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COPING WITH GLAUCOMA
by Edith Marks

To keep this article current, the editors of therubins have inserted some later news items about glaucoma. Edith Marks article is located below the editor's note items,

Editor's Note: (12/30/08)- The FDA has cleared for sale Allergan's prescription drug Latisse, to treat hypotrichosis of the eyelashes. The drug makes eyelashes longer, darker and thicker. Latisse contains the same main ingredient as does the company's Lumigan, which has been on the market since 2001 to treat glaucoma.

The company said it would introduce the drug to the U.S market sometime in March 2009. Allergan is best known as the maker of Botox, the wrinkle smoothing medication.

Editor's Note: (12/2/08)- There are many causes for glaucoma, but scientists believe that the elevated pressure is caused by clogging in the trabecular meshwork tissue that serves as a drainage for the eye. A new minimally invasive surgery for the disease seems to be gaining more medical acceptance. It is called canaloplasty but the data on the procedure only covers a 2-year period of time.

Traditional surgery for the disease is called trabeculectomy, in which a portion of the trabecular meshwork is removed.

Canaloplasty involves forcing open a drainage canal, wherein an incision is made in the eye and a thin catheter is inserted into Schlemm's Canal, a tube in the trabecular meshwork. A thick gel is injected to open the canal and a surgical tie is placed inside the canal and pulled tight to stretch open the trabecular meshwork.

The procedure takes about a half-hour and can be done under local anesthetic with a sedative. The procedure can cost between $2, 500 to $3,500 and many insurance companies do pay for it

The catheter is made by iScience Interventional Corp., a Menlo Park, Cal. Company.

Editor's Note: Bausch & Lomb announced that it had won approval from the FDA to manufacture a generic form of the glaucoma treatment Alphagan. The company will have the exclusive right to manufacture the generic version of the drug though September 20, 2003. Allergan makes Alphagan, but Bausch & Lomb and Alcon won a patent case in the federal appeals court in March 2003 to make a generic version of the drug. Allergan said that it intended to make a generic version of the drug also.

Dated: May 31, 2003

Editor's Note: The recently published results of a study of prescription eye drops used to treat elevated pressure inside the eye showed that it can result in the delay or possible prevention of the onset of glaucoma. The results of the study were published recently in the Archives of Ophthalmology. The pressure-lowering drops cut the risk of developing primary-open angle glaucoma, the most common form of the disease by 50%.

The study was conducted at 22 medical facilities, and there were 1,636 people involved who were between the ages of 40 to 80, who had elevated eye pressure but showed no signs of glaucoma. Half were given daily eye drops; the other half were observed by did not receive any medications for the eyes. The eye drops used were derived from beta-blockers.

For those who received the drops, eye pressure was reduced by about 20%, and only 4.4% of this group developed glaucoma within five years, compared with 9.5% of those who did not receive the drops. Dr. Michael Kass, chairman of the department of ophthalmology and visual sciences at the Washington University School of Medicine in St. Louis led the study.

According to Dr. Robert Stamper, director of the Glaucoma Service at the University of California at San Francisco: " It is important to remember that most people with elevated pressure will not go on to develop any kind of vision loss over the next five years." He added: " Is it worth adding another medication, with its side effects and costs, to a person whi is already taking a number of medications and is on a limited income."

Dated: June 18, 2002.

Editor's Note: Julie Bain had an interesting article updating glaucoma treatment in the December 25, 2001 edition of the N.Y.Times entitled "As Glaucoma Treatment Advances, Vision is Saved". The article points out the fact that 3 million Americans have glaucoma, and it is the 2nd leading cause of blindness in this country.

In quoting Dr. Robert Rich, a professor and chief of glaucoma at the New York Eye and Ear Infirmary he points out that: " With proper treatment, and if patients do their part, they should be able to see for the rest of their lives". The article also points out that blacks are four times as likely to have open-angle glaucoma as are whites. The elderly with high blood pressure are much more likely to get glaucoma than are those whose pressure is under control. About 50 % of Americans with glaucoma do not realize that they have it.

