The importance of eye drops for glaucoma.
What is glaucoma?
Glaucoma is the name given to a group of eye conditions in which nerve fibres in the optic nerve are damaged where they leave the eye. This results in parts of your vision being lost. Glaucoma commonly affects both eyes, although one may be more affected than the other. Most often, the off-centre (peripheral) vision is lost first.
Aqueous humour is the clear, watery fluid that fills the front portion of the eye. The aqueous humour bathes and nourishes the lens and maintains pressure within the eye. In glaucoma, aqueous humour builds up and increases pressure within your eye. This increased pressure can damage the optic nerve directly or restrict blood flow, damaging the optic nerve indirectly.
Loss of vision caused by glaucoma often goes unnoticed because the central vision, for reading and recognising faces, remains good. Also, one eye can make up for vision loss in the other eye, unless both of your eyes have lost vision in the same area. For this reason, a lot of damage has often been done before a person with glaucoma realises there is a problem with their sight. The loss of the peripheral vision can make people with glaucoma more likely to fall and may affect eligibility to drive. If left untreated, the damage continues (‘progresses’), usually slowly over a period of years, eventually affecting your central, detailed vision.
Although any vision which has been lost from glaucoma cannot be recovered, with early diagnosis, careful monitoring and regular use of the treatments, the vast majority of people with glaucoma retain useful sight for life. Glaucoma affects about two in 100 people over the age of 40 in the UK. However, glaucoma gets much more common as people get older, with about 1 in 10 people over 75 having glaucoma.
Why should I use eye drops for glaucoma?
Eye drops are currently the most common treatment for glaucoma. Other treatments such as laser are becoming increasingly common, but you will usually need to use drops as well. There are also surgical options.
Eye drops control the fluid inside your eye by reducing the amount being produced and/or increasing the amount being drained. This reduces pressure to stop further damage to the optic nerve and prevent more vision loss. In addition to regular eye tests and generally looking after yourself, using your glaucoma eye drops is vital and a really important thing to do to protect your eyesight.
The drops won’t restore or improve any vision you’ve already lost to glaucoma – but they should prevent further damage. Once you start using eye drops, it’s important to continue using them. Stopping them could further damage your eyes and you risk losing more of your sight. As glaucoma is often symptomless, the damage may not be obvious until your next appointment, so it’s important to use your eye drops as prescribed – and to keep using them until your eye specialist tells you otherwise.
What are the different types of eye drops for glaucoma?
There are several different types of eye drop for glaucoma. Your eye specialist might need to change your treatment until the right drop, or combination of drops, is found. Some drops are preservative-free as some preservatives may irritate your eyes, especially if you have moderate or severe dry eyes.
The different drops fall into five main categories, which work in slightly different ways:
- Alpha agonists - reduce production and improve flow of fluid.
- Beta blockers - reduce production of fluid.
- Carbonic anhydrase inhibitors - reduce production of fluid.
- Cholinergic inhibitors - improve flow of fluid.
- Prostaglandin analogues - improve outflow of fluid.
Why people stop putting in eye drops for their glaucoma
We now know how important it is to take glaucoma eye drops as prescribed.
So why would someone not take them? There are many reasons why some people stop taking their eye drops:
Physical:
- They cause side effects to the eyes such as itchy eyes, stinging of the eye and/or blurred vision.
- They can also cause other side effects such as fatigue, dizziness and a dry mouth.
- During Ramadan, people are concerned they are consuming food and/or drink as they can taste the eye drops at the back of their throat. However, eye drops are not considered food or drink, so they do not break the fast.
Practical:
- They struggle getting the drops in and have no-one to help them.
- They have run out of eye drops and cannot get another prescription for several days.
- They’ve never been shown how to put their drops in correctly.
Psychological:
- They feel that putting a colourless liquid in their eye will not help their vision.
- They think that they only needed to put drops in to lower their eye pressure and once it is lowered, they no longer need them.
- They do not see eye drops as important medication.
- They do not have any symptoms so do not feel they need medication.
- They have not been given any information about glaucoma and eye drops.
- They have poor memory and forget to take them.
Is there a correct way to put in your eye drops?
Putting in eye drops may sound easy, but many people often struggle with them. However, there are various techniques you can use to find the right angle, dispense the right amount and make sure the drop goes into your eye.
It’s really important to persevere with your eye drops. With practice, putting them in will become much easier. Glaucoma UK can help with resources such as online tutorials to show you how to put your eye drops in correctly, as well as leaflets, digital glaucoma support groups and a helpline you can contact for any advice.
Are there any aids to help me put in my eye drops?
There are a variety of aids available for eye drop bottles, single dose units and multi-dose preservative-free bottles. These aids help you squeeze the bottle, or hold the bottle in place over the eye, so the eye drop goes in.
Anthony’s story
Anthony, from Mid Glamorgan, was diagnosed with glaucoma at the age of 40 during a routine eye test. He later found out his grandfather had gone blind from the disease.
I am an architectural technologist, so my work involves a lot of computer work. The company I work for provides free eye tests, so in 2010 I decided to go along for one as I hadn’t had my eyes tested for a while.
During the test, the optician asked me whether there was any family history of glaucoma. I had a vague recollection that my grandfather had experienced eye problems but the details were sketchy, so she decided to take a scan of my eyes. When she showed me the images, there was clearly something very different with my left eye, so she referred me to a specialist.
I saw a consultant and he confirmed that I had glaucoma. He explained the diagnosis to me and handed me some leaflets and a prescription for eye drops, which I’ve used every day since.
At the time of diagnosis, I didn’t really know much about glaucoma or the consequences of having the disease. But after visiting the optician, then seeing the specialist and reading through the leaflets, reality soon hit home. I realised the significance, not least because of the job I do. I remember thinking ‘How can I do my job if I lose my eyesight?’.
Being told that this could potentially happen was initially a shock, but the early diagnosis along with the treatment and after-care I’ve received has certainly helped calm my concerns - although there is always something there in the back of my mind.
I wasn’t fully aware of any family history until after my diagnosis, when I discovered that my late grandfather had in fact lost his eyesight to glaucoma. I have two adult daughters and a teenage son. All three regularly visit the optician, who is aware that I have the disease. He now takes scans each time they visit to monitor for changes or any abnormalities.
In addition to taking eye drops every day, I go to my local opticians for an eye scan and field tests, which I take with me when I go to see my consultant twice a year.
My advice to anyone reading this is to visit your optician regularly and make them aware if you have any family history of glaucoma. The sooner you get a diagnosis, the sooner you can receive appropriate treatment. Don’t take your eyesight for granted!
For more information:
If you have any more questions about glaucoma, you can contact the Glaucoma UK helpline. Our helpline team can offer advice, guidance and information to support you at every stage of your glaucoma journey.
Call the team on 01233 64 81 70 Monday to Friday from 9.30am to 5.00pm, or email helpline@glaucoma.uk. Calls are charged at your standard network cost.
Join as a member or supporter, to find out more about our work and how we can help call our Supporter administrator, Natalie Smith, on 01233 64 81 71.
This article was first published in WCB Roundup 40, 2022 and has been slightly modified here.
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