any changes to sleeping habits.
 

Eye drops used in the treatment of glaucoma work by reducing the intraocular pressure (IOP) within your eyes. There are several classes of drops, which have different mechanisms of action. Prostaglandins, such as latanoprost, travoprost and bimatoprost reduce IOP by increasing drainage outflow from the eye. Other drop classes reduce the formation of fluid within the eye – such as beta blockers (eg timolol), alpha agonists (eg brimonidine, apraclonidine) and carbonic anhydrase inhibitors (eg dorzolamide, brinzolamide).

The eye drops only work when they are being used – if you stop using them the eye pressure will increase again. Hence it is important to use them every day, otherwise the IOP will fluctuate. There is some evidence to suggest that fluctuations in IOP may be as harmful to the optic nerve as high IOP.

Use the drops at the same time each day to prevent day-to-day fluctuations in 24 hour IOP patterns. Getting into a fixed daily routine generally helps patients to remember to use the drops each day. If, on the occasional day, you are a little late with using the drops, it is better to use the drops late than not at all.

Eye drops used in the treatment of glaucoma typically come in bottles that last approximately 1 month and are then discarded. Preservatives in the solutions are important in preventing bacteria building up in the bottles after opening.

The most common preservative, benzalkonium chloride, is very good at preventing bacterial growth, but can be irritating to the surface of the eye. Hence in recent years some eye drops have been formulated with other, potentially gentler preservatives that seem to be just as effective at preventing bacterial growth. Still other eye drops have been formulated with no preservatives at all – these may be the gentlest form of glaucoma drops and may be suitable for sore, irritated eyes.

The preservative-free eye drops are designed for single usage – they come in very small, clear plastic dispensers designed to be discarded after each drop administration – hence are only ever used on opening, when the solution is still sterile.

On average, the preservatives in bottles of glaucoma medications are designed to safely prevent bacterial growth for 28 days. Hence using the bottle longer than is recommended by the manufacturer can potentially lead to solution degradation, less effective active ingredients and dangerous build-up of bacteria that can lead to infection of the surface of the eye.

Single use containers generally have preservative free medication formulations within them. These are designed to be used once and then immediately discarded. If kept for a period after being opened, bacteria and other harmful micro-organisms could potentially grow in the solutions to dangerous levels. If reused after this period the micro-organisms in the solution could lead to a harmful infection of the surface of the eye.

It is recommended to store eye drops refrigerated before opening the bottle. Once opened, the bottle can be kept at or below 25 degrees (room temperature), ensuring it is out of direct sunlight and not in a hot environment for prolonged periods, to avoid medication degradation.

It is best to refer to the manufacturer consumer product information for the storage requirements of your eye drops. Your pharmacist can also offer further advice on your eye drops once it has been dispensed and how you should store it.  Some eye drops require refrigeration between 2 to 8 degrees Celsius and others require storage in a cool, dry area away from light, heat and humidity. 

If your eye drops have been accidentally left in a hot car or outside of the recommended storage requirements, I would suggest replacing the drops to ensure you receive an adequate and clinically effective dose of the medication.

If drops have not been stored correctly, it can affect the stability and composition of the drops and the efficacy can not be guaranteed by the company. 
 

Like recovering from jet-lag, it is useful to have a period of adjustment for 24-48 hours and then change over to the new time zone for administering medications. For example – daily drops can be administered slightly later one day to get in the new time zone.

At this point in time there is no cure for glaucoma. Fortunately though, for most people with glaucoma, taking the appropriate eye drop medication will preserve their vision and minimise the chance of further losses. This is why early detection, ensuring the medication is taken as prescribed and attending regular follow-up appointments is so important.

At these follow-up appointments the effectiveness of treatment is assessed by taking a reading of the pressure in your eye, examining the health of the eye structures and measuring how well you see from the centre of your vision all the way to the edge of your sight. If you are experiencing problems taking your medication or with their side effects then this should be discussed with your eye-care practitioner as there may be a more suitable medication or treatment option for you.

It is vital to continue to use your prescribed glaucoma eye drops every day. Erratic dosing can contribute to vision loss and may ultimately result in the need for more aggressive glaucoma interventions. In the event that you run out of your eye drops, repeat prescriptions can be obtained from your GP. However, only your ophthalmologist or optometrist is able to assess if the medication is still effective. For this reason regular assessments (as directed) with your eye care professional remain critical in the management of your glaucoma.

If you are not able to see your ophthalmologist before your prescription runs out you may be able to renew your prescription with your optometrist if they are therapeutically endorsed.

Optometrists are also very familiar with glaucoma management and have equipment not available in GP practices to determine if your eye drops are still effective in controlling your glaucoma.

Firstly, it is important that you follow the dosage as prescribed. If one drop has been prescribed there is no need for a second. Two drops will generally not cause your eyes harm, but will mean you run out of drops faster and spend more money on your treatment.

