January 2023 Newsletter

MESSAGE FROM THE PRESIDENT

Dear Readers,

In 2022, TGF made important strides in our research and education initiatives. We’re ringing in the new year with another new webinar for patients, a discussion and Q&A on lifestyle recommendations for glaucoma with Dr. Aakriti Shukla of Columbia University. Join us live on January 4 or watch the recording on our website.

With glaucoma still the leading cause of preventative blindness, increasing awareness remains critical. January is Glaucoma Awareness Month. We urge you and your family to heed its call and make an appointment to have your eyes examined. Early diagnosis and ongoing treatment can save your sight.

To spread this message, we have placed several bus shelter posters in Manhattan, Brooklyn, and Queens, a public service announcement on 1010WINS Radio, a billboard in Jackson Heights, and a broad campaign on social media. We are also excited to announce that on January 19, in partnership with the STEM Institute (CCNY), we are launching an innovative pilot program to educate young people about glaucoma.  We look forward to telling you more about this project as it progresses.

In 2021, we announced that the Foundation, in partnership with Research to Prevent Blindness (RPB), is granting fellowships to young physicians specializing in glaucoma. Three doctors were awarded the fellowship last month and you can read about them in this newsletter.  

We have also continued to expand our Board of Directors. Our newest members are Annette Grollman, president of Oestreicher Medical Communications, and Barbara Hearst, a former Board member who rejoined us in December. We are grateful for their dedication and enthusiasm for our mission.

In closing, we thank you for being a newsletter reader and a supporter of TGF’s efforts.

In closing, we thank you for being a newsletter reader and a supporter of TGF’s efforts. In the year ahead, we look forward to continuing answering questions and addressing subjects of importance to you. If there are topics you would like us to explore in future issues, let us know at info@glaucomafoundation.org.

With all best wishes for a happy and healthy New Year, 

Elena Sturman

DOCTOR, I HAVE A QUESTION.
How should I use my eye drops?
Question answered by Aakriti Garg Shukla, MD

Dr. Shukla is a board-certified ophthalmologist, fellowship-trained glaucoma specialist, and the Leonard A. Lauder Assistant Professor of Ophthalmology at the Columbia University Irving Medical Center.

Currently, the goal of glaucoma treatment is centered on the prevention of progression, or worsening, of glaucoma. Complementary to this aim and equally important is to help patients maintain their vision-related quality of life, which can be associated with many factors including treatment burden, the extent of glaucoma severity, and other topics beyond the scope of the present discussion.

Lowering the pressure inside the eye is the only known way to prevent the worsening of glaucomatous damage. This is accomplished by eye drop medications, laser procedures in the office, or surgical procedures in the operating room. While medicated eye drops are the option most patients and ophthalmologists choose first, their use is not completely straightforward. Below are common questions regarding eye drops:

How should I get the drop in my eye? It tends to land on my cheek or forehead. My recommendation is to optimally position your body and hand to maximize the chance that the drop will successfully land on your eye. First, lie flat when instilling drops. This could mean laying down on a bed (probably the easiest way) or laying your head back - ensure that your head is completely horizontal - when sitting down. Second, prepare your hand by resting it on the bridge of your nose, forehead, or cheek. Third, gently squeeze the bottle to elicit a drop. In some bottles, this will require a slightly stronger squeeze, while in others, the drop will come out due only to the effect of gravity. Some people find a benefit in pulling down their lower lid to ensure the eye stays open.

The eye drop landed in my eye. What do I do now? I recommend closing your eye for about a minute to ensure the drop is absorbed. One can also press gently on the inner aspect of the eyelid near the nose to prevent systemic absorption of the medication. This is known as nasolacrimal occlusion and is more important for certain eye drops (especially beta-blocking medications such as timolol) than others. Performing this maneuver can also help you avoid an unpleasant taste in your throat after instilling the drop, which sometimes occurs when the drop travels down the canal that connects your eyes, nose, and throat.

