HM Medical Clinic


Understanding and living with glaucoma

Samantha hopes
future generations won't
have to live with
Dr. Horner's
breakthrough research
could mean they
won't have to.
Supported by an educational grant from The Allergan Foundation.

"Glaucoma Research Foundation
is dedicated to improving the lives of
glaucoma patients and funding research
to find a cure."
Roberta Kameda, Glaucoma Research Foundation donor Roberta Kameda and her daughter, Samantha, live in the San Francisco Bay Area. Samantha was diagnosed with glaucoma in her first year of high school. Today, Samantha is excited about starting her freshman year of college.
Understanding And Living
"Glaucoma Research Foundation
is dedicated to improving the lives of
glaucoma patients and funding research
to find a cure."
Roberta Kameda, 2 What Is Glaucoma? Glaucoma Research Foundation donor 2 How The Eye Works4 The Eye With Glaucoma 5 Are There Symptoms? 6 Different Types Of Glaucoma 10 How Is Glaucoma Diagnosed?10 What To Expect During Glaucoma Examinations 14 Glaucoma Medications16 How To Use Eye Drops 18 Glaucoma Surgery Living With Glaucoma
22 Working With Your Doctor 22 What You Can Do To Manage Your Glaucoma 24 Your Lifestyle Counts 27 Glaucoma Medication Manufacturers 28 A Guide To Glaucoma Medications 30 Glossary What Is Glaucoma?
Glaucoma is an eye disease that gradual y steals your vision. Often, glaucoma has no symptoms and can suddenly result in vision loss. Without proper treatment, glaucoma can lead to blindness. The good news is that with regular eye exams, early detection, and treatment, you can preserve your sight. This guide will give you a complete introduction to the facts about glaucoma. How The Eye Works
A tough white covering cal ed the sclera protects the eye. A clear, delicate membrane cal ed the conjunctiva covers the sclera. The cornea is the clear part of the eye's protective covering that al ows in light. The iris is the colored part of the eye that contracts and expands so the pupil can let just the right amount of light into the eye. The lens focuses the light onto the the retina (lining the back of the eye). Nerve fibers in the retina carry images to the brain through the optic nerve.
Healthy Eye Drainage
The front part of the eye is fil ed with a clear fluid (cal ed intraocular fluid or aqueous humor) made by the ciliary body. The fluid flows out through the pupil. It is then absorbed into the bloodstream through the eye's drainage system (a meshwork of drainage canals around the outer edge of the iris). Proper drainage helps keep eye pressure at a normal level. The production, flow, and drainage of this fluid is an active, continuous process that is needed for the health of the eye.

The inner pressure of the eye (intraocular pressure or IOP) depends on the amount of fluid in the eye. If your eye's drainage system is working properly, then fluid can drain freely out and prevent a buildup. Likewise, if your eye's fluid system is working properly, then the right amount of fluid can be produced. Your IOP can vary during the day, but normal y stays within a manageable range.
Development of Glaucoma
Blocked drainage canals increase eye pressure, causing optic
nerve damage.

The Eye With Glaucoma
In most types of glaucoma, the eye's drainage system becomes clogged so the intraocular fluid cannot drain. As the fluid builds up, it causes pressure to build inside the eye. High pressure damages the sensitive optic nerve and results in vision loss. The Optic Disc
You have mil ions of nerve fibers that run from your retina to the optic nerve. These fibers meet at the optic disc. As fluid pressure within your eye increases, it damages these sensitive nerve fibers and they begin to die. As they die, the disc begins to hol ow and develops a cupped or curved shape. If the pressure remains too high for too long, the extra pressure can damage the optic nerve and result in vision loss.
It was once thought that high intraocular pressure (IOP) was the main cause of this optic nerve damage. Although IOP is clearly a risk factor, we now know that other factors must also be involved because people with "normal" IOP can experience vision loss from glaucoma.
How Vision Loss Occurs
Glaucoma usual y occurs in both eyes, but extra fluid pressure often starts to build up in one eye first. This damage may cause gradual visual changes and loss of sight. Often, peripheral (side) vision is affected first, so the change in your vision may be small enough that you may not notice it. With time, your central (direct) vision will also begin to be lost.
Who Gets Glaucoma?
Anyone. But those at higher risk to develop glaucoma are: • Over 60 years old • Very nearsighted (myopic) • People of African descent • People of Asian descent • Relatives of glaucoma patients • Extensive users of steroids • Hispanics in older age groups • People with thin central cornea

When Should You Get Your Eyes
Checked For Glaucoma?
Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma. It is important to have your eyes examined regularly. Your eyes should be tested: Before age 40, every two to • From age 40 to age 54, every one to three years • From age 55 to 64, every • After age 65, every six to Are There Symptoms?
In the most common form of glaucoma, buildup of
fluid pressure happens very slowly. Often, there are no
uncomfortable or painful symptoms.

In less common kinds of glaucoma, symptoms can be more severe. These symptoms can include: n • The appearance of rainbow- n colored circles around bright lights Nausea or vomitin Sudden sight loss Glaucoma affects people of all ages, from babies to older adults. Although everyone is at risk for glaucoma, those at higher risk include people over age 60, relatives of people with glaucoma, people of African descent, people with diabetes, people with extensive use of steroids, and people who have elevated eye pressure. Sight loss resulting from glaucoma cannot be reversed. However, early detection and careful, lifelong treatment with medication or surgery can maintain vision.