One good tip is to get into the practice of closing your eye and lightly pressing the inside corner of your eye when the drop has gone in. This maximises the absorption of the drop by your eye and stops it from being washed away into your tear duct.

If you take more than one type of drop, you should leave 5 minutes between each type. It is preferable that the drop doesn’t make contact with your skin, but if it does, simply wipe it away.

Immediately contact your eye care professional to inform them. They can provide you with a prescription for an alternative glaucoma eye drop which you can use while waiting for your usual eye drops to be available again. 

Most pharmacists are trained in pharmacy medicines, but some will also know about herbal and homeopathic medicines. 

If you are planning to use any herbal or homeopathic medicines, it is always a good idea to consult your ophthalmologist or the prescribing eye care practitioner who is looking after your eye health as well.

Some things are evidence based, for instance there are studies for Dry Eye that recommend the use of fish oil, but fish oil is not appropriate for everybody because if you are on a blood thinner it can affect the blood thinning medication.

So, you must make sure that any herbal or homeopathic medicines are safe to use with anything else that you are currently prescribed by your doctor or your ophthalmologist.

During COVID-19 lockdowns and restrictions in 2020 and even 2021 shortages occurred for a lot of reasons; ingredient shortages, packaging shortages, lack of people in the factories that make them and manufacture them.

There are a lot of different factors involved so we would suggest always trying to have at least one week's supply left. So, if you know you need to replenish your eye drop in a week, which is why we should mark it on a calendar, make sure you use that week ahead to source another supply so that you've got a fresh bottle ready.

If you've got supply issues, then it gives you a chance to try a few different pharmacies. If they are unable to assist, then you've got time to reach out to your ophthalmologist or GP and they can sometimes prescribe something else. That's obviously not ideal but in the short term if that's the best solution, and they're going to assess that for you, then that might be the best option.

Sometimes your pharmacist might ring the supplier directly and find out how long your eye drops are going to be out of production so you can plan around this and make some alternative arrangements with your prescribing eye care practitioner.

Traditionally all eye drops will usually have some side effects.

One of the most common side effects of most glaucoma eye drops is they can make your eye lashes longer and more prominent. While there have been some cases where glaucoma eye drops have caused changes in eye colour the risk is small, and it occurs after long term use of the eye drops.

Your prescribing health care professional or pharmacist will be able to discuss the risks and the benefits with you. 

Yes, everything that you are taking when you have your flu and/or your COVID vaccination should just be taken as usual.

If you have been on glaucoma eye drops as a regular part of your routine and you've been stable on them for a long time, then yes you can still use your eye drops on the day you get vaccinated. However, if you are starting your glaucoma eye drops it is a good idea to wait until after you've had your flu or COVID shot because, by spacing them out, if there is any reaction, you’ll know which one caused it. 

The good news is your glaucoma drops aren’t going to cause any long-term harm if you accidentally instil two drops on the odd occasion. It's quite easy to do; if you accidentally squeeze the bottle too hard it may release a large drop, or two drops. However, if this happens on a regular basis because you are having difficulty with the bottle, Glaucoma Australia has a variety of eye drop aids that may assist.

Someone who's on glucosamine may have other medical conditions , so any increase in eye pressure could be related to one of these other conditions. It is a good idea to discuss this with your ophthalmologist or GP.

To provide the preservative free version, the pharmacist would need to check first with the prescriber. Usually this process would occur to respect the prescribing practitioner and check any reasonings. 
 

This will depend on the discretion of the pharmacist and the patient’s medication history.  If they are likely to be stable and waiting to see their prescriber, the pharmacist may provide them with a single supply. Due to legislative requirements, there may be restrictions on the supply of particular glaucoma medicines. 

This will depend on the discretion of the pharmacist and the patient’s individual circumstances. The pharmacist would need to contact the prescriber to request for the old drop as this change would need to be documented unless there was a letter indicating that this could be actioned. It would be useful for the prescribing practitioner to know if a reaction had occurred also.

Total area in which objects can be seen whilst maintaining focus straight ahead or at a central point. 
The normal human visual field in each eye extends approximately 60 degrees towards the nose, 100 degrees outwards, 60 degrees upwards and 75 degrees downwards.

• A visual field test evaluates vision loss due to glaucoma and other conditions affecting the optic nerves and brain, by measuring your ability to see small points of light in your central and peripheral vision.
• It is a test to detect how well you can see throughout visual space whilst maintaining focus on one point.  
• Visual field testing is a crucial part in the diagnosis and treatment of all glaucomas and many neurological diseases.

• Loss of visual field due to glaucoma.
• Areas of vision loss that cannot be detected are called scotomas. A visual field test is able to map out the scotomas. 
• Glaucomatous visual field loss usually starts in the periphery, and the test can pick up changes over time if your glaucoma is worsening. 

