Doctor, I Have a Question
Question answered by:
Robert Ritch, MD.
Founder, Medical Director, & Scientific Advisory Board Chair of TGF
How is exfoliation glaucoma treated?
Traditional IOP-lowering medications, while less effective in exfoliation glaucoma than in POAG, are used frequently as first-line therapy. Pilocarpine 2%, long regarded as a drug which needed to be taken 4 times a day, can be used once a day at bedtime and this suffices to both increase the rate of fluid outflow through the drain of the eye and also to inhibit the pupil from constricting and dilating in response to external light conditions, thus preventing rubbing of the iris over the lens (the major cause of pigment release from the iris) and reducing the rate of progression of the disease. The next line of therapy often is laser trabeculoplasty (ALT).
Most studies have shown good responses to ALT. But once laser trabeculoplasty starts to wear off, patients with exfoliation glaucoma tend to demonstrate a more rapid IOP increase than POAG patients. This increase is also inhibited if the eye is maintained on 2% pilocarpine after the laser treatment. If medications and laser treatment do not control IOP adequately, traditional surgery, trabeculectomy, may be performed.
The Temperature’s Rising – It’s Time for a Swim
Maintaining an active lifestyle with a routine of exercise is a good prescription for anyone, including people with glaucoma. And swimming can be a good choice. But before embarking on any new exercise, always discuss the pros and cons with your doctors.
When swimming, large googles that don’t press too hard on the orbit of the eye are recommended. That’s especially important after trabeculectomy surgery. The surgeon will restrict patients from strenuous activity, such as swimming, usually for at least several weeks. After that, a gradual resumption of some activities may be permitted. Talk to your doctor about when you can start swimming after your surgery.Take care to wear wrap-around goggles as infection in post trabeculectomy eyes can be serious. It’s best to stick with sea water or a pool – fresh lake water has more infectious capabilities. If you suspect the water quality, don’t take a chance. Let caution be the rule. And remember to avoid small tight swim goggles, especially after surgery. They can really mess up your blebs, elevate your IOP considerably and affect blood flow to the eyes. Select goggles that don’t rest on the eyeball, but rather press on the orbital bones.