Questions & Answers

Increased intraocular pressure and a positive family history are associated with an increased risk of developing visual damage from glaucoma. If you have ocular hypertension without evidence of optic nerve damage, in which case treatment to reduce the eye pressure decreases your risk of developing glaucoma by 50% over the next 5 years. On the other hand, you may have increased eye pressure and signs of glaucoma damage seen with visual field testing or optic nerve analysis. In this case, reduction of eye pressure by 20-30% is successful in halting progression of glaucoma.

Optometrists are trained in glaucoma diagnosis and management. The typical evaluation for glaucoma should include a thorough ocular history, measurement of intraocular pressure, complete eye examination, gonioscopy, visual field testing, color vision testing, and optic nerve analysis with photography or special testing such as optical coherence tomography (OCT). If you are concerned about your eye care, a second opinion is never discouraged.

Primary open-angle glaucoma typically affects both eyes, but may be asymmetric, meaning that one eye is affected more than another. Unilateral glaucoma is a diagnosis of exclusion. In patients who present with glaucomatous damage to one eye, treatment of that eye is necessary to prevent further damage. Evaluation of other causes of optic neuropathy is also necessary, and it is important for your doctor to closely follow both eyes.

While the majority of patients with glaucoma have elevated eye pressures, progressive vision loss from glaucoma despite pressures less than 20 mm Hg (millimeters of mercury) can certainly occur. Some of these patients have thin corneas, which causes the instrument used to measure eye pressure to underestimate the true intraocular pressure, since all of these instruments assume a “normal” corneal thickness. Other patients simply have optic nerves that are highly susceptible and will suffer progressive damage despite normal intraocular pressure. In either case, careful monitoring and further lowering of eye pressure (even to the below 10 range) using either medications or sometimes surgery will often slow if not stop this progression.

Your double vision is not likely to be a symptom of glaucoma. There are several possible causes for this, and you should definitely return to your doctor to have this, as well as your glaucoma, evaluated and treated. Regardless of the underlying condition, postponing this care will only delay diagnosis, and may leave you with a more difficult problem to treat later on. Remember, vision lost from glaucoma is permanent and the only effective management we currently have is proper lowering of your eye pressure to keep the loss from occurring in the first place. Your doctor’s office may be able to suggest who you might contact in your area for assistance in paying for your care.

In addition, there are organizations listed on our financial aid page that can provide you with resources to contact.

There is relatively little information on the effect of statin use on glaucoma. However, one study, using laboratory methods, suggests that these drugs may induce the cells lining the trabecular meshwork to reduce resistance to aqueous humor outflow, and, thus lower intraocular pressure. Another study, performed in patients, has revealed that statins, if anything, may reduce the risk of developing open-angle glaucoma while another suggests that these drugs may be protective against progression of glaucomatous optic nerve damage. However, the effect of blood pressure, serum cholesterol and cardiovascular disease in general on glaucoma is poorly understood, with many studies providing conflicting answers. Although these uncertainties prevent us from drawing firm conclusions, the available evidence at this time does not indicate that using statin drugs will exacerbate glaucoma.

Eye pressure can also be lowered with laser or incisional surgery. Selective laser trabeculoplasty (SLT) is a glaucoma laser procedure that has shown successful reduction of eye pressure in patients with open-angle glaucoma. Glaucoma filtering surgery additionally can lower eye pressure successfully.

Betimol is a topical beta blocker that reduces eye pressure. Your eye pressure will most likely be 2-5 points higher once you discontinue the eye drops. However, if you do not have glaucoma, then this slight increase in eye pressure may be well-tolerated by your eyes. The diagnosis of glaucoma is made when there are characteristic visual field defects and/or optic nerve damage seen on exam. Reduction of the eye pressure serves to stabilize glaucoma and prevent further damage. Patients with risk factors for developing glaucoma (family history, ocular hypertension, trauma history, suspicious appearing optic nerves or thin corneas, for example) are called glaucoma suspects. Many glaucoma suspects are prescribed pressure-lowering medications to prevent any glaucomatous damage. Sometimes, in such patients, after years of follow-up and stable eye examinations, it may be determined that treatment is not needed. Your eye doctor should be able to explain his/her reasoning for recommending the discontinuation of the eye drop.

Glaucoma is a condition that does not cure itself. It is possible that your friend had elevated eye pressures related to medication use or other factors that have now normalized. It is also possible that your friend was incorrectly diagnosed with glaucoma 10 years ago, or that she was diagnosed with risk factors for developing glaucoma (a glaucoma suspect), but has not developed glaucoma at this point in time. Glaucoma suspects require routine examination and monitoring for signs of optic nerve damage that mark the development of glaucoma.

There are many websites that list information related to medications and their actions, side effects, and drug interactions; however, it would be best to obtain this type of information from your eye doctor and pharmacist. Regarding your particular medications, there is not generic medication that is in the same drug class as Travatan. Other classes of glaucoma medications, including topical beta blockers, alpha agonists, and carbonic anhydrase inhibitors, are available in generic form. Your eye care provider can make a medication recommendation for you.