• Vision loss from glaucoma usually starts in the periphery (side vision). The loss of sight is usually gradual and a considerable amount of peripheral vision may be lost before someone with glaucoma is aware of any problem. A visual field test is the only way to detect early signs of peripheral vision loss. 
• It provides vital information for diagnosis and then continues to affect how your eye care practitioner manages the glaucoma. 
•  It is also used to determine the severity of the glaucoma and is the most sensitive way to check if the glaucoma is getting worse, which is why visual field tests are repeated periodically.
• Visual field testing is performed one eye at a time (monocularly) as visual field loss may not be detected with both eyes open (binocularly).
• Visual field testing is a very useful measure and helps determine whether your current treatment is sufficient or if treatment(s) may need to be altered.
• They are critical for establishing baseline results and monitoring glaucoma progression over time.

• The visual field test can be done binocularly (both eyes tested at the same time) or monocularly (one eye at a time). For glaucoma, your eyes will be tested one at a time.
• A field test typically takes between 5-10 minutes per eye, and it is helpful if you are calm and alert when doing the test to achieve a reliable result. 
• First, one eye will be covered with a patch. Make sure to let the technician know if you feel the eye is not completely covered. 
• You will be set up on the machine - Your back, arms, feet and legs should be supported; your chin should be firmly on the chin-rest and your forehead gently against the brow-band to produce an accurate test reading.  Remember to breathe normally.
• Remember to blink normally. This will prevent your eyes from drying out and watering. Each point is tested more than once - You will not miss any points or flashing lights while blinking.
• Firstly, keep your eye fixed on the central point target straight ahead of you – the machine will locate your eyes so that it can monitor any movement of your eyes throughout the test.  
• Once the test starts, you will notice lights flashing in the machine. These lights will appear one at a time. Some will be bright and some will be dull. 
• Try your best not to search for the lights, but keep looking at the central target.
• Don’t worry if time seems to be passing without a light appearing. There are parts where it is normal not to see the lights – such as your blind spot. 
• Press the button when you think you see the light. Respond to all lights – they can be fuzzy, dim, or bright – it doesn’t matter as long as you know they are there.

• If you are doing the test for the first time, ask the technician to take you through a practice session before you begin the test itself.
• The technician should monitor your progress intermittently throughout the test, and give you feedback on how well you’re doing.
• The eye care professional will choose the most appropriate test and strategy for you but the technician is responsible for setting up the equipment so you are comfortable and to explain what you need to do. 
• Do not hesitate to ask for anything that makes you more comfortable (e.g. a cushion for your back, a tissue to dab your eyes if needed, or to raise or lower the chair or equipment) as this will assist you to concentrate and to do your best. 
• Make sure you completely understand what you need to do, and ask repeatedly for a clearer explanation, if required.
• Important to note: Some people find this tiring and you can have days when you perform well on the test and not so well on other days. As a result you may need multiple tests to obtain an accurate measurement of any vision loss.
• Remember you are in charge of the machine – not the other way around! You can pause the test whenever you wish by holding down the button on the buzzer- when you are ready to resume, focus back onto the central target first, and then release the buzzer. The test will automatically continue from where it left off.
• It is very important to not look around during the test. Looking around will give inaccurate results and can also make your test longer. 

Optical Coherence Tomography (OCT) Testing, is part of a series of tests that we ask persons with glaucoma or glaucoma suspects to undertake. OCT scans are used in conjunction with a patient's clinical history, eye examination and visual field testing. All these investigations are used to determine if someone has glaucoma or if their glaucoma is progressing. OCT scans measure the retinal nerve fibres that travel in the optic nerve.

Ultimately glaucoma is a condition of the optic nerve, where individual nerve fibres are lost over many months, years or decades. Measuring the nerve fibre layer thickness is therefore very important in the assessment of glaucoma. 

An infrared light is sent through the pupil and to the back of the eye. Reflections of this infrared light are captured by the OCT. These reflections produce a beautiful 2D image of the back of the eye. OCT gives us high resolution images of the microscopic layers of the retina. We can measure the thickness of these layers.
 
OCT is very safe for the eye. In fact, there have been millions of OCT scans performed all around the world, without any evidence of damage to the eye.

Glaucoma is a disease of the optic nerve. It's a condition where the nerve fibres within the optic nerve are destroyed over time. The optic nerve is like a cable that runs  from the eye to the brain, and is filled with nerve fibres. We have  around a million of them when we're babies and slowly lose some as we age. Glaucoma patients lose them much more quickly.

Light goes through the cornea, which is the front window of the eye, through the pupil and to the retina. The retina is the inner lining of the eye and acts like the film of the eye. The retina captures the image, changes light from the image to electricity and sends the image to the brain via the optic nerve. The optic nerve is a  cable of nerve fibres sends information from eye to brain.