Different Types Of
There are several types of glaucoma. The two main types are open-angle and angle-closure.
Open-angle glaucoma, the most common form of glaucoma, accounting for at least 90% of all glaucoma cases: • Is caused by the slow clogging of the drainage canals, resulting in increased eye pressure • Has a wide and open angle between the iris and cornea• Develops slowly and is a lifelong condition • Has symptoms and damage that are not noticed.
There are no early warning signs of open-angle glaucoma (also cal ed primary or chronic glaucoma). It develops slowly and sometimes without noticeable sight loss for many years. Most people who have open-angle glaucoma feel fine and do not notice a change in their vision. That is why regular eye exams are so important.
With early detection, open-angle glaucoma usual y responds wel to medication.
However, it will be very important that you careful y fol ow your medication regimen to continual y preserve healthy eye pressure and prevent vision loss.
Fluid Flow
Open-angle is the
most common type
of glaucoma.

The other main type of glaucoma is cal ed angle-closure glaucoma. It is also cal ed acute glaucoma or narrow-angle glaucoma. This type is rare and: • Is caused by blocked drainage canals, resulting in a sudden rise in intraocular pressure • Has a closed or narrow angle between the iris and cornea • Develops very quickly • Has symptoms and damage that are usual y very noticeable • Demands immediate medical attention.
The closed angle prevents fluid from reaching the drainage canals. As a result, the intraocular pressure rises very quickly, causing a painful attack in the eye. The eye may appear red. You may have a headache, feel nauseous, feel intense eye pain, see rainbows around lights at night, or have blurred vision. If you have any of these symptoms, you should seek immediate medical attention to prevent serious eye damage.
Treatment of angle-closure glaucoma usual y involves either laser or conventional surgery to remove a small portion of the bunched-up outer edge of the iris. Surgery helps unblock the drainage canals so that the extra fluid can drain. If you have angle-closure glaucoma in one eye, doctors may go ahead and treat the other eye as a safety measure. In general, surgery for angle-closure glaucoma is successful and long lasting. Regular checkups are still Fluid Flow
Closed Angle
important though, because a chronic form of glaucoma could stil occur.
Fluid Flow
glaucoma needs
immediate treatment.

Other Types Of Glaucoma
Most of the other types of glaucoma are variations of open-angle
or angle-closure types. These types can occur in one or both of
your eyes.
Secondary Glaucoma
Can occur as the result of an eye injury, inflammation, tumor, in
advanced cases of cataract or diabetes or by certain drugs such as
steroids. This form of glaucoma may be mild or severe. The type
of treatment will depend on whether it is open-angle or
angle-closure glaucoma.
Pigmentary Glaucoma
Is a form of secondary open-angle glaucoma, occurring when the
pigment granules that are in the back of the iris (the colored part
of the eye) break into the clear fluid produced inside the eye. These
tiny pigment granules flow toward the drainage canals in the eye
and slowly clog them, causing eye pressure to rise. Treatment usual y
includes medications, laser surgery, or filtering surgery.
Normal-tension Glaucoma (NTG)
Is also cal ed low-tension or normal-pressure glaucoma. In this
type of glaucoma, the optic nerve is damaged even though the
intraocular pressure (IOP) is not very high. The cause is unknown.
People at higher risk for normal tension glaucoma have a family
history of normal-tension glaucoma, are of Japanese ancestry,
or have a history of systemic heart disease, such as irregular
heart rhythm.
Asians are at higher risk for normal-tension glaucoma.
Congenital Glaucoma
Occurs in babies when
there's incorrect or
incomplete development
of the eye's drainage canals
during the prenatal period.
This is a rare condition
that may be inherited.
Exfoliative Glaucoma
Occurs when a flaky,
dandruff-like material peels
off the outer layer of the
lens within the eye. The
Congenital glaucoma can often be
corrected with microsurgery.

