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While researchers are actively seeking new therapies to treat glaucoma, the only proven treatment to prevent glaucoma from developing or getting worse is to lower the pressure in the eye.
Eye pressure is a proven cause of glaucoma and currently the only known modifiable risk factor for progression. Glaucoma can occur at any eye pressure and the exact safe eye pressure for individuals varies. Some people may need an eye pressure in the low teens, while others can tolerate eye pressures that are in the twenties.
Eye pressure can be lowered with medications, laser procedures and surgeries. Most people with glaucoma and those at high risk of developing glaucoma will use medications at some point to lower eye pressure in order to prevent the disease from getting worse. While there are many effective medications, the fact remains that a large number of patients do not take medications as prescribed.
A series of recent publications has documented that only about 70% of prescribed doses of medications are taken in most chronic diseases. While many patients take nearly 100% of the doses prescribed, many take far less. This has been shown to be true for glaucoma patients as was demonstrated using pharmacy claims data as well as direct monitoring of patients.
Taking eye drops poses real challenges. Just physically getting a drop in the eye can be difficult, particularly for older patients with arthritis or hand tremors. Remembering to take drops is a stumbling block. Important factors associated with poor drop taking include older age, traveling, missing appointments, and cost. In addition, when patients do not believe that glaucoma can cause vision loss they are less likely to take their drops. A final important determinant of who takes drops as prescribed is cost. Some patients cannot afford the medications they are prescribed.
Overcoming these obstacles requires ongoing communication with the doctor as well as self-motivation. For those who have difficulty with the mechanics of putting drops in the eye, drop guides are available from most manufacturers or are sold by independent companies. If these do not help, patients might consider finding somebody who can help put the drops in for them.
Patients also need to learn more about glaucoma in order to understand that it can lead to severe vision loss if untreated, but that most people with properly treated glaucoma will have vision for as long as they live. Organizations like the Glaucoma Research Foundation (www.glaucoma.org) and the National Eye Institute (www.nei.nih.gov/health/glaucoma) offer comprehensive, free information about glaucoma.
Finally, patients can ask for lower cost medications if cost is an issue. Beta blockers are now commonly available for as little as $5 per month and are effective therapy. Other medications are coming down is price as well, as patents expire and more generics become available.
Financial assistance is available to qualified patients through programs such as EyeCare America (call 1-800-391-EYES), Pfizer Helpful Answers (1-866-706-2400), and others. For a complete list online, visit www.glaucoma.org/living/financial_assis.php.
Article by David S. Friedman, MD, Professor of Ophthalmology at Wilmer Eye Institute, and Professor of International Health at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Last reviewed on May 14, 2021