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Medical Forum / Diseases and Disorders / Glaucoma / February 2006Anything wrong with an aggressive approach
I am taking Xalatan right now, my IOP being around 17 on both eyes. They were around 20 before treatment. There is some damage in my left eye, while there is none on the right. Visual field shows marginal according to the doc. (ie. almost no defect). I am 40 years old. My question: is there any harm if I request my doctor to prescribe me one more medication (eg. Timolol), so that my IOP can be lower further, to 14 or 15 may be ? Is there any major side effect to Timolol ? Thanks. My personal feeling: Never take more drugs than you need. They all have side effects, interactions with other drugs, etc. Why put yourself at unnecessary additional risk? Plus, glaucoma drugs can lose their effectiveness after awhile. The more you take, the fewer you'll have left to try if you need to switch or add more later. I'd say you and your doctor should just watch your visual fields. As long as they're holding steady and you're not having problems with Xalatan, then it's working fine. Leave it alone. Laura >My question: is there any harm if I request my doctor to prescribe me >one more medication (eg. Timolol), so that my IOP can be lower further, >to 14 or 15 may be ? Is there any major side effect to Timolol ? Thanks for your response. I did not realise glaucoma drugs lose their effectiveness with time ! Thanks for bringing this up. The reason why I thought I might want to further lower the IOP was because I read on a study that by lower IOP by 30% there is a large chance that further damage can be prevented. I thought since I am relatively young I might want to take a more aggressive approach, so that if I am luck I might still be able see when I retire.... : ) **Plus, glaucoma drugs can **lose their effectiveness after awhile. The more you take, the fewer **you'll have left to try if you need to switch or add more later. Well, I'm sure there will be those who will disagree with me. You can always discuss it with your doctor and see what he thinks. Honestly, though, I read how even simple over-the-counter pain killers like Tylenol can have bad side effects for some people. I just don't think it's a good idea to use any medications you don't need. Laura >Thanks for your response. I did not realise glaucoma drugs lose their >effectiveness with time ! Thanks for bringing this up. The reason why I [quoted text clipped - 3 lines] >want to take a more aggressive approach, so that if I am luck I might >still be able see when I retire.... : ) Damn my IOP is between 20 and 22 in both eyes and my eye doctor says i don't need the drops as there is no damage although there is some amount of cupping and my cornea is slightly thicker then normal..dunno maybe its time to see a new eye doctor. Even though he see's no damage i defintely see a difference in my left eye as compared to my right eye although i did well in the visual field tests with both eyes. >I am taking Xalatan right now, my IOP being around 17 on both eyes. > They were around 20 before treatment. There is some damage in my left [quoted text clipped - 6 lines] > > Thanks. > Damn my IOP is between 20 and 22 in both eyes and my eye doctor says i don't > need the drops as there is no damage although there is some amount of > cupping and my cornea is slightly thicker then normal..dunno maybe its time > to see a new eye doctor. Even though he see's no damage i defintely see a > difference in my left eye as compared to my right eye although i did well in > the visual field tests with both eyes. As I said in another post, I'm no doctor. I'm just relating my own experience. Some people have "normal tension" glaucoma, where the IOPs are in the normal range. It's other factors like the damage to the retina that lead to the diagnosis of glaucoma.It sounds like your doctor has checked for those other factors and has not found them, so he can't make a diagnosis of glaucoma -- at least not yet. Make sure to have visual field tests done as often as the doctor recommends, and if you start developing signs of glaucoma, it should be caught early enough to begin treatment before you have lost a noticeable amount of vision. It took seven years from the time a doctor first thought I *might* have glaucoma until the time I was actually diagnosed due to a loss of peripheral vision. And I was (and still am) totally unaware of the loss. The reason your doctor doesn't want to prescribe drops now might be for the same reason one of the other posters mentioned... if the drops lose effectiveness over time, you could end up not having a pharmaceutical treatment option at a relatively young age. And the drops are not innocuous. Xalatan was the only one that didn't bother me much; one med threw me into a deep depression, and another caused a lot of irritation to my eyes. If it really worries you, though, absolutely get a second opinion. I hope all goes well for you. Cindy Thank you cindy , I appreciate the advice and it makes perfect sense too..I am just trying to avoid the damage before it happens but I guess that would be a mistake. Can high IOP give headaches? My head feels weird a lot and I had an MRI without contrast and they found no issues. Thanks