- Is it safe to have the COVID-19 vaccination if I have glaucoma?Show lessShow more
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.
- How do I know if I am eligible for the vaccine?Show lessShow more
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.
- When I find out I'm eligible, how will I be able to get the vaccine?Show lessShow more
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.
- What can I expect if I opt to get my vaccination at a pharmacy?Show lessShow more
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.
- On the day of the COVID vaccine, is it still safe to use your glaucoma eye drops or other medications?Show lessShow more
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.
- And what about steroid eye drops?Show lessShow more
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.
- If you are pregnant or breastfeeding and also have glaucoma, is the COVID-19 vaccine safe?Show lessShow more
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.
- Can the vaccine increase glaucoma?Show lessShow more
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.
- During the clinical trials for COVID vaccine did they test for side effects to the eyes?Show lessShow more
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.
- How is my personal vaccination data handled?Show lessShow more
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.
- Am I at risk of developing glaucoma?Show lessShow more
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
- There’s glaucoma in my family – what does this mean for me?Show lessShow more
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.
- How often should I be checked for glaucoma?Show lessShow more
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.
- How do I find a glaucoma eye specialist?Show lessShow more
Click here find an ophthalmologist (eye specialist) near you.
- I’ve just been diagnosed, what now?Show lessShow more
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.
- I was told to use my eye drops every day and to make sure I did it at the same time each day. Why is that important?Show lessShow more
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.
- Is glaucoma related to my blood pressure?Show lessShow more
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.
- If glaucoma can’t be cured then why do I need treatment?Show lessShow more
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.
- Will I lose my licence because I have glaucoma?Show lessShow more
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:
- My doctor has recommend treatment/surgery for me? Will it restore my vision?Show lessShow more
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.
- What is high eye pressure and why does it cause damage?Show lessShow more
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.
- I have increased eye pressure, does that mean I have glaucoma?Show lessShow more
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.
- Will I develop glaucoma if I have increased eye pressure (ocular hypertension)?Show lessShow more
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.
- Can you have glaucoma without high eye pressure?Show lessShow more
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.
- My doctor never tells me what my eye pressure is, saying she is “satisfied”. Should I know my pressure?Show lessShow more
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.
- I have high eye pressure and I heard that my sleeping position may have an effect on it. Does it matter whether I lie flat or have a high pillow?Show lessShow more
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.
- What do my eye drops actually do?Show lessShow more
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).
- I was told to use my eye drops every day and to make sure I did it at the same time each day. Why is that important?Show lessShow more
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.
- Why are there different preservatives in my eye drops and in some cases none at all?Show lessShow more
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.
- The information says to discard my eye drop bottle 28 days after opening. I always have some left, why can’t I keep using it until it is empty?Show lessShow more
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.
- I use a product that comes in single use containers. Do I have to throw it out after one use if it holds more than I need for the day?Show lessShow more
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.
- Do I need to keep my drops cool?Show lessShow more
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.
- When travelling overseas or in a different time zone when should I take my eye drops? Should I adjust my treatment regimen to the new time zone?Show lessShow more
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.
- I don't think my drops are making my vision any better.Show lessShow more
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.
- Is it OK for my GP to renew my glaucoma eye drop prescription?Show lessShow more
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.
- Can I instil 2 drops to make sure it goes in?Show lessShow more
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.
- What is ‘field of vision’?Show lessShow more
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.
- What is a Visual Field Test?Show lessShow more
- 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.
- What does a Visual Field Test look for?Show lessShow more
- 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.
- Why is it important to have a Visual Field Test?Show lessShow more
- 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.
- What can I expect at a Visual Field Test?Show lessShow more
- 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.
- What else do I need to be aware of?Show lessShow more
- 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.
- What is OCT Testing?Show lessShow more
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.
- How does OCT work?Show lessShow more
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.
- Why is OCT testing important in glaucoma?Show lessShow more
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.
- What do you look for in an OCT when testing for glaucoma?Show lessShow more
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.
- Why is OCT testing just as Important as Visual Field Testing?Show lessShow more
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.
