Greetings!  Every year or so I like to post the details of
my own glaucoma case -- it is a very positive story!

I was first diagnosed as a glaucoma suspect 35 years ago in 1970.  I
was only 39 years old at the time.  I  will be 74 next month.  My
intraocular pressures (IOP) were typically 22/25 mmHg.

I went through some tests including field measurements and several
tests that are not done any longer -- for example, the
"water-provocative" test, where the patient drinks about six glasses
of water in a short period of time and the IOP is measured at brief
intervals.  I was diagnosed with common open-angle glaucoma and
pilocarpine was prescribed -- one drop four times per day in each
eye.  This brought the IOP down to something like 18 or 20.  I had
very little visual field damage.

Pilocarpine, in addition to its short-term activity (only about four
to six hours), is a terrible drug!  It hurts!  It gave me a 'brow
ache' for the first 30 minutes or so.  In addition, it reduces the
pupil down to a very small size, which makes driving in the dark
very scary.  And finally, it induces myopia (at the age of 39 I
still had pretty good accommodation -- that means the ability of the
eye lens to focus at different distances).  My myopia after taking
pilocarpine was six diopters!  (I measured it myself.)  Six diopters
of myopia means that the eye is focused about six or seven inches
away.  This would last about 45 minutes after taking the drops.

After a few years the pressures were creeping up and so we added
epinephrine to the regimen.  And that worked for a while.  About
every five years or so, we would add a new drug in order to stay
ahead of the problem. Timoptic, Cosopt, Alphagan, Betoptic, you name
it. Over a period of about 25 years, I think I used every drop known
to man.  The most recent drop I used was Xalatan (and I have the
curly lashes to prove it!)

I also had argon-laser trabeculoplasty (ALT), which did not seem to
do any good.

My right eye was beginning to show the presence of a cataract, which
was probably induced by the years of pilocarpine therapy.

About five years ago my ophthalmologist suggested that it is time we
considered trabeculectomy surgery.  We scheduled a combination of
trab surgery and cataract/lens replacement at the same time.  The
surgery went well.  We operated both eyes, about six weeks apart (no
surgeon will operate both eyes at the same time -- the danger of
infection could be catastrophic).

The outcome:  Fast forward to today.  My IOP is typically 15/16 with
*NO* drops at all.  I have a little more than one diopter of myopia
(this was chosen by me, by the way, when we selected the implant
lenses.  This means that I am now naturally focused at about 20
inches distance -- perfect for reading, computer operating, etc. --
I wear -1.25 diopter glasses when I drive.)  I have a few small
peripheral scotoma (areas in the retina of reduced sensitivity)
which are not significant.

My corrected central visual acuity is 20:20; I have no problems
driving at night.  I see my ophthalmologist three times a year.  She
is my hero!

My ophthalmologist is Mary Ann Lloyd, MD at the Palo Alto Medical
Clinic in California.

My advice to *all* glaucoma patients:  You must first satisfy
yourself that you have a very good glaucoma specialist.  Then, do
what you are told.  Follow the doctor's orders.  The use of drops
should become a routine like brushing your teeth.  Don't miss a drop!

And I hope your outcome will be as positive as mine was.

Good luck!

earle
*
(I am an engineer and not a health-care professional.)
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