Open-Angle Glaucoma: Concerns and Treatment Options

Questions about glaucoma?

Hello Doctor, I have approximately -4.00 diopters of myopia in my left eye and -5.00 diopters in my right eye, with no family history of glaucoma.
However, I have been diagnosed with open-angle glaucoma.
Since my diagnosis, my doctor prescribed 0.5% latanoprost eye drops for me, but my intraocular pressure (IOP) two hours after instillation remains around 18-21 mmHg, which is on the borderline of normal.
After six months of treatment, my doctor believes my IOP is still not low enough and mentioned that my optic nerve has deteriorated compared to before.
Now, I have been prescribed brimonidine eye drops, but I am still very concerned.
(1) Why is my IOP not dropping below the ideal target of 16 mmHg after using the eye drops? Is it because the medication is not suitable for me, or is it that my IOP cannot be sufficiently lowered with drops alone? I have seen many cases online where patients achieve IOP below 16 mmHg after using their medications.
(2) My attending physician mentioned that my optic nerve shows significant deterioration, but in my previous OCT images, both eyes had only one area marked in yellow, while the rest were green.
The visual field test did not show much damage.
Does this indicate that I caught the condition early? Is it possible for my optic nerve to deteriorate to a red status in just six months?
(3) Is it possible that at my young age, I may not be able to lower my IOP with medication? I am very afraid of losing my vision.
Is there a chance that I can maintain my eyesight for the rest of my life? I would appreciate your clarification on these concerns.

Ke Xiansheng, 20~29 year old female. Ask Date: 2018/05/13

Dr. He Jianxian reply Ophthalmology

1.
If the effect of the eye drops for lowering intraocular pressure is not satisfactory, you can switch medications or consider combination therapy.

2.
Since I have not seen your OCT results, I cannot comment definitively, but based on your description of the OCT condition, it does not seem to be a significant issue.
Are you certain that you have glaucoma? Have you undergone any procedures that confirm the presence of defects?
3.
You are overthinking this; there are many methods to control glaucoma nowadays.
If eye drops are ineffective, surgery is also an option, which generally helps to slow down the progression of visual field deterioration.

Reply Date: 2018/05/13

More Info

Open-angle glaucoma (OAG) is a chronic eye condition characterized by progressive damage to the optic nerve, often associated with elevated intraocular pressure (IOP). Your concerns regarding your diagnosis and treatment options are valid, especially considering the potential impact on your vision. Let’s address your questions systematically.

1. Inadequate IOP Control with Medication: It is not uncommon for some patients to experience difficulty in achieving target IOP levels with topical medications. The effectiveness of glaucoma medications can vary significantly from person to person. Factors that may contribute to your IOP remaining above the desired level of 16 mmHg include the specific formulation of the eye drops, the frequency of administration, and individual variations in drug absorption and metabolism. Additionally, the severity of your glaucoma may necessitate a more aggressive treatment approach, which could include combination therapy or even surgical options if medications alone are insufficient. It’s essential to maintain open communication with your ophthalmologist about your concerns and the effectiveness of your current treatment regimen.

2. Optic Nerve Damage and OCT Findings: The fact that your OCT (Optical Coherence Tomography) results show mostly green with only one yellow indicator suggests that significant damage has not yet occurred, which is a positive sign. However, the observation of optic nerve degeneration is concerning. The optic nerve can be affected by various factors, including IOP fluctuations, blood flow issues, and individual susceptibility. While it is possible for damage to progress rapidly in some cases, especially if the IOP remains elevated, the presence of mostly green areas on your OCT indicates that you may have caught the condition relatively early. Regular monitoring and follow-up with your eye care provider are crucial to track any changes in your optic nerve health.

3. Long-term Prognosis and Vision Preservation: Your fear of losing vision is understandable, especially with a diagnosis of glaucoma. However, many patients with open-angle glaucoma can maintain their vision with appropriate treatment and monitoring. The key is to adhere to your prescribed treatment plan and attend regular follow-ups to assess the effectiveness of the therapy and make necessary adjustments. If medication alone does not adequately control your IOP, your ophthalmologist may discuss alternative treatments, including laser therapy or surgical options, which can help lower IOP more effectively.
In summary, while your current situation may seem daunting, it’s important to remember that glaucoma is a manageable condition. With the right treatment strategy and regular monitoring, many patients can preserve their vision for years to come. If you have ongoing concerns about your treatment or the progression of your condition, consider seeking a second opinion from a glaucoma specialist. They can provide additional insights and potential treatment options tailored to your specific needs. Always prioritize your eye health and stay proactive in your treatment journey.

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