Glaucoma: what every patient should know. Part 3. What treatments are the right ones? Drops, scissors, laser

This part of the article discusses present mainline therapy for glaucoma, lowering the eye pressure: daily eye drops, laser treatment to the angle, or various forms of surgery. Though each method works, they all have their own advantages and downsides. Choice of the starting treatment largely depends on the form of glaucoma and should be a mutual decision of both the doctor and the patient. Eyedrops are the most widespread beginning treatment and can be enough for many patients. Their strong points are that they usually don’t do permanent damage to the eye, they work as indicated the majority of the time and, in case of necessity are easily switched to something else, mostly without any ill effects. The two weak points are: side effects and adherence problems. Side effects vary from temporary to lasting and serious, that can force about 10% of patients to stop regular instillations. The second problem with taking drops is adherence: patients forgetting to take them or not taking them as prescribed. As for laser angle treatment, its good points are that it is nearly impossible to hurt vision or the eye when done properly, and, having laser treatment doesn’t prevent a person from later using other treatments to lower eye pressure if the laser doesn’t work. It’s painless, takes only eyedrop anesthesia, takes about 15 minutes to do, and vision is nearly normal immediately. It’s biggest problem is that laser angle treatment often isn’t powerful enough. It works best for those with uncomplicated or primary glaucoma, and probably shouldn’t be tried in those with secondary glaucoma. The main upside of glaucoma surgery is a reasonable success at lowering pressure. As for the risks of surgery, they can be grouped into the bothersome, such as a gritty sensation and the dangerous, such as overly low pressure potentially aggravating vision, infections and risk of cataract development. Further details are given on hypotensive drop instillations. According to the studies conducted over the last years, patients instill from 20% to 75% of the prescribed medicine. Possible reasons for the adherence problems are numbered. The importance of having an iron-clad reminder system is emphasized, for example, wrist watch alarms going off every day or every 12 hours, relatives reminding to take drops, making instillation schedules, linking the instillations to something in daily routine and keeping the medicine in plain sight. The article dwells on the doctor-patient collaboration when taking the drops, gives tips for the doctors that could help increase the adherence and finally the 13 ways the patient can get glaucoma eye drops into the eye, while being effective at lowering eye pressure and saving money are enumerated in details.

glaucoma, hypotensive drops, laser treatment, glaucoma surgery, adherence, глаукома, гипотензивные капли, лазерное лечение, хирургия глаукомы, приверженность лечению