Can medications influence the results of a regular eye exam?
A: This is question merits a complicated response because what to do depends on the purpose of the examination. The only medications, which could influence the result of an examination, are anti-glaucoma medications. Whether or not to discontinue the medications on the morning of the examination depends on the purpose of the examination. When I see a patient for the first time, it is important that the patient be taking the medications that have been previously prescribed. This is the only way that I can tell whether or not the pressure is controlled on the medications that the patient is taking.
If the patient does not take his or her medications on the morning of the first visit, before I can make any decision about the adequacy of control, I need to see the patient back a second time on the medications. Also, the patient should take the medications at the time that they are normally taken. For instance, if a patient normally gets up at 9:00 a.m. (some people do although perhaps not that many in New York) but the patient has an 8:00 a.m. appointment for an initial consultation, that patient should not take medications at 7:00 a.m. because it will not give me a picture of what is going on in the patient's day to day situation.
If a patient is referred to me because of progressive visual field loss despite apparent control on medications, I may have that patient come in early in the morning (i.e., at 7:00 a.m.) before patient normally takes his or her medication so that I can see what the pressure is on awakening in the morning. The patient then takes the drops in the office after the initial pressure an hour and a half later.
In general, we try to check the pressures under circumstances which mimic as closely as possible the patient's day to day life style so as not to introduce artifacts created by office appointment environment. There is an exception this rule, and that is a patient taking pilocarpine who has come for a visual field. If there is any question about the adequacy of a patient's pressure control, I will have the patient take the pilocarpine on the morning of the examination and check the pressure prior to dilating the pupils for the visual field. If, on the other hand the patient has been well controlled for a long time and I am just getting an annual visual field, I may have that patient not take the pilocarpine on the morning of the examination.
I know that topical steroids, like eye drops, can very seriously raise IOP, but does this also apply to steroid creams?
A: Yes. Using any type of steroid for extended peropds [usually over 3 months at a time] can raise IOP. If you have to continue using steroid or cortisone products for a long time, you should have your pressure monitored regularly.
Over-The-Counter Cold and Allergy Medications
A: Various drugs, which can cause dilation of the pupil and suddenly cause angle-closure attacks, promote the development of chronic angle-closure in susceptible patients with very narrow angles. Drugs prescribed for such diverse conditions as depression, allergy and systemic hypertension can cause elevation (and reduction) of intraocular pressure, papillary dilation and lens swelling. A patient with narrow angles or previously undiagnosed angle-closure glaucoma is in particular danger. However, this applies only to people with undiagnosed or untreated narrow angles. It does not apply to patients with open angels or patients who have already been treated for angle-closure. Additional questions should be directed to your doctor. Glaucoma is a group of different diseases and what is best for one patient may not work for another. Only a doctor who examines your eyes can determine the most appropriate treatment for you or answer questions about your specific condition. If you are still unsure or uncomfortable with your options, we recommend seeking a second opinion.
Open-angle glaucoma and Hashimoto's disease, a thyroid condition.
Q: I have open-angle glaucoma in both eyes and am presently being treated with Ocupress 1% and Pilocarpine 2%. I have recently been diagnosed with Hashimoto's disease, a thyroid condition, and will be taking Synthroid 0.1, probably for life. Does the Synthroid have any effect on my eye condition, and if so, how serious could this side effect be? Could my glaucoma be in any way related, or made worse, by the Hashimoto's disease?
A: The relationship between thyroid disease and glaucoma is very complex. Patients with hypothyroidism have a high incidence of elevated pressure. Patients with Hashimoto's thyroiditis and hyperthyroidism can get thyroid problems but these are related to thickening of the muscles which control the eye movements and deposition of increased connective tissue in the eye socket. Synthroid itself, used to correct hypothyroidism, probably has a beneficial effect on intraocular pressure.
Does the Synthroid have any effect on my eye condition, and if so, how serious could this side effect be?
Q: I have open-angle glaucoma in both eyes and am presently being treated with Ocupress 1% and Pilocarpine 2%. I have recently been diagnosed with Hashimoto's disease, a thyroid condition, and will be taking Synthroid 0.1, probably for life. Does the Synthroid have any effect on my eye condition, and if so, how serious could this side effect be? Could my glaucoma be in any way related, or made worse, by the Hashimoto's disease?
A: The relationship between thyroid disease and glaucoma is very complex. Patients with hypothyroidism have a high incidence of elevated pressure. Patients with Hashimoto's thyroiditis and hyperthyroidism can get thyroid problems but these are related to thickening of the muscles which control the eye movements and deposition of increased connective tissue in the eye socket. Synthroid itself, used to correct hypothyroidism, probably has a beneficial effect on intraocular pressure.
Are beta-blockers useful as a calming agent in cases of stage fright?