material col ects in the angle between the cornea and iris and can clog the drainage system of the eye, causing eye pressure to rise. Also cal ed pseudoexfoliative glaucoma, it is common among those of Scandinavian descent.
Neovascular Glaucoma
The abnormal formation of new blood vessels on the iris and over
the eye's drainage channels can cause this form of open-angle
glaucoma. Neovascular glaucoma is always associated with other
abnormalities, most often diabetes. It never occurs on its own. The
new blood vessels block the eye's fluid from exiting through the
trabecular meshwork (the eye's drainage canals), causing an increase
in eye pressure.
Uveitic Glaucoma
Uveitis is swel ing and inflammation of the uvea, the middle layer of
the eye. The uvea provides most of the blood supply to the retina.
Increased eye pressure in uveitis can result from the inflammatory
process itself or the medication (steroids) used to treat it.
Traumatic Glaucoma
Injury to the eye may cause traumatic glaucoma. This form of open-
angle glaucoma can occur immediately after the injury or develop
years later. It can be caused by blunt injuries that bruise the eye
(cal ed blunt trauma) or by injuries that penetrate the eye.
How Is Glaucoma Diagnosed?
To be safe and accurate, five factors should be checked before making a glaucoma diagnosis: 1. The inner eye pressure (intraocular pressure or IOP) [tonometry]2. The shape and color of the optic nerve (ophthalmoscopy or dilated eye exam) 3. The complete field of vision (perimetry test)4. The angle in the eye where the iris meets the cornea 5. Thickness of the cornea (pachymetry).
What To Expect During Glaucoma
Regular glaucoma checkups should include two routine, painless eye exams—tonometry and ophthalmoscopy. If the pressure in the eye is not in the normal range, or if the optic nerve looks unusual, then additional special glaucoma exams may be done. These diagnostic exams are cal ed perimetry, gonioscopy, and pachymetry.
During tonometry, eye drops are used to numb the eye. Then a doctor or technician uses a device cal ed a tonometer to measure the inner pressure of the eye. A small amount of pressure is applied to the eye by a tiny device or by a warm puff of air. The range for normal pressure is 12-22 mm Hg ("mm Hg" refers to millimeters of mercury, a scale used to record eye pressure). Most glaucoma cases are diagnosed with pressure exceeding 20 mm Hg. However, some people can have glaucoma at pressures between Checking the inner pressure of the eye.
This diagnostic procedure helps the doctor examine your optic nerve for glaucoma damage. Eye drops are used to dilate the pupil so that the doctor can see through your eye to examine the shape and color of the optic nerve. The doctor will then use a small device with a light on the end to light and magnify the optic nerve. An optic nerve that is cupped or not a healthy pink color is cause for concern.
Additional ophthalmoscopy technologies your doctor may use include:• Heidelberg Retina Tomography (HRT), a special laser that produces a three-dimensional high-resolution image of the optic nerve. This test provides clinicians with measurements of nerve fiber damage (or loss).
• The Nerve Fiber Analyzer (GDx) uses laser light to measure the thickness of the nerve fiber layer. • Optical Coherence Tomography (OCT) measures the reflection of laser light much like an ultrasound measures the reflection of sound, and can directly measure the thickness of the nerve fiber layer and Ophthalmoscopy helps the doctor to
create a three-dimensional representation of the optic nerve.
By imaging your optic nerve over time during multiple visits to your eye doctor, these technologies can help monitor and detect loss of optic nerve fibers. This helps your doctor to visualize and monitor glaucoma progression.
Damaged optic nerve in
an eye with glaucoma.

Perimetry is a visual field test that produces
a map of your complete field of vision. This
test will help a doctor determine whether
your vision has been affected by glaucoma.
Do not be concerned if there is a delay in seeing the light as it moves in or around your Visual field within normal limits blind spot. This is perfectly normal and does not necessarily mean that your field of vision is damaged.
Try to relax and respond as accurately as possible during the test. Your test performance may be worse if you are tired or having a bad day.
Visual field outside Your doctor may want you to repeat normal limits the test to see if the results are the same the next time you take it. After glaucoma has been diagnosed, visual field tests are usual y done one to two times a year to check for any changes in your vision.
Gonioscopy is a diagnostic exam that helps determine whether the angle where the iris meets the cornea is open and wide or narrow and closed. During the exam, eye drops are used to numb the eye and a special hand-held contact lens is gently placed on the eye. Gonioscopy uses a contact lens to see the
angle between the iris and cornea.

Why does my eye pressure change from one
appointment to the next?
Eye pressure can vary hourly, daily, and weekly. Many factors
can affect the up and down changes in a person's intraocular
pressure. These daily changes are normal and should not affect
your glaucoma on a long-term basis.
Pachymetry measures the thickness of the cornea—the clear window at the front of the eye. Corneal thickness has the potential to influence eye pressure readings. If a cornea is thicker than average, pressure readings with a tonometer may be A pachymeter measures corneal thickness.
higher. This gives your eye doctor additional i f n ormation for your glaucoma diagnosis.
Why Are There So Many
Diagnosing glaucoma is not always easy. The most important concern is protecting your sight. Doctors look at many factors before you and he or she make decisions about treatment. If your condition is particularly difficult to diagnose or treat, you may be referred to a glaucoma specialist. A second opinion is always wise if you or your doctor become concerned about your diagnosis or your progress.
Is There A Cure?
With early diagnosis and proper medication and treatment, glaucoma can be control ed. However, sight loss resulting from glaucoma cannot be restored. At the present time, there is no cure. Once detected, glaucoma usual y requires ongoing, long-term care. Keeping your eye pressure under control is very important. You must fol ow your treatment plan careful y to help control your eye pressure. This will protect the optic nerve and prevent sight loss.
Many people think that glaucoma has been cured when high eye pressure is lowered to safe levels with medication or surgery. In fact, the glaucoma is only being control ed, not cured. Regular checkups are still needed even after medications or surgeries have control ed the eye pressure.
Glaucoma is typical y treated with the use of medications that either
help the fluid drain better or decrease the amount of fluid made by
the eye. In most cases, medication can safely control eye pressure
for many years. Experts agree that your eye pressure must remain
under constant control to prevent your glaucoma from growing
worse. That's why it is especial y important that you take your
prescribed medication on schedule every day.
What About Side Effects?
Most medications have some side effects. Usual y, side effects
lessen after a few weeks. However, you should ask your doctor
about any physical or emotional changes that occur when taking
glaucoma medications. Make sure that you tell all of your doctors
(including your family physician) about any glaucoma medications
you are taking and any side effects you are feeling.
In particular, older people with glaucoma should look for changes in behavior or mobility that may be a side effect of
medications. If the side effects are very uncomfortable or last
a while, your doctor can prescribe another medication.
If Your Doctor Changes Medications
Changing medications does not necessarily mean that the
glaucoma is getting worse. In fact, it is normal for your medication
prescriptions to change over time. As your body begins to develop
a tolerance for your medication, it will slowly lose its effectiveness
and may need to be replaced by a stronger version of the same
drug or a different medication. Doctors can often return to
previously used medications after your body has had a chance
to "forget" the old medication.
Medication programs can also change to include new drugs that are more effective or more comfortable for you to use. Researchers are working to find glaucoma medications with fewer side effects and medications that can be taken less often.
Eye drops are often
the first choice for
treating glaucoma.