Newer drugs that are used to treat the disease include ones based on prostaglandins, and they have been more effective at lowering pressure without having too many side effects. According to Dr. Rich: "But now the success rate from surgery is about 95 percent". Several British studies have shown that surgery is more effective than is drug treatment, but this fact has not been born out by U.S. researchers. Some interesting results have come to pass with drugs similar to those used to treat multiple sclerosis. Dr. Michal Schwartz, a professor of neuroimmunology at the Weizmann Institute of Science in Rehovot, Isreal is developing a glaucoma vaccine which researchers may begin testing in people in the next year or two.)

Dated: December 30, 2001

Editor's note: The Food and Drug Administration (FDA) announced the approval of two new drugs to treat the elevated intraocular pressure which is often associated with glaucoma - Lumigan (bimatoprost ophthalmic solution) 0.03% and Travatan (travoprost ophthalmic solution) 0.004%. They will provide additional alternatives for the reduction of intraocular pressure in patients who are intolerant of other intraoular lowering medications, or in patients who have had insufficient responses to other intraocular pressure lowering medications. Many of these patients might otherwise need surgery for management of their glaucoma. Allergan, Inc. of Irvine, California will market Lumigan. Alcon Universal, Ltd of Fort Fort Worth, Texas will market Travatan. Allergan is expected to begin marketing the drug sometime in the next 6-12 weeks. The new drug is expected to go head to head against Pharmacia's Xalatin.

Coping with Glaucoma
by Edith Marks

(4/11/00)-Eyesight is a terrible thing to lose, and when one is diagnosed with a blinding disease such as glaucoma, that knowledge can be terrifying. But what most people don’t know is that glaucoma is the second leading cause of preventable blindness. Complete loss of sight or legal blindness occurs in only l0% of the glaucoma cases.

While glaucoma primarily affects persons sixty-five or older, it can occur in babies, juveniles and in those who are twenty, thirty, forty, and fifty. People of all races get glaucoma but African-Americans are 4-5 times more likely to be affected, and in the age range of 35-45 more likely to lose significant vision.

There are over forty different kinds of glaucoma. Open angle glaucoma is the most prevalent, and most of these glaucomas are called the "silent thief of sight" for they are painless. The only indication that you know you have glaucoma is to have an eye examination performed by an ophthalmologist or optometrist. There is one glaucoma, however, that announces itself loud and clear. It is angle-closure glaucoma. The patient may see halos, have a severe headache, feel nauseated and the eye may get red. If this situation occurs it is imperative to seek medical help immediately for eye pressure can rise dramatically and vision can be lost in a short period of time. Another kind of glaucoma, not easily detected, is normal tension glaucoma. People with this type of glaucoma may pass the vision-screening test where only a pressure check is made and all the while they are losing sight.

At present all treatment for glaucoma is aimed at lowering the intraocular pressure (pressure that builds up within the eye.). With most glaucoma patients pressure is higher than the normal 10-21 millimeters of mercury. High pressure damages the thin optic nerve fibers that carry the messages from the retina to the visual centers in the brain. If this system is impaired – light entering through the pupil, taken up by the photoreceptors in the retina, sent via ganglion nerves to the optic disk and then onto the brain – loss of sight will occur.

Medical treatment for glaucoma consists of eyedrops, laser therapy and operations that are all directed at lowering the intraocular pressure. The eyedrops are the first line of defense and these are aimed at reducing the amount of fluid manufactured by the eye and increasing the outflow of fluid.

Side effects from medications do occur and these can range from mild tosevere. The beta-blocker drugs (Timoptic, etc.) can cause cardiac and pulmonary problems as well as depression, but they do such a good job of lowering eye pressure that ophthalmologists use them as the gold standard. Other eyedrops include Xalatan, which is a prostaglandin derivative and is taken once at night.

This medication has fewer side effects except that it causes a darkening of the iris in people with hazel eyes. Another medication now commonly described is Alphagan. Its side effects include an irritated cornea, inflammation and red eye. For some people the eyedrop Trusopf, which acts to decrease the amount of fluid, manufactured may be appropriate. This drop is made from tablets that are prescribed to maintain a lower pressure.

These tablets cause serious side effects including kidney damage and pernicious anemia in a few cases. Trusopf does not have these side effects, but it may cause red eye, and for people who are sensitive to sulfur drugs an allergic reaction. There is a combination drug, Cosopf, on the market that combines Timoptic and Trusopf.

Laser treatment consists of applying laser to the trabecular meshwork, which is the drainage channel for the eye. This procedure can be done twice and with some patients, a third time. It reduces pressure but patients still need to use eyedrops and the effect can last from just three-to-five years.