Q: I read somewhere that beta-blockers are useful as a calming agent in cases of stage fright, for example, but the article said they can be especially dangerous for diabetics, asthmatics, and people with glaucoma. Now, of course, this has set me to wondering as I have been using Betagan 0.5% once a day for a few years, prescribed by my ophthalmologist. Is this true?
A: Although the article you read is correct in regard to the fact that systemic beta-blockers may be helpful in the short-term reduction of anxiety, beta-blockers are not "dangerous for patients with glaucoma." Beta-blockers can have a variety of untoward effects including slowing of the heart rate (bradycardia), cardiac arrhythmias, congestive heart failure and bronchospasm. Insulin-dependent diabetics should use beta-blockers cautiously, since they may be prone to episodes of low blood sugar, or hypoglycemia, and beta-blockers prevent the reflex physiologic increase in heart rate. The side-effect profile of topical beta-blockers is similar to their systemic counterparts, and patients should always practice punctal occlusion to reduce systemic absorption and enhance ocular absorption. Of note, patients using systemic beta-blockers may have a reduced response to topical beta-blockers.
Could the use of steroid drops for a few weeks at a time cause cataracts to develop?
A: No. Steroid eye drops (or even steroid pills or lotions) can cause cataracts to develop or worsen, but only after prolonged use. For most individuals, this often requires years of steroid therapy. Despite this, steroid eye drops should only be used under a doctor's direction, as these potent medications can cause other problems within the eye, such as a worsening of some viral illnesses or increased eye pressure in susceptible patients.
Can you tell me if taking female hormones could have an effect on my eye pressure?
Q: Can you tell me if taking female hormones could have an effect on my eye pressure? I am currently taking four eye drops to control my pressure. If there is any chance that taking hormones could make my pressure harder to control, I doubt I would take them regardless of the advice of my gynecologist. Also, in the future, will there be a way for a person to check their eye pressure at home similar to the way a diabetic can check their sugar levels and people with high blood pressure can check their pressure? During the time between visits to my eye doctor, I always wonder what my pressure is and I think this leads me to be more apprehensive about these appointments.
A: The interaction of hormones and eye pressure is a complex one. Steroid medication, given topically as eyedrops or ointments or for systemic diseases as creams, pills, or inhalants, can cause eye pressure to rise. It is generally a good idea for glaucoma patients to have their eye pressure checked with any change of systemic medication, particularly medications for high blood pressure, which often contain medications which can affect eye pressure. Although many patients would feel more comfortable checking their eye pressure at home, inexpensive instrumentation to perform this test is not yet available. An important concept is that although the pressure in the eye is an important factor in glaucoma damage, accurate assessment of the status of the optic nerve to detect further glaucoma damage is more important than just checking the intraocular pressure. If the pressure is slightly high, but the nerve is unchanged, then the glaucoma is stable. If, on the other hand, the pressure is normal but the nerve continues to deteriorate, then the glaucoma is getting worse and the treatment needs to be changed.
Calcium channel blockers in glaucoma treatment
Q: Please, explain the use of calcium channel blockers in glaucoma treatment. Do they replace other medications such as beta-blockers or are they used in conjunction with other glaucoma medication? Is it more dangerous to the patient to use calcium channel blockers when the patient is being treated for other health problems such as heart disease?
A: Calcium channel blockers represent an entirely new approach to the treatment of glaucoma. Hopefully, the advent of these drugs marks only the beginning of a trend in finding new approaches to the treatment of glaucoma over the coming years.
Previously, the only form of treatment of glaucoma has involved lowering intraocular pressure (IOP), even when IOP is normal to begin with. Although the evidence is not all in yet, calcium channel blockers have been reported to increase blood flow to the eye and to stabilize the visual field. Thus, instead of lowering IOP (although they appear to do this also), calcium channel blockers increase the resistance of the eye to glaucomatous damage. Because they represent an entirely new approach to the treatment of glaucoma, they do not replace other medications that are used in conjunction with them.
There are different types of calcium channel blockers. Some primarily affect the strength with which the heart contracts, while others affect peripheral blood vessels, making them dilate so that more blood can pass through. The calcium channel blockers used in the treatment of glaucoma ideally would be those which increase blood flow to the brain, since the eye and the brain share a common blood supply.
It remains to be determined just which patients will be helped and which will not be helped, or even perhaps harmed, by calcium channel blockers. Calcium channel blockers can also lower blood pressure, and a low blood pressure predisposes to glaucomatous damage. Therefore, we do not use these drugs at the present time in patients who have low blood pressure, but only in those with normal or high blood pressure. The patient's internist or family physician should be consulted with regard to the treatment plan.
Is Flonaise a Cortisone product? Can it raise my IOP?
A: Yes, it is a steroid preparation. Yes, inhalational steroids have been reported to be able to cause a steroid-induced rise in IOP. This is infrequent, but the frequency is not truly known. IOP should be checked approximately one month after starting this medication in patients with, or at risk for, glaucoma.