The Importance Of Following Your
You may hear your doctor talk about the importance of your compliance with your medication regimen. Compliance simply refers to a patient's ability to fol ow their prescribed plan for taking medications. Much of your eye health is up to you. Medications only work as long as they are taken in the prescribed method. Tips to help you stay on track:
• Make a schedule.
Write down the name and dosage, and
number of times your medication(s) should be taken each day. Post
your medication
schedule in a place
where you wil see
it often such as on
the refrigerator door
or above your desk
at work. You may
find color-coding
your medications
will help you better
identify them.
• If you forget to
use your eye drops,
put them in as soon
Your compliance is important to keep glaucoma
instead of waiting
until the next scheduled time. Then get back on your regular
schedule for the next time. Always check with your doctor if you
are not sure about any part of your eye drop routine. To be certain,
you may want to demonstrate how you put in your eye drops for
your doctor.
• Always check with your doctor and/or pharmacist when taking
more than three drugs of any kind, including vitamins and natural
remedies, for assurance that your medications are not interacting
in a negative manner.
Tips On Using Medications
• Schedule medications around daily routines like waking and mealtimes.
• Remember that twice a day means every 12 hours, for example, 7 am and 7 pm.
• Keep your medications in a visible place at home and take them with you when you go out.
• Keep eye drops out of the reach of children and out of direct sunlight. • Tell your doctor or pharmacist if your medications are causing reactions or if you are having any difficulty using them. It may be possible to change your medication program.
How To Use Eye Drops
Before using eyedrops, wash your hands. Sit down and tilt your head back, or lie down and look at the ceiling. Then fol ow these steps: 1) Make a pocket in your lower lid
pul ing down with your index finger.
2) Look up. Squeeze one drop into the
pocket in your lower lid. Don't blink,
wipe your eye, or touch the tip of the
bottle to your eye or face.
3) Close your eye. Press the inside corner
of the eye. (This stops the drop from
draining into your throat.) Continue
pressing for 2-3 minutes.
Repeat steps 1 through 3 for each eye and each kind of drop you use.
Wait 3 to 5 minutes between drops.

Trouble-shooting eye drops:
• Fol ow your doctor's instructions for using your drops.
• Tell your doctor about any other drugs you're taking (including
everyday products like vitamins and aspirin) and about any al ergies.
• If using two or more kinds of drops at the same time, wait five
minutes before putting the next drop in the eye to make sure the
first drop has had time to work.
• If your hands are shaking, try approaching your eye from the side
so you can rest your hand on your face to help steady your hand.
• If you're having trouble getting the drop into your eye, lie down
flat, face up with your eye closed. Place the drop outside of the lid
in the corner of your eye near the nose. As you open your eye, the
drop will roll in.
• If you're not sure the drop actual y got into your eye, put in
another. The eyelid can hold only about one drop, so any excess wil
run out of the eye. It's better to have excess runoff than to not have
enough medication in your eye.
• If you're having trouble holding onto the bottle, try wrapping
something (like a paper towel) around the bottle to make it wider.
• Some manufacturers of glaucoma eye drop medications make
helpful devices that can assist you in putting the drops in your eye.
If you continue to have trouble despite the above suggestions, ask
your eye doctor if such a device might be useful to you.
Make sure
the dropper
stays clean.

Surgery is another way to treat glaucoma. In general, any kind of surgery carries some risk, so your doctor may try to exhaust other treatment methods first. However, modern glaucoma surgery is successful for many patients. Surgery is the main treatment method for angle-closure glaucoma and congenital glaucoma, because it may be the only way that the blocked or incorrectly formed drainage canals can be opened. In cases of open-angle glaucoma, surgery is usual y considered when the maximum amount of medication is not control ing your eye pressure or when you cannot tolerate the side effects of the medication. There are several types of laser surgery used to treat glaucoma. The type of laser surgery will depend on the form of glaucoma and how severe it is. Laser surgeries are performed in an outpatient setting in your doctor's office or in a hospital clinic. Laser surgery may reduce the need for pressure-lowering eye drops.
In laser surgery, special eye drops are used to numb your eye. Then your
doctor, using a microscope, focuses the light beam on exactly the right
place in your eye.

