Glaucoma, Medicine and Life
Chat Highlights
February 3, 2010

On Wednesday, February 3, 2010, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma, Medicine and Life".

Moderator: Welcome back Dr Pro. Our topic this evening is Glaucoma, Medicine and Life. Let’s begin. Do you have any advice for glaucoma patients who have lost their jobs and benefits due to the economy and use medication to control their glaucoma but cannot afford the medication?

Dr. Pro: I have to find the address of a site that I know. Give me a minute to find it later. But, I might add that each pharmaceutical company does support programs that provide low or no cost drops to financially qualifying persons. They can usually be contacted directly through their websites.

Dr. Pro: Your doctor will also need to fill out some forms. In some individuals, generic drugs are an alternative.

Moderator: There is a links page at www.willsglaucoma.org/links.html. If this is a new link I can surely add it.

P: Can the unemployed change their medication once a day to once every other day to extend the life of a bottle of drops?

Dr. Pro: I cannot recommend that. The prostaglandins in general have the longest half-life and are dosed once-per-day.

P: Can a bottle of glaucoma medication be used beyond the expiration date printed on the label?

Dr. Pro: The issue is about efficacy. The company can only vouch for the efficacy of the drug before the expiration date. In general if the drop has been keep unopened and in a cool dry area, the drop is unlikely to suddenly become ineffective once the expiration date has passed.

P: I take Xalatan and have been getting the drops from my local pharmacy; they are refrigerated. Is there any risk in getting them from a reliable mail order pharmacy?

Dr. Pro: No, that should be okay. Xalatan does not have to be refrigerated to maintain its efficacy.

P: If multiple drops are used in the evening at bedtime, and a patient cannot remember if they used one of them, is it best to reuse the one that might have been skipped or just skip the medication for that dose all together?

Dr. Pro: It is better to re-use the ones that may have been skipped. A second dose is very unlikely to cause any adverse effect. To avoid that situation in the future it might be useful to make a system for taking the drops in a particular order.

P: If medication needs to be ordered in a three month supply and delivered by mail, can the medication be used if it sits in the patient’s mailbox for four to five hours during the middle of a hot summer afternoon or the middle of winter?

Dr. Pro: That question has been asked in other chats and it is a great one. I do not know the exact temperature to which the pharmaceutical company certifies that the drug remains effective with extended periods of temperatures over 100 degrees or below freezing and whether it could be expected to harm the drug.

P: How close to the temperature guidelines on the medication insert do we need to follow?

Dr. Pro: As close as you can. Temperatures higher or lower than recommended may cause the drop to lose its efficacy sooner.

P: How close to every 12 hours or every eight hours does one need to use the drops? Does obsessiveness in keeping close to the time intervals of drops make a difference in pressure or optic nerve damage?

Dr. Pro: It's good to keep close to the recommended dosage spacing. Each drop has a different duration of action. When drops are studied in clinical trials, we are able to identify a peak and trough of effect. Some drugs wear off sooner than others and thus must be dosed more frequently, so proper drop spacing helps avoid a trough, where the effect on IOP reduction is minimal.

P: If a patient has a trabeculectomy, what changes need to be made when participating in summer water activities such as jet skiing, snorkeling, and swimming?

Dr. Pro: Great question. First we will discuss swimming. You need to wear goggles if swimming for an extended period in any type of water. I recommend the type where the goggles do not press on the globe.
With snorkeling you are wearing a mask. Jet skiing is probably pretty risky. If you involved in that type of activity then perhaps, you need to adjust your activity, or discuss your lifestyle prior to any surgery.
Your doctor may recommend a "bleb-less" surgery, such as tube shunt, canaloplasty, or other, depending on your clinical situation.

P: Why is jet skiing risky? Is it because of falling and the mask maybe coming off?

Dr. Pro: Yes, I would think so.

P: Can cruises be taken after a trab if an ophthalmologist is not an hour away?

Dr. Pro: How soon after surgery?

P: One