In glaucoma, you slowly lose the nerve fibres in the optic nerve. Typically you lose them over years and decades rather than months and weeks. The pattern of vision loss begins with peripheral or edge vision first. It only involves the central vision very late. Sometimes it's too late. This is why visual field testing and OCT Testing is so important - your eyecare professional can pick up progression of your glaucoma before it is too advanced.

OCT Testing gives us a picture of the back of the eye via a coloured thickness map. The head of the optic nerve appears as a grey spot in the centre, while colours such as blue, red and yellow give us an idea about the thickness of the tissues surrounding the optic nerve.

Red and yellow are indicative of thicker tissue, blue and white illustrate thinner tissue. Red and yellow tissue is the point of maximum concentration of nerve fibres (the nerve fibres concentrate at the top and bottom of the nerve).

An OCT scan in a person without glaucoma may show a lot of red and yellow colour at the top and bottom of the optic nerve head.
An OCT scan in a person with glaucoma will show very little amounts of red and yellow colour indicating thinning of the tissue.

We need to lose 50%  or more of our nerve fibres before we see loss of vision. 

If we take many OCT tests over time, we can measure very small changes in the nerve fibre layer thickness over time. This can be quite accurate as the OCT has very little measurement variability. This is why the OCT is so powerful.
The OCT can tell us that your glaucoma is progressing, often times before you see changes in your vision on the visual field test. 

Many OCT scans over time can be a powerful indicator of change. If a person has one test less than once per year  we are unlikely to pick up change quick enough. The more OCT scans, the quicker and more precisely we can pick up true change from glaucoma progression.

Some studies have told us that in about 40% of patients, OCT can tell us four years ahead of time that your glaucoma is worsening, and in about 20% of people it can tell us eight years ahead of time. That is a substantial lead time for your doctors to do things to help stabilise your glaucoma.

OCT Testing every six months or so is how we get a real handle on how your glaucoma is progressing. Generally most people do an OCT once a year and that's okay, however, if you do have more frequent scans  you can get an even quicker indication of how the damage is progressing.

Studies have shown eye drops or SLT laser can be effective in lowering eye pressure in the treatment of glaucoma. However a doctor may prefer initial treatment with drops or SLT laser based on factors such as patient lifestyle, pre-existing eye problems or disease, type of glaucoma, the severity of glaucoma and initial untreated intraocular pressure. In some instances the eye specialist may recommend both treatments (eye drops and SLT) be started simultaneously. Discussing these two treatment options with your doctor will help you decide which one to choose.

SLT laser is generally a very safe treatment. The risk of permanent harm to the eye is extremely rare or possibly even non-existent. There may be a very rare risk of the eye pressure rising for a prolonged period after SLT in patients with pigmentary glaucoma. If this occurs surgery may be required to lower the eye pressure. Significant but rare and reversible complications from SLT which can reduce vision for a time but not permanently include inflammation of the eye, bleeding into the front of the eye, swelling of the retina and clouding of the cornea. With time these complications resolve and vision returns to normal. Occasionally glasses may need to be adjusted to bring vision back to normal. 

Thankfully SLT is generally not a painful procedure. Many patients report “feeling” the procedure as it is occurring but wouldn’t describe it as painful. In the rare instance that it does feel painful the doctor can help by reducing the power of the laser treatment during the treatment process.

Sensitivity to light, blurry vision, eye redness and a gritty sensation are all normal after SLT treatment. These symptoms are usually mild and resolve over 2-3 days.

Many doctors don’t routinely prescribe eye drops after SLT laser. However there may be instances related to a patients previous eye history or health or lifestyle demands where use of eye drops after SLT is recommended by the doctor. Generally the eye drops would only need to be used for one week after SLT.

Yes, lubricating eye drops can often help the eyes feel more comfortable after treatment.

Yes, in fact most doctors will routinely treat both eyes with SLT on the same day.

SLT can be repeated indefinitely every 12 to 24 months. The treatment may be performed as a one or two-stage procedure depending on whether your doctor treats 360 degrees or 180 degrees (50% of the drainage channels) at a time. In this situation the other half of the eye(s) maybe treated only a few weeks later. Treatment intervals will vary depending on patient eye pressure and whether the glaucoma is stable. Effects of third SLT have been studied and proven to be effective, but the procedure may become less effective over time, with the decision to repeat or not dependent on response at an individual level. SLT can be effective for up to 5 years in some patients without need for more treatment. 

Some types of glaucoma are not suitable for SLT. In rare instances if you have pre-existing eye disease such as corneal disease or a history of uveitis (eye inflammation) SLT may not be suitable. 
 