Laser Surgery—What To Expect
• Special eye drops are used to numb your eye. Then your doctor
uses a special type of lens to visualize the treatment area.
• Using a microscope, your doctor focuses the laser light beam on
exactly the right place in your eye.
• During laser surgery, you will see a bright light—like a camera
flash—and you may feel a faint tingling sensation.
• The laser light beam passes harmlessly through the outer covering
of your eye and treats only where it is focused.
• Afterward, your eye may be slightly irritated, and your doctor may
tell you to take it easy for a day or so.
• Although laser surgery may not permanently control your eye
pressure, it can often delay the need for microsurgery.
Types Of Laser Surgery
Selective Laser Trabeculoplasty (SLT)
• Uses a laser that works at very low levels.
• Treats specific cel s and leaves the mesh-like drainage canals
surrounding the iris intact. For this reason, SLT may be safely
• May be an alternative for those who have been treated
unsuccessful y with traditional laser surgery or with pressure-
lowering eye drops.
Argon Laser Trabeculoplasty (ALT)
• Used for primary open-angle glaucoma.
• Laser beam is aimed at the fluid drainage channels helping
the drainage system work.
Micropulse Laser Trabeculoplasty (MLT)
• Provides the same pressure-lowering effects as SLT and ALT.
• Uses a specific diode laser to deliver laser energy in short
Laser Peripheral Iridotomy (LPI)
• Used for angle-closure glaucoma where the iris in the eye blocks
fluid drainage.
• Procedure makes an opening in the iris, helping the fluid to drain.
Laser Cyclophotocoagulation
• Used for those with very severe glaucoma damage that is not
being managed by standard glaucoma surgery.
• Laser is used to treat the ciliary process to decrease the amount
of fluid produced.
Laser surgery helps to lower pressure
in the eye.

Microsurgery is also cal ed conventional surgery because it is done in a hospital or surgery center and uses conventional but tiny instruments, along with a microscope. Microsurgery is successful with many types of glaucoma. What To Expect
• Before surgery begins, a
local anesthetic, along with a
medication to help you relax,
is given to prevent you from
feeling any discomfort during
the procedure.
• During surgery, the doctor
looks through a microscope
that is placed several inches
above your eye.
• A tiny opening is made in
the sclera (the white part of
the eye) with a small surgical
instrument. This procedure is
cal ed a trabeculectomy. This
new opening al ows the
intraocular fluid to bypass
the clogged drainage canals
Microsurgery has risk of complication
but is typically successful.