again for any replies. >> Damn my IOP is between 20 and 22 in both eyes and my eye doctor says i >> don't [quoted text clipped - 35 lines] > > Cindy > My question: is there any harm if I request my doctor to prescribe me > one more medication (eg. Timolol), so that my IOP can be lower further, > to 14 or 15 may be ? Is there any major side effect to Timolol ? I am not a doctor, so I can only speak from my experience and reading. My situation is almost exactly like yours. I am 44, my IOPs were around 20 before treatment and around 17 with Xalatan. I also have peripheral vision loss in one eye. Timolol does have effects other than lowering IOP. In fact, Timolol was not an option for me because it would have worsened my asthma. If you Google Timolol, you should easily find a website that details the effects. You asked if there was any harm in asking your doctor for another prescription. Of course not; he can always say no. Do you know what your doctor's thoughts are on what your target IOP should be? My doctor quoted to me the same data you mentioned in another post, about lowering pressure by 30%, and so he told me my target pressure would be based on that -- about 14. How long have you been on Xalatan? Has your doctor mentioned anything before about the possibility of adding another medication once he has seen what the effect of Xalatan is over a period of time? When I first started treatment, my doctor put me on a single medication for a month at a time to see how much of an effect each one had on the pressures.If a couple of them individually had lowered IOP -- but not enough to hit the target pressure -- he would have combined the most appropriate ones to try to get the target pressure. I understand how it is to be thinking about how long one's vision will last. This is the first time in a long time a doctor has told me I was young and I was unhappy about it. Take care; I hope you and your doctor can work out the best and most effective treatment for you. Cindy Thank you Cindy for your response. My doctor seem to have a different perspective on target IOP. Actually quite different from what I read in the medical literature. Last time I asked him about target IOP, he said he does not believe in any easy formula to calculate target IOPs. He said to him a target IOP is an IOP that halts any further damage. He said since I am at an earlier stage of glaucoma, he would rather take a conservative approach in term of medication in the beginning, while monitoring any changes in my nerve cup (through his own eyes and with the aid of HRT) and visual field tests. If under a certain IOP my eyes still changes, he will then consider further medication. > > My question: is there any harm if I request my doctor to prescribe me > > one more medication (eg. Timolol), so that my IOP can be lower further, [quoted text clipped - 32 lines] > > Cindy > Thank you Cindy for your response. My doctor seem to have a different > perspective on target IOP. Actually quite different from what I read in [quoted text clipped - 6 lines] > the aid of HRT) and visual field tests. If under a certain IOP my eyes > still changes, he will then consider further medication. A lot of glaucoma specialists would agree with what your own specialist told you, that the target IOP is the one at which no more damage occurs, and that in early glaucoma it makes sense to take a more conservative approach. Sounds like you are in good hands. -Gudrun > I am taking Xalatan right now, my IOP being around 17 on both eyes. > They were around 20 before treatment. There is some damage in my left [quoted text clipped - 6 lines] > > Thanks. * Timolol maleate (Trade name: Timoptic) is a beta-blocker. This has been known to cause some side effects. Google on "timolol maleate" "side effects" and you'll get a ton of info. Note: the generic version is now available -- you don't need to pay the higher price of the branded version. Like this: http://www.glaucoma.org/treating/medication.html#i56 Beta Blockers COMPANY BRAND NAME GENERIC NAME Akorn Ophthalmics Timolol Maleate USP Timolol Maleate 0.5% Alcon Laboratories Inc. Betoptic S Betaxolol HCI 0.25%, 0.5% Allergan Inc. Betagan Levobunolol HCI ophthalmic solution, USP 0.25%, 0.5% Bausch & Lomb Pharm. OptiPranolo Metipranolol 0.3% Johnson & Johnson Betimol Timolol hemihydrate 0.25%, 0.5% Merck & Co. Inc. Timoptic-XE Timolol maleate ophthalmic gel forming solution 0.25%, 0.5% Decreases production of intraocular fluid. SIDE EFFECTS Side effects can include low blood pressure, reduced pulse rate, and fatigue. Beta blockers can also cause a shortness of breath in people who have a history of asthma or other respiratory disorders. Additionally, beta blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart¹s response rate during exercise. Rare side effects include reduced libido and depression. Note: There is also a drug called Trusopt, which is a carbonic anhydrase inhibitor. Ask your ophthalmologist about using Cosopt, which is a mixture of timolol maleate and trusopt. I used this drug for years with no significant side effects. There's nothing like Google. (Anything that comes from two Stanford students can't be all bad!) earle * (I am an engineer and not a health-care professional.) |
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