The Top Five Questions My Patients Ask Me About Glaucoma

An ophthalmologist provides answers to the top five questions she gets from patients in her glaucoma practice.

1. Do I have glaucoma?
   
   Some cases of glaucoma are clear cut, but others are not. There are people who end up in the category of “glaucoma suspect” because the appearance of their optic nerves suggests glaucoma, but the diagnosis is not definite. I often tell my patients that I need to get a sense of whether their optic nerves are changing over time since glaucoma is a progressive disease.
   
   There are other situations in which the diagnosis of glaucoma is challenging, for example, in patients with myopia (nearsightedness). In myopic patients, the optic nerves have a different appearance that makes the diagnosis more challenging.
   
   So, if your ophthalmologist tells you that you are a “glaucoma suspect,” the important thing to do is to continue follow-up because sometimes the diagnosis of glaucoma is made over time.


2. Will I go blind?
   
   Glaucoma is a potentially blinding disease, and it is currently irreversible with no cure. So, of course, this is an important question to ask. While your ophthalmologist cannot predict the future, there are several features of glaucoma that usually hold true. First, the more damaged the optic nerve at the time of diagnosis, the more advanced the glaucoma and the higher the risk of losing vision. And unfortunately, many patients do not know they have the disease because there are no symptoms at the early and moderate stages. Therefore, it is important to understand what stage of glaucoma you have: mild, moderate, or advanced.
   
   Second, patients who continue to seek follow-up care with their ophthalmologist decrease their risk of going blind. This is because most types of glaucoma progress slowly, and your ophthalmologist can offer treatments to slow the disease. However, you have to be a partner with your ophthalmologist, and this means coming for follow-up appointments and following the recommended treatment regimen.


3. What is my eye pressure?
   
   Eye pressure is a very important measurement, since lowering eye pressure is the only glaucoma treatment we currently have. You can ask your ophthalmologist what your “target pressure” is, and get a sense of whether you are reaching that goal. However, it is important to realize that the eye pressure ophthalmologists measure in the clinic is only one very small snapshot of your eye pressure over the course of a given year, month, or even day. Furthermore, eye pressure cannot only vary according to the time of day, but also according to when you last took your eye drops, the thickness of your cornea, your stress level, and the measurement device or technique used.
   
   While it is important to know your eye pressure, it is also important to recognize that it is only one measurement related to your glaucoma. Your ophthalmologist will also be examining your eyes and optic nerves, assessing your field of vision, and measuring your optic nerve thickness.


4. Is my glaucoma stable?
   
   The goal of your ophthalmologist is to stabilize the disease and prevent you from losing vision that could affect your long-term quality of life. So, stable glaucoma is good news. Your ophthalmologist will determine whether your glaucoma is stable by performing an eye exam, looking at your optic nerves, and measuring your eye pressures; assessing the function of your optic nerve by asking you to perform a visual field test; and quantifying your optic nerve thickness using OCT (optical coherence tomography).
   
   Sometimes determining whether a patient is stable or not is difficult. This may be due to a patient having difficulty taking visual field tests reliably, or to conditions that affect the appearance or thickness of the optic nerve, such as myopia (nearsightedness). Your ophthalmologist will synthesize all of the available information to determine whether your disease is stable, and if not, have a conversation with you about next steps in advancing treatment.


5. Can lifestyle changes improve my glaucoma?
   
   There is no clinically proven lifestyle modification that improves glaucoma. However, there are some activities and lifestyle modifications you might consider for your overall health. Just recognize that ophthalmologists may have varying opinions on the benefits of lifestyle changes.
   
   First, general advice about improving your overall health applies: eat in moderation, maintain a healthy weight, perform aerobic exercise, and don’t smoke. There is some evidence that eating green leafy vegetables decreases the risk of developing glaucoma. Currently, there are no clinically proven vitamin supplements that will improve or even slow glaucoma.
   
   Second, in terms of exercise, aerobic exercise is good for the body and also good for glaucoma. However, other types of exercise that are good for the body, such as yoga, can temporarily increase eye pressure. I usually tell patients that many yoga positions, such as sun salutations and warrior positions, combined with breathing exercises, should not be avoided, but positions in which the head is inverted, such as shoulder stands, will raise the eye pressure. However, this effect is temporary and has not actually been proven to worsen glaucoma.
   
   Third, alcohol and caffeine consumption in moderation is prudent.
   
   Finally, the guidelines for blood pressure control continue to evolve, with more strict targets being set by internists and primary care physicians. Having low blood pressure can be a risk factor for developing glaucoma, so it is important for people who have glaucoma not to be overtreated for high blood pressure. Of course, blood pressure control has to be weighed against the possibility of heart attack or stroke, so this is a conversation that you should raise with both your ophthalmologist and internist. Your doctors should work as a team to make sure your health and your eyes are appropriately treated.