and flow out of this new, artificial drainage canal. Special medications (antifibrotics) may be given to prevent healing of the artificial drainage canal. • A relatively new microsurgery procedure uses an artificial drainage device (aqueous shunt) or implant to lower intraocular pressure. Several different kinds of these devices are in use.
• Microsurgery does require some recovery time, which will vary according to your age, job, and other personal factors. Most people can move around and return to their normal activities soon after going home from the hospital, though you may have to wear an eye patch to protect your eye. • For at least a week after microsurgery, it is advisable to keep water out of the eye. It is also good to take a break from driving, reading, bending, and strenuous exercise.
• If necessary, glaucoma surgery can be done several times without substantial risk.
Living With Glaucoma
If Your Vision Begins To Change
Some people with glaucoma have "low vision." Low vision means there may be problems doing daily, routine things even if using glasses or contact lenses. With glaucoma, this can include loss of contrast sensitivity (the ability to see shades of the same color), problems with glare, light sensitivity, and reduced visual acuity (the ability to see fine details). A variety of products and resources are available to help people who have low vision. Examples include magnifiers, colored lenses, and computer text enlargers. If you have low vision concerns, help is available. Discuss your concerns with your doctor.
Working With Your Doctor
As a newly diagnosed person with glaucoma, you may need to have your eye pressure checked every week or month until it is under control. Even when your eye pressure is at a safe level, you may need to see your doctor several times a year for checkups. It is important that your doctor listens and responds to your concerns and questions, is willingto explain your treatment options, and is available for cal s and checkups. If you do not feel confident and comfortable with your doctor, remember, you always have the right to seek a A good relationship with your eye doctor is
second opinion.
What You Can Do To Manage
Know And Keep Track Of Your Medications
Some medications may cause you to experience strong side effects. Be sure to tell your doctor about any side effects you experience once you have started your medication. The intensity of your side effects may mean you need a different type of medication.
• Make your medications part of your daily routine, perhaps by taking them when you get up, at mealtimes, and/or at bedtime. Use an alarm watch to remind you of when to take your medication.
• Get an extra supply of medication in case you misplace a bottle of eye drops or pil s. Take an extra prescription along with you on trips away from home.
• Find out about possible side effects. This will take some of the mystery out of e your medications part of your
daily ro B
er, if your side effects are severe, the medication may not be right for you. Talk to your doctor about any side effects.
• It's important that you tell everyone on your healthcare team—including your family doctor and any other specialists—that youhave glaucoma and what medications you are taking. This wil help them in prescribing treatments that won't interfere with your glaucoma medications. Be especial y careful about using any medication that contains cortisone.
• Let your doctor know if, for any reason, your medications are not working for you, or if your daily routine has changed. Your doctor may be able to solve such problems by changing the type or timing of your medications.
• Report any changes to your doctor, especial y eye irritation, watering, blurring or scratchiness, unusual discharge in the corner of your eye, temporarily cloudy vision, continual headaches, flashes of light or floating objects in the field of vision, or rainbows around lights at night.
• Keep a record of each medication you are taking. Write down the name, the dosage, and the number of times it should be taken each day. Keep it in your purse or wal et, or place it where you will see it every day.
• Schedule your next checkup before you leave the doctor's office, and put your appointment on your calendar.
• Go for a checkup before you go on a long trip or start a long-term,demanding project.
• Write down any questions you have about your eyes, vision, or medications before you see your doctor. During your checkup, bring this list of questions, and write down your doctor's answers.
Keep a record of your medications.
Your Lifestyle Counts
• Try to keep your eyes clean and free of irritants. Women might want to be careful about eye cosmetics, by using non-al ergenic brands and by replacing them often.
• Don't rub your eyes, even though some glaucoma medications might make them feel itchy or blurry.
• If you have had eye surgery, it's a good idea to wear goggles when swimming and protective glasses when doing yard work or when playing contact sports.
• Take care of the rest of your body. Keeping in good general health is just as important as taking care of your eyes.
• Eating healthy foods, getting enough exercise, not smoking, not ingesting too much caffeine, and staying at a healthy weight are important. Be sure to check with your doctor before you start any strenuous exercise program.
• Space out your fluid intake. This will help prevent fluid retention.
• Lower your salt intake to prevent fluid retention.
Reduce stress in your life, and make time for relaxation.
Your Feelings Are Important
Glaucoma has another side—the emotional and psychological aspects of having a chronic, sight-threatening health condition. When you are first diagnosed with glaucoma you may experience worry, fear, helplessness, depression, or lethargy. Take the time to learn about the disease and you'll find that there are many steps you can take to help manage glaucoma. Even if you lose some of your vision, you can work with low vision rehabilitation counselors to learn how to continue leading an active life.
As a glaucoma patient, you have the chance to teach your friends and relatives about this disease. Many people are unaware of the importance of eye checkups and do not know that individuals with glaucoma may have no symptoms. You can help protect their eye health by encouraging them to have their eye pressure and optic nerves checked regularly.
We are limited only by what we think we can or cannot do. You can continue with what you were doing before glaucoma was diagnosed. You can make new plans and start new ventures. And you can trust the eye care community to keep looking for better treatment methods for glaucoma. Take good care of yourself and your eyes, and get on with enjoying your life.
Share your feelings with loved ones so they can be supportive.
Glaucoma Medication Manufacturers
Ista Pharmaceuticals, Inc.
1925 West Field Court, Suite 300 50 Technology Drive Lake Forest, IL 60045 Toll Free: (800) 932-5676 Toll Free: (877) 788-2020 Website: Medication: Timolol Maleate Medication: Istalol® Alcon Laboratories, Inc.