Selective Laser Trabeculoplasty is considered a safe and effective procedure with few risks. While glaucoma treatments cannot restore vision already lost from glaucoma, early detection and treatment of glaucoma offers the best chance of preserving your vision.

Keeping your weight down and being physically fit helps prevent health problems such as heart attacks and diabetes, and is important for overall well-being. How pleasant to know, therefore, that these same measures also help protect you from glaucoma.

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.

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.

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.

No specific foods are particularly good or bad for glaucoma treatment. Because optic nerve 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!

There is no scientific evidence that any particular diet has a helpful (or unhelpful) effect on glaucoma and available evidence does not show a benefit of herb, vitamin and mineral supplements. Your eye health professional will recommend the best way to manage your glaucoma.

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.

340mg of caffeine is considered high in glaucoma management which is approximately 2-3 cups. However even 1 cup of coffee can increase eye pressure by 1mmHg. Brewed coffee has approximately 150mg caffeine so if you are getting coffee from a barista, we recommend reducing the number of cups you order each day. Tea has a lot less caffeine if you are looking for an alternative, you can replace your intake with 1-2 cups of tea instead.

Drinking coffee or other caffeinated drinks can raise your eye pressure for about two hours. Caffeine is thought to increase the production of fluid (aqueous) within the eye. This short-term increase does not cause any problem for most people, but those with a strong family history or advanced glaucoma should consider reducing their caffeine intake if it exceeds the equivalent of 3-5 cups of coffee per day. De-caffeinated drinks may be considered as a safer option.

You can read more about managing lifestyle, diet, and exercise with glaucoma here

Well yes, and no. People with glaucoma may have increased eye pressure when doing head-down positions during yoga, such as downward dog. Advise will vary between individuals depending on your general eye health, how well controlled your glaucoma is, and also your individual management and treatment plan. 

If you're thinking of starting yoga or Pilates, please consult your eye care health professional on how this may impact your glaucoma.

You can read more about managing lifestyle, diet, and exercise with glaucoma here

This depends on the amount of vision loss your glaucoma has caused. Whilst licensing requirements vary between states, fitness to drive for a private car licence may require a best corrected visual acuity of 6/12 or better, with both eyes open. In addition there may need 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 is not met, a restricted licence may still be possible. Your eye health professional can advise you.

Glare and halos at night can be from a variety of reasons and may not be related to your glaucoma at all. Other causes could be due to cataract (cloudy lens) or an unstable tear film from having dry irritated eyes. Rarely halos around lights could be due to high pressure in the eye. All of these conditions are best discussed with your treating Ophthalmologist.

Fitness to drive for a private car licence usually requires a best corrected visual acuity of 6/12 or better with both eyes open. Visual acuity is a measure of central vision- the ability to distinguish details and the shape of objects.

In addition there usually needs to be at least 120 degrees of visual field free of glaucoma defects with at least 10 degrees free above the horizon. This is tested with a special visual field test called an Esterman Visual Field which again is undertaken with both eyes open. If either of these criteria is not met, a restricted licence may still be possible after further assessment. Consult your ophthalmologist or optometrist for advice.

The restrictions of licences for larger vehicles and commercial vehicles are generally more stringent. These standards are available via the motor licencing authorities in each State and Territory.

To drive a private car you only need one eye to drive! You must not drive within three months of an acute loss if vision. Provided you meet the requirements as outlined by the motor licensing authorities, you may still drive.

You are obliged to tell the motor licensing authorities if you have an eye condition limiting your vision. You will be given an assessment form that will need to be filled out either by an optometrist or ophthalmologist declaring your suitability to drive.

There are a new generation of spectacle lenses that can help reduce glare for night driving and address problems of depth perception and visual acuity. New products become available all the time so it is best to discuss options with your optometrist.

The Esterman test is best performed wearing your usual driving glasses. If you do not wear glasses to drive then that is how the test should be performed.

Glaucoma Australia continues to advocate for fair, safe and clear driving standards for people with glaucoma. Holding a drivers licence in Australia does not require a specific Esterman Efficiency Score to be achieved.

A number of factors need to be considered by your eye-care practitioner and general practitioner to determine if the status or conditions of your licence should be amended. Your optometrist or ophthalmologist can provide you with the details of any changes you may need to make or start planning for in your driving habits.

Current treatment for glaucoma aims to lower intraocular pressure. This is achieved through medications (drops and oral medication), laser and surgery. Outside of these, the treatment is considered “alternative”.

While there may be no direct harm in these alternative treatments, they are generally not evidence based.
Firstly, there is usually no scientific evidence to support alternative treatments for glaucoma or the evidence may be limited to laboratory setting or animal models only.

Secondly, the supply of these treatments may be from an overseas supplier via the internet. In this situation there is no guarantee as to the quality of the medication or the exact ingredients.