No matter what I do, I cannot make the eye drop land on my eye. What are my options? The options for you will be based on what your ophthalmologist recommends, but almost everyone can use an eye drop instillation device. These are available over-the-counter at most pharmacies and online. Studies on these devices have mixed results, although most have shown that they help with successful drop instillation, are associated with less bottle tip contact on the periocular or ocular surface, and allow for the release of only one drop from the bottle compared to traditional techniques. Most patients report that these devices are relatively easy to use.

Depending on the type of glaucoma you have and other factors specific to your condition, alternatives to eye drops include selective laser trabeculoplasty, an office-based laser procedure, and incisional glaucoma surgery in the operating room.

How many drops from each bottle do I need to get into my eye? You need just one drop from each bottle into the eye at a given time. Some glaucoma medications are dosed once a day, while others are dosed as frequently as four times a day. Regardless of the frequency, you need no more than one drop at each dosing. There is some evidence that you need less than one drop at a time for it to have a sufficient pressure-lowering effect. Devices that use innovative techniques to deliver less than a drop of medications, which may make medication bottles last longer, are being studied. While their efficacy is still being tested, the results are quite promising. For patients taking preservative-free eye drops, the drops come in individual vials, and are intended for one-time use only.  One week of vials come in a foil pouch, and should be stored in pouch until use. Once pouch is opened, the vials should be used within 15 days, or discarded.

How long do I need to wait between various types of eye medications? Many patients are on more than one type of eye drop. If using more than one type of medication at a time, it is important to separate the different medications by 5 minutes. Some of my patients say that they wait for an hour or two between multiple medications. This is also fine to do, but if using three types of medication, it could mean that you spend your entire evening putting in eye drops. This is not practical or necessary. It is also not necessary to use the drops in a specific order.

Do the eye drops have side effects? Glaucoma medications can have side effects that vary from ocular surface discomfort (often manifests as a sandy feeling in the eye) to changes in your heart rate. These are specific to each class of medication and it is important to inform your ophthalmologist immediately if you notice a change in your eye or systemic health. 

JANUARY IS GLAUCOMA AWARENESS MONTH

Start off the New Year by scheduling an appointment for a comprehensive eye exam. It could save your sight.  

Glaucoma, the silent thief of sight, is a group of eye diseases that affect the optic nerve and permanently impair your vision. It is the leading cause of preventative blindness, affecting as many as 80 million people around the world. The number of glaucoma patients is estimated to increase 40% to almost 112 million by 2040.

Many people are unaware of their risk, and at least half of those with glaucoma experience no symptoms until significant damage and loss of vision has occurred. Right now, as many as 1.5 million Americans are unaware that the disease is silently damaging their optic nerves.

Glaucoma can run in families, and it disproportionately affects people of African and Latin descent. Although most patients are diagnosed after the age of 40, glaucoma can arise at birth or at any time of life.

TGF urges you to protect your vision. Make a comprehensive eye exam a part of the annual healthcare for yourself and your loved ones

 High-risk factors for glaucoma include:

People over the age of 40. 
While glaucoma can develop in younger patients, it occurs more frequently as we get older.

People who have a family history of glaucoma. 
Glaucoma appears to run in families. The tendency for developing glaucoma may be inherited. However, just because someone in your family has glaucoma does not mean that you will necessarily develop the disease.

People with abnormally high intraocular pressure (IOP). 
High IOP is the most important risk factor for glaucomatous damage.

People of African, Hispanic, Latino, and Asian descent. 
People with African and Latino ancestry have a greater tendency for developing primary open-angle glaucoma than do people of other races. People of Asian descent are more prone to develop angle-closure glaucoma and normal-tension glaucoma.

People who have:
– Diabetes
– Myopia (nearsightedness)
– Regular, long-term steroid/cortisone use
– A previous eye injury
– Extremely high or low blood pressure
– Thin central corneas

Comprehensive eye exams are recommended for:

Everyone under 40: every three to four years.

Individuals under 40 with one of the above risk factors: every one-and-a-half to two years.

Everyone 40 years or older: every one-and a-half to two years.

Everyone 40 years or older with an additional risk factor listed above: annually.

Although there is still no cure, the good news is that glaucoma can be managed if it is detected early. With early diagnosis and medical and/or surgical treatment, most people with glaucoma will not lose their sight.