Merck & Co., Inc.
6201 South Freeway One Merck Drive, P.O. Box 100 Fort Worth, TX 76134 Whitehouse Station, NJ 08889 Toll Free: (800) 757-9195 Toll Free: (800) 444-2080 Website: Website: Medications: Azopt™, Betoptic S®, Medications: Cosopt®, Timoptic®, Iopidine®, Timolol Maleate Gel, Timoptic XE®, Trusopt®, ZIOPTAN™ Timolol Maleate solution, Travatan® Z,Isopto® Carpine, Pilopine HS®, Pfizer, Inc.
Isopto® Carbachol 235 East 42nd StNew York, NY 10017 Al ergan, Inc.
Toll Free: (800) 879-3477 Website: Medication: Xalatan® Tol -Free: (800) 433-8871Website: Teva North America Medications: Alphagan® P, Combigan™, 1090 Horsham Road Betagan®, Lumigan® North Wales, PA 19454Toll Free: (800) 545-8800 Bausch & Lomb, Inc. 8500 Hidden River Parkway Medication: Acetazolamide Toll Free: (800) 323-0000Website: VISTAKON Pharmaceuticals, LLC 7500 Centurion Parkway Pilocarpine, Timolol Maleate Jacksonvil e, FL 32256Tol -Free: (800) 523-6225www.vistakonpharmaceutical.comMedication: Betimol® A note about generic medications:
Some glaucoma medications are available in generic forms. If you are
interested, you should ask your doctor if the medication(s) you are
using would be available generical y and if so, whether switching to
that generic would be right for you.
A Guide To Glaucoma
Dipivefrin HCI 0.1% ACTION Increases drainage of intraocular fluidNOTES Al ergic reactions to these drops are frequent. Blurred vision can also occur. Vision can also be decreased in people who have had cataracts removed. Headaches and burning of the eyes are common side effects. Cardiac side effects include rapid heart rate or fluctuations in heart rhythm.
Alpha AgonistMANUFACTURER Alcon Laboratories, Inc. Apraclonidine HCI0.5%, Brimonidine tartrate0.1%, ACTION Decreases the production of intraocular fluid. Also increases drainage of intraocular fluid.
NOTES Side effects can include burning or stinging upon instil ation of the eye drop, fatigue, headache, drowsiness, dry mouth, and dry nose.
Beta BlockersMANUFACTURER Timolol Maleate USP Timolol maleate 0.5% Alcon Laboratories, Inc. Bausch & Lomb, Inc. Metipranolol 0.3% ISTA Pharmaceuticals, Inc. Istalol® Merck & Co., Inc. Timolol maleate ophthalmic gel Timolol hemihydrate0.25%, ACTION Decreases production of intraocular fluidNOTES Side effects can include low blood pressure, reduced pulse rate, and fatigue. Beta blockers can also cause a shortness of breath in people who have a history of asthma or other respiratory disorders. Additional y, beta blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart's response rate during exercise. Rare side effects include reduced libido and depression.
Carbonic Anhydrase Inhibitor (CAI)MANUFACTURER Alcon Laboratories, Inc. Brinzolamide ophthalmicsuspension Fera Pharmaceuticals Merck & Co., Inc. Dorzolamide HCI 2% Diamox® Sequels® ACTION Decreases production of intraocular fluidNOTES Side effects of Diamox Sequels can include tingling or loss of strength of the hands and feet, upset stomach, memory problems, depression, kidney stones, and frequent urination. Side effects of Azopt and Trusopt include stinging, burning, and other eye discomfort.
Cholinergic (Miotic)MANUFACTURER Alcon Laboratories, Inc. Isopto® Carpine Pilocarpine HCI 1%,2%, Isopto® Carbachol Carbachol 0.75%, 1.5%, 3% Pilocarpine HCI gel 4% Bausch & Lomb, Inc. Pilocarpine HCI Ophthalmic Pilocarpine HCI ACTION Increases drainage of intraocular fluidNOTES Many people who use these medications complain of dim vision, especial y at night or in a darkened area such as movie theaters. This is due to constriction of the pupil. Miotics increase drainage of intraocular fluid by making the pupil size smal er and thereby increasing the flow of intraocular fluid from the eye.
Prostaglandin AnalogsMANUFACTURER Alcon Laboratories, Inc. Travaprost 0.004% Bimatoprost 0.01%, 0.03% Merck & Co., Inc. Tafluprost ophthalmic solution Latanoprost 0.005% ACTION Increases drainage of intraocular fluidNOTES Side effects can include a gradual change in eye color, darkening of eyelid skin, gradual growth of eyelashes, stinging, blurred vision, eye redness, itching and burning.
Combined DrugsMANUFACTURER Brimonidine tartrate & Timolol Maleate ophthalmic Merck & Co., Inc. Dorzolomide HCI & Timolol Maleate ACTION Decreases production of intraocular fluidNOTES Combigan™ is a combination of beta blocker and alpha agonist – side effects include symptoms of both. Cosopt® is a combination of beta blocker and carbonic anhydrase inhibitor —side effects include burning and/or stinging of the eyes and changes in sense of taste. Angle-Closure Glaucoma
A type of glaucoma characterized by a sudden and severe rise in eye pressure. Occurs when the
pupil enlarges too much or too quickly, and the outer edge of the iris blocks the eye's drainage
canals. Can be either acute or chronic.
Aqueous Humor
The fluid fil ing the front part of the eye.
A bubble in the eye tissue that lays over the new drainage opening created during surgery.
Central Vision
What is seen when you look straight ahead or when you read.
Ciliary Body
Tissues located around the lens of the eye that supply fluid to nourish the eye.
Congenital Glaucoma
A rare form of glaucoma that occurs in babies and young children. This condition can be
inherited. It is usual y the result of incorrect or incomplete development of the eye's drainage
canals during the prenatal period.
A thin, clear membrane that lines the inner surface of the eyelids and the outer surface of the
eyebal , except for the cornea.
The clear part of the eye located in front of the iris. Part of the eye's protective covering.
Drainage Canals
Small openings around the outer edge of the iris. These canals provide the final pathway for fluid to
leave the inside of the eye. Sometimes referred to as the trabecular meshwork or Schlemm's canal.
In this diagnostic procedure a contact lens that contains a mirror is gently placed on the eye. The
mirror lets the doctor look sideways into the eye to check whether the angle where the iris meets
the cornea is open or closed. This helps the doctor decide whether open-angle or angle-closure
glaucoma is present.
Heidelberg Retina Tomograph (HRT)
A special laser that produces a three-dimensional high-resolution image of the optic nerve.
Intraocular Pressure (IOP)
The inner pressure of the eye. Normal intraocular pressure usual y ranges from 12-22 mm Hg,
although people with relatively low pressures can still have glaucoma (see normal-tension glaucoma).
The colored part of the eye that can expand or contract to al ow just the right amount of light to
enter the eye.
Laser Surgery
A type of surgery in which a tiny beam of light energy is used to modify tissues in the eye. There
are three common forms of laser surgery for glaucoma.
Laser Peripheral Iridotomy
Creates a new drainage hole in the iris, al owing the iris to fall away from the outflow channel so
fluid can drain out of the eye.