- Why do I need to do so many OCTs? I have to do one almost every time I go to my doctor. Isn't it just telling us the same thing?Show lessShow more
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.
- Why do some doctors start treatment with eye drops and others with SLT laser? How do I decide the best option for me?Show lessShow more
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.
- Can SLT laser harm my eyes?Show lessShow more
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.
- I am scared to have the laser treatment done. Is it painful?Show lessShow more
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.
- What symptoms are considered normal after the SLT laser? Is it normal for my eyes to feel gritty and look red?Show lessShow more
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.
- My friend had some eye drops to use for a few days after the laser - some antibiotics and anti-inflammatory. But my doctor did not recommend any eye drops post laser. Why would that be the case?Show lessShow more
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.
- Can I use lubricating eye drops to help with post laser symptoms such as irritated and dry eyes?Show lessShow more
Yes, lubricating eye drops can often help the eyes feel more comfortable after treatment.
- Can I have SLT laser in both eyes on the same day?Show lessShow more
Yes, in fact most doctors will routinely treat both eyes with SLT on the same day.
- How often or how many times can SLT laser be repeated?Show lessShow more
SLT can be repeated indefinitely every 12 to 24 months. The treatment interval maybe more frequent initially if the doctor treats only one half or 50% of the eye. 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. SLT can be effective for up to 5 years in some patients without need for more treatment.
- Why would SLT laser not be suitable for me?Show lessShow more
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.
- Can I (or should I) do physical activity?Show lessShow more
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.
- Is sex safe for people with glaucoma?Show lessShow more
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.
- I have glaucoma, is it okay to fly in an aeroplane?Show lessShow more
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.
- Is there anything I can eat to help with my glaucoma?Show lessShow more
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!
- Instead of conventional treatment, will any specific diet or complimentary medicine help my glaucoma?Show lessShow more
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.
- Can I continue to do weight lifting?Show lessShow more
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.
- What is the maximum amount of caffeine I can consume daily?Show lessShow more
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
- Is it safe to do yoga and Pilates if I have glaucoma?Show lessShow more
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
- Will I lose my licence because I have glaucoma?Show lessShow more
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.
- I have glaucoma and when driving at night I get halos around the street lights, especially when it is raining. Why does that happen and can I do anything about it?Show lessShow more
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.
- I have to renew my licence soon and I have to have an eye test- what tests are done?Show lessShow more
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.
- I have lost all vision in one eye, because of glaucoma. Will I still pass an eye test for driving as my good eye has perfect vision?Show lessShow more
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.
- What do I need to tell the motor registry if I am diagnosed with glaucoma or any other eye condition?Show lessShow more
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.
- Can I get glasses with specific driving lenses to help me refocus with near/far vision, reduce glare and/or see better in low light?Show lessShow more
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.
- Should I wear my glasses for an Esterman visual field test?Show lessShow more
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.
- What Esterman Efficiency Score do I need to keep my driving licence?Show lessShow more
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.
- Can coconut water alleviate glaucoma?Show lessShow more
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.
- I have read about dietary changes and exercise that can lower eye pressure naturally without taking medications. Why take eye drops that are artificial chemicals?Show lessShow more
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.
- I am always looking for a “natural” way to control my eye pressure. Is there one?Show lessShow more
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.
- I have heard that diet and vitamins could help my glaucoma. Is that correct?Show lessShow more
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.
- Are the current glaucoma treatments working?Show lessShow more
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.
- I have read that glaucoma is the result of a hormone imbalance. Can it be cured by healthy eating and antioxidants?Show lessShow more
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.
- What is dry eye?Show lessShow more
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.
- What causes dry eye?Show lessShow more
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.
- What are the symptoms of dry eye?Show lessShow more
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.
- How is dry eye treated?Show lessShow more
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.
- Why does dry eye commonly affect people with glaucoma?Show lessShow more
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.
- What should people with glaucoma do if they suspect they have dry eye?Show lessShow more
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.
- What do people with glaucoma need to be conscious of if they have dry eye?Show lessShow more
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.
- What can people with glaucoma do to alleviate dry eye?Show lessShow more
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