Thirdly, there may be significant financial cost to these treatments which may be of no benefit to you.

Glaucoma can cause permanent vision loss without proper follow up and treatment. It is advisable that if you are thinking about starting alternative treatments that you discuss this with your treating ophthalmologist first. In all cases, it will be important that you continue with accepted and evidence-based therapies that have been previously recommended.

There is no scientific evidence that coconut water alleviates glaucoma.
Glaucoma is a chronic and incurable disease and there is no simple cure. However there are a number of proven, effective medical treatments that can slow the process down, help control it and there is long-term validated data available on this, which forms the basis for what can be offered to patients with this condition.

Coconut water should not be used as an alternative to conventional treatments. When treating glaucoma we aim to lower the pressure over the 24 hour cycle, so a treatment that only lasts a few hours would be largely ineffective. It is important for patients to be monitored under the supervision of a medically trained eye specialist to minimise the chance of blindness. It is worth discussing with your treating doctor all medications you are taking, including natural remedies and supplements, as this could have an impact on the condition and its treatment.

Generally any lowering of intraocular pressure achieved via dietary modification or exercise would be fairly minor. If patients have significantly elevated eye pressure then medical therapy (eye drops), or in some cases surgery, is the only proven way to treat this effectively. It is worth discussing with your treating specialist about any alternative approaches or interventions you are considering, to see how this might tie in with your glaucoma treatment. Some milder cases of glaucoma can be monitored without treatment for a period of time. It is important to have regular ongoing follow-up to monitor optic nerve changes and any visual field loss – irrespective of how it is being treated.

Supplementary medicines are not as effective as conventional glaucoma treatment and should not be used as an alternative. Beware of miracle cures or a ‘quick fix’ peddled over the Internet.

Discuss any dietary supplements with your specialist - there is no reason healthy dietary supplements and lifestyle changes can’t be adopted alongside conventional glaucoma treatments.

Glaucoma is a complex, incompletely understood and ultimately incurable condition but there are many beneficial treatments available to help patients retain their sight and quality of life.

When we look at whether glaucoma treatments are “working” we are mainly seeing that they have lowered the pressure from what it was when first diagnosed but we are also looking at the rate of deterioration of the optic nerve and visual field – ultimately what the treatments seek to do is slow down any deterioration of the optic nerve so that the affected individual does not go blind in their lifetime. 

While the exact cause of glaucoma remains unknown there is a lot of research examining the processes by which the optic nerve is affected in this group of conditions. There is no evidence that a hormone imbalance causes glaucoma, and the role of intraocular pressure level as the main modifiable risk factor in most forms of glaucoma is well established.

Equally, well established is the role of lowering intraocular pressure to treat glaucoma - of all forms and at all stages of the disease. Healthy eating, good nutrition and a balanced lifestyle may well have a role to play alongside mainstream treatments but do not replace them.

Dry eye is a common problem affecting between 5% and 35% (up to 50% in DEWS II) of the population. It is a complex condition with multiple factors that contribute to an unstable and imbalanced tear film. The resulting tear composition is no longer able to adequately lubricate and protect the surface of the eye which leads to irritation and inflammation.

Broadly speaking, the two major causes of dry eye are insufficient tear production and excess evaporation of tears.  Commonly, these two factors exist together.  Both of these are associated with ageing but also with medical conditions of the body or eye, environmental factors and medications.

Dry eye is a complex condition and can have a wide range of symptoms. Commonly, patients report irritation in the form of itching or burning, foreign body sensation, the perceived need for increased blinking or eye rubbing.

Paradoxically, the eyes can also become watery as a reflex response to irritation.  Sometimes, the vision may be affected or fluctuate. These symptoms overlap with many other eye conditions and should be investigated by your eye health practitioner.

The recommended treatment for dry eye will depend on the cause identified by your eye health practitioner.  It may involve a combination of changes to your environment, lifestyle, diet, eye drops or medications.  Home-based therapies may be recommended, and in more severe cases, surgery, contact lenses or in-office procedures many also be an option.

There are many contributing factors to both dry eye and glaucoma. One significant common factor is that the risk of both conditions increases as we age. As such, it is not unexpected that many people with glaucoma also experience dry eyes.  

There are also some medical and surgical treatments for glaucoma that may have side-effects that contribute to dry eye or mimic dry eye.  If you are concerned about any change to your eyes, you should discuss this with your eye health practitioner.

If you are experiencing symptoms of dry eye then it is best you consult with your eye health practitioner. It is important to not change your glaucoma management without first consulting your optometrist or ophthalmologist. They will work with you to find the best treatment for your lifestyle and with the most acceptable side effect profile.