When pressure continues to rise ophthalmologists recommend an eye operation to create another channel for the outflow of fluid. This is accomplished by cutting a flap in the sclera, the white part of the eye. A hole is then created right into the eye. Fluid leaks out of the hole under the flap. In so doing a bubble or bleb forms. As long as this bubble remains patent, the operation is working. In the past the body eager to repair damage to its systems scarred over the flap, but now, using anti-scarring medications, ophthalmologists are able to achieve about an 80% success rate.

An important element in coping with glaucoma is learning techniques you can do for yourself. Exercise has been documented as means to lower your pressure, especially if you do aerobic for fifteen minutes or more. Meditation for stress reduction may help your condition. Some people claim that prayer is effective.

There is some evidence that supplementation of bilberry, gingko biloba, grape seed extract and the antioxidants, such as vitamins A, C, and E and all the carotenoids that mop up free radicals (these are destructive molecules that destabilize cells) will help to maintain optic nerve health. And don’t neglect the B-vitamins. All of the B’s have been documented as supporters of optimal eye function.

Diet is extremely important. Eat lots of green, leafy vegetables, especially vegetables such as kale, collards and chard. Eliminate or reduce your intake of white flour products, white rice and sugar. Whole grains are best. Saturated fats should be used sparingly, but you want to include the essential fatty acids that are found in fish such as salmon, sardines and mackerel, in flaxseed and in olive oil. You can take a supplement such as Evening Primrose Oil, Borage Oil, or Black Current Seed Oil capsules.

Many people find that they feel better about their conditions when they join a support group. In New York City, Prevent Blindness America, 212-980-2020 offers a10-month program that meets on the third Saturday of each month from September through June. A guest speaker in the field of eye care is schedule for each meeting.

For addition free information click on The Glaucoma Foundation and click on http://www.glaucoma.org (The Glaucoma Research Foundation).

The Food and Drug Administration has approved another drug in the battle against glaucoma. The drug is Novartis A.G's Rescula. According to the latest figures glaucoma affects about 4 million people in the U.S., and about 5 million in Europe. Xalatan, which was discussed in the article above, is presently the top selling glaucoma medication, with sales in 1999 of about $507 million. Pharmacia Corp manufactures Xalatan.)

RESCULA. This is the newest glaucoma drop to reach the United States market. It has been used in Japan since 1994 and has generated a great deal of research. Although still unclear, its mode of action for reducing IOP is believed to increase the flow of fluid via the uvea-scleral route and also through the trabecular meshwork.

There is a possibility that Rescula will have a neuro-protective effect. It is in the DHA family (docosanoids that are omega 3 polyunsaturated fatty acids). DHA phospholipids are essential for the development and functioning of photo-receptor cells and accounts for as much as 50% of the total fatty acids of the rods outer segment of phosopholipids. The photoreceptor cells receive DHA from both dietary sources and a recylcing of DHA from the retinal tissue.

The endothelial cells in the eye play a role regulating blood flow. They are stimulated by nitrous oxide. With open angle and normal tension glaucoma these cells may have a restrictive effect on blood flow. DHA is believed to counter this restrictive effect.

Clinical tests have demonstrated that Rescula can be used both as a mono-or adjunctive therapy. Measured against Timoptic it doesn’t quite lower IOP as effectively, (3-4 mm Hg against 4-6 mm Hg,) but it does not affect the pulmonary-vascular system. Its side effects include, burning and/or stinging when instilled, itching, dry eyes, lengthening of eyelashes, brown pigmentation of the iris. Other side effects include blepharitis, cataract, conjunctivitis, corneal lesion, eye hemorrhage, eye pain, keratitis, photo phobia, vitreous disorder and discharge from the eye.

Note: A precursor to DHA is linolinic acid that is one of the essential fatty acids. It is found in Black Current Seed Oil and Evening Primrose Oil.

For comprehensive information you might want to take a look at Coping with Glaucoma by Edith S. Marks, Avery Publishing Group. This book is in all bookstores and is available on
http://www.amazon.com and http://www.barnesandnoble.com

If you wish to chat with Edith Marks on line, e-mail to edjamark@aol.com.

By Edith S. Marks
updated December 16, 2000

Author, Coping With Glaucoma

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"

updated December 30, 2008

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