Laser Trabeculoplasty
In this procedure, the laser is aimed toward the normal drainage channels of the eye, in an
attempt to open those channels so fluid can leave the eye more efficiently.
Laser Cyclophotocoagulation
This laser procedure is usual y used in people who have severe glaucoma and are not responding
to standard glaucoma surgery. The laser is used to partial y destroy the tissues that make the fluid
in the eye.
Located behind the iris, this helps light focus onto the retina.
Surgery performed with a microscope in which a surgical instrument is used to make a tiny, new
opening in the sclera so that intraocular fluid can drain out of the inside of the eye.
mm Hg
An abbreviation for "mil imeters of mercury," which is a scale for recording intraocular pressure.
Nerve Fiber Analyzer (GDx)
Uses laser light to measure the thickness of the nerve fiber layer.
Normal-Tension Glaucoma
Also called low-tension glaucoma. A rare form of glaucoma in which intraocular pressure stays
within the normal range (12-22 mm Hg), but damage still occurs to the optic nerve and visual
(Primary) Open-Angle Glaucoma
The most common form of glaucoma in the western world. This form of glaucoma usual y
develops very slowly as the eye's drainage canals gradual y become clogged. There are no early
warning signs for open-angle glaucoma, which is why it is often called the "sneak thief of sight."
An exam used to look at the inside of the eye, especial y the optic nerve. A device with a smal
light on the end is held up to the inside of the eye in a darkened room. This device lights up and
magnifies the eye, so that the shape and color of the optic nerve can be seen.
Optical Coherence Tomography (OCT)
Measures the reflection of infrared light off eye tissues to produce an image of the retina and
optic nerve.
Optic Nerve
The nerve in the back of the eye that carries visual images to the brain.
Also known as the visual field test. A test that produces a map of the complete visual field, to
check whether there is damage to any area of vision.
Peripheral Vision
The top, sides, and bottom areas of vision. These are usual y the first areas of vision affected by
The opening that controls how much light enters the inner part of the eye.
The part of the eye that carries images to the brain through the optic nerve.
The tough, white, protective outer covering of the eye.
Secondary Open-Angle Glaucoma
A form of glaucoma that can occur as the result of an eye injury, inflammation, or tumor.
Includes forms such as pigmentary glaucoma and steroid-induced glaucoma.
The use of a device to measure the pressure in the eye. There are two types of tonometry:
• Air Puff: This is the only type of tonometry that does not touch the surface of the eye. The
patient sits facing the instrument, and a warm puff of air is directed at the eye.
• Applanation: The patient's eye is first treated with numbing drops and a stain called
fluorescein. The tonometer is then placed gently on the cornea, and a very small amount of
pressure is applied to the cornea. The patient may sit in front of the tonometer or a hand-held
tonometer may be used.
Trabecular Meshwork
The formal name of the mesh-like drainage canals surrounding the iris.
How Glaucoma Research
Foundation Is Speeding The Cure
Glaucoma is the leading cause of preventable blindness. Founded in 1978 in San Francisco, Glaucoma Research Foundation (GRF) works to prevent vision loss from glaucoma by investing in innovative research, education, and support with the ultimate goal of finding a cure.
Leading the Way In Glaucoma Research
The Col aborative Normal Tension Glaucoma Study, funded by GRF, was the first control ed clinical trial to establish that lowering eye pressure preserves vision. Now, another major col aborative effort, Catalyst for a Cure, is redefining how glaucoma research is conducted and speeding the process of discovery. The Catalyst for a Cure research consortium brings together scientific investigators from university laboratories who are working to understand the genetic and neurologic development of the eye and find ways to intervene to stop glaucoma's progression. In addition, GRF invests in Shaffer Grants—individual study grants awarded to researchers with promising new ideas to bring to the field of glaucoma which might otherwise be overlooked or go unexplored.
The Glaucoma Research Foundation, a 501(c)(3) non-profit organization, receives no government funds and is almost entirely supported through donations from private individuals—often patients like you.
GRF Mission
To prevent vision loss from glaucoma by investing in innovative research, education, and support with the ultimate goal of finding a cure.
Pictured On The Cover: "My glaucoma diagnosis came at me right out of the blue. I didn't even know young people could get glaucoma. In the future, I hope there will be more education, awareness, and checking for eye problems in kids and "Our collaborative approach to research is bringing exciting new insights into understanding vision loss in glaucoma." - Philip J. Horner, PhD University of Washington, and principal investigator in Glaucoma Research Foundation's Catalyst for a Cure consortium Understanding and Living with Glaucoma
Copyright 1984, 1986, 1988, 1990, 1992, 1993, 1994, 1996, 1999, 2000, 2001, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2011, 2012 by the Glaucoma Research Foundation (GRF). All rights reserved. No parts of this publication may be reproduced without written permission from the Glaucoma Research Foundation.
Glaucoma Research Foundation is a national, non-profit tax-exempt organization dedicated to funding innovative research to find a cure for glaucoma. GRF's education and outreach programs include the free newsletter Gleams, the comprehensive website, patient education brochures on glaucoma, and this guide for
people with glaucoma and their families.
Editor: Andrew JacksonReviewed by the American Academy of Ophthalmology Special thanks to the National Eye Institute and Terri Pickering, MD for the use of testing photos.
Library of Congress catalog number 88-207450ISBN 978-0-9621579-0-2 251 Post Street, Suite 600, San Francisco, CA 94108 Phone: (415) 986-3162 • Tol -free: (800) 826-6693 • Fax: (415) 986-3763


Indian time winter09.indd

inter 2009 This issue is dedicated to the life and legacy of the late Roscoe Jacobs Sr. This issue is dedicated to the life and legacy of the late Roscoe Jacobs Sr. of Bolton, longtime Chief of the Waccamaw-Siouan. of Bolton, longtime Chief of the Waccamaw-Siouan. REMEMBERING A MODERN DAY WARRIOR It is with deep affection and respect that I refl ect on the life and contributions of Chief Roscoe Jacobs, the fi rst elected and, until his death at age 86 on January 27, the presiding chief of the Waccamaw-Siouan Tribe. He also was a beloved and longstanding member of the N.C. Commission of Indian Affairs, which since 1971 has served to assist the more than 100,000 American Indians who call North Carolina home.