Dry eye can be exacerbated by preservatives that are present in some glaucoma medications. Also, some glaucoma medications can cause symptoms similar to dry eye, or exacerbate pre-existing dry eye. These symptoms should be discussed with your eye care practitioner so that they can work with you to find the most appropriate glaucoma management and medication options for you. It is important to not to change your treatment without first consulting your optometrist or ophthalmologist.

Both dry eye and glaucoma are chronic conditions requiring life-long management. The most effective treatment for both may change over time with your needs and as the conditions evolve. Dry eye and glaucoma have a range of treatment options that can be explored with your eye health practitioner to find the right combination for you.

Connect with a Dry Eye Clinic near you, visit dryeyedirectory.com

The current recommendation for Vitamin B3 dosage is to follow the instructions on the label for the products. You can buy any brand of the Vitamin B3 supplement. Your pharmacist will be able to help you find the right product.

The strength used in the clinical trials for Vitamin B3 is 3000mg. Please note this is a high dose strength and only to be taken under the instructions and supervision of a qualified health professional. For those who are not participating in the clinical trial, it is recommended to take the dose on the packaging of the products, unless and until advised to increase the dose by your GP or ophthalmologist.

The most common side effects seen with nicotinamide (NAM) when used in high doses is gastrointestinal upset/nausea (CERA's first study concurs with this) – this is usually helped by taking nicotinamide with food. NAM has been safely used at high doses for over 70 years for a range of conditions, including a 5 year clinical trial of high dose NAM in diabetes with no difference in adverse events between those taking placebo or NAM.

As to the theoretical risks, they are indeed theoretical at this point, all studies to now have been inconclusive. However, the reason for our current clinical trials is to thoroughly assess the safety and we have numerous checks and studies as part of this trial to understand whether there are undiscovered risks involved.

There are some studies to suggest that NAD (nicotinamide adenine dinucleotide) which is what nicotinamide is boosting levels of, may have some positive effects on the heart. However, we don’t have good clinical evidence for it yet.

There are many supplements on the market that are marketed for a range of eye conditions that may not have any or sufficient scientific evidence to back their claims. Lutein and Zeaxanthin have been studied for age-related macular degeneration. There have been some studies that show that such compounds might be beneficial in glaucoma but there is no definitive clinical evidence.

Whilst there is evidence that nicotinamide is preventative in the lab-based models of glaucoma, we simply don’t know what effect it has for people.

This is partly because a clinical trial on preventing glaucoma with nicotinamide is a huge project that would have to run over decades and would be very difficult to resource. There have been some epidemiology studies to look at the link between diet and exercise including the following: 

NCBI - Lifestyle, Nutrition and Glaucoma

 and 

NCBI - Healthy Lifestyle Score and Incidence of Glaucoma: The Sun Project

There were people with pseudoexfoliative glaucoma in the first study though not enough for us to definitively say whether NAM is beneficial for people with pseudoexfoliative glaucoma specifically. We are trying to answer this question in this current trial, we are actively recruiting people with pseudoexfoliative glaucoma in Australia and have partnered with collaborators in Sweden for this purpose where ~50% of their glaucoma population have pseudoexfoliative glaucoma.

The best way is to join the CERA trial registry, which will allow CERA researchers to contact you if there is a trail you might be suitable for. Alternatively, you can ask your eye care practitioner to share your information though CERA’s refer a patient registry.

• Ophthalmologist / Eye specialist: Your ophthalmologist is a medical specialist, who specialises in the medical and surgical management of eye diseases. Also known as an eye doctor or eye surgeon, they provide diagnostic, treatment and preventative medical services related to conditions such as glaucoma. It is very important for glaucoma patients to have an ophthalmologist involved in their care to ensure they are under the correct treatment plan to manage their glaucoma. The ophthalmologist is the only person able to perform laser or surgery for glaucoma. Glaucoma patients have the option of seeing a general ophthalmologist or a glaucoma specialist who has received additional subspecialty training in managing complex glaucoma. A general ophthalmologist is fully equipped and qualified to treat and manage glaucoma, but may refer patients to a glaucoma specialist if needed.  
• Optometrist: Optometrists are health care professionals who provide comprehensive primary eye care. They assess, diagnose and can co-manage a range of ocular diseases. Usually, they are the first person to detect possible glaucoma and will then refer to an ophthalmologist to confirm the diagnosis and initiate treatment if necessary. When it is in the patients best interests, a therapeutically endorsed optometrist can make an initial diagnosis and start treatment prior to referring to an ophthalmologist.  
• Pharmacist: The experts in understanding medications - the pharmacological effects of drugs, drug uses, therapeutic roles, side effects, potential drug interactions, and monitoring parameters. Your pharmacist plays an important role in helping you understand and choose the correct medications, supplements and products to ensure you can safely treat all your health conditions including glaucoma.  
• General Practitioner/ GP/ family doctor: usually the first person you go to if you have a health issue. They have broad knowledge and the skills to treat most general health issues you might have throughout life. Like an optometrist, your GP can also provide you with a referral to see an ophthalmologist  and renew your prescription for glaucoma eye drops.  Unlike optometrists or ophthalmologists, most GPs do not have the equipment necessary to perform a comprehensive eye examination. 

You will need to get a referral to see an eye specialist. A referral will allow you to claim benefits from Medicare for the consultation and some of the tests done on the day. Referrals can be obtained from your optometrist, GP or a current specialist. Please note that referrals expire. We would advise you to discuss the possibility of obtaining an indefinite referral.  
 

People with glaucoma, suspected glaucoma and those with high eye pressures need lifelong monitoring.  Shared care models are an effective option for ongoing care in cases of stable glaucoma and those at low risk of vision loss.  Shared care plans generally involve optometrists and general practitioners working in collaboration with ophthalmologists.  

A person who fits the criteria may choose to have both their optometrist and their eye specialist involved in the management of their glaucoma. Together with your ophthalmologist, your optometrist can help with ongoing monitoring of your glaucoma and general eye health. Apart from addressing your vision needs, refraction, optometrists are also generally well equipped with the skills and resources needed for glaucoma monitoring, and also for urgent appointments when your ophthalmologist is not available. In an effort to provide high quality care, examination findings and treatment decisions will be communicated to all practitioners involved in the agreed shared care arrangement.  

Speak to your ophthalmologist about a shared care plan with your optometrist. 

As glaucoma is a lifelong condition requiring ongoing follow up appointments, the cost associated with consultations, tests and treatment over the years can add up. In Australia, Medicare does cover a significant proportion of the costs in private  ophthalmology clinics. In the public eye clinics, this cost can be fully covered. 
 
Things to consider when looking into public eye care is the wait time involved in getting an initial appointment (which at times can be up to a year, depending on individual cases), and not being able to choose your specific ophthalmologist to look after you. If you are considering getting your glaucoma managed in the public hospital, a report on your behalf will need to be sent to your public eye clinic by your optometrist, GP or current ophthalmologist. 

It is important to have your optometrist monitor your glaucoma while you wait for your appointment at the public eye clinic. 

Being diagnosed with and monitored for glaucoma requires ongoing appointments with your ophthalmologist. Appointment frequency can range from monthly to bi-annually. Each patient and their glaucoma are different, and time spent at the clinic can be hours at a time depending on the tests you are doing on the day. Additionally, you may not always be able to drive after your consultation and may need to rely on a friend or a family member for transport. You may therefore wish to be seen at a local eye clinic for convenience. 

You can find an ophthalmologist near you via our Find a Health Professional directory.  

All ophthalmologists are able to diagnose, treat and manage your glaucoma. A glaucoma specialist however, has received additional subspecialty training in performing glaucoma surgery and managing complicated glaucoma cases. Your general ophthalmologist will refer you to a glaucoma specialist if more complex interventions are required. 
 

Recommendations can come from health care professionals referring you (your GP, optometrist or your current ophthalmologist), as well as family or friends who have been under the care of the ophthalmologist.  

The Glaucoma Australia Support Group is a safe and supportive online group with over 1000 members who can offer valuable feedback and recommendations for ophthalmologists. Follow the below links to our Facebook support groups:  

• Glaucoma Australia Support Group 
• Congenital Glaucoma Support Group 

Whether an eye specialist is the “best eye specialist” for you also depends on the rapport and trust you build during your appointments. It often helps to write out your questions before going into your appointments; it is very easy to forget what you initially wanted to ask especially after you receive new information to process about your diagnosis and results. Staff at your eye clinic often have busy and stressful days and can often run short of time to spend extra time with you to answer questions. We always encourage patients to ask questions so that they can understand more about their glaucoma. . 

It is ok to seek a second opinion. You may be wanting to explore a different treatment option that your current ophthalmologist may not offer, or you may need the opinion of another expert for reassurance. Patients often consider a second opinion for various reasons, including to have confidence in their management plan and for emotional well-being. A referral is needed to seek a second opinion from an ophthalmologist you have not seen before. This can be obtained from your current ophthalmologist, your optometrist or your GP. 

It always helps for your new ophthalmologist to have a copy of your past medical records. This is because future treatment and management plans can depend on how your glaucoma has progressed over the years and how you have responded to past treatments.  For this reason, we encourage that you have an open conversation with your current ophthalmologist about your reasons for seeking a second opinion. At times, your previous and new ophthalmologists can work together on your glaucoma management to ensure the best outcome for you. Your permission will be needed to release your medical notes from any previous eye clinic you have been to, so please discuss this at the time of making your appointment. 

Please be aware that if you see a specialist for a second opinion regarding glaucoma and they do not have background information then tests such as OCT and visual field are going to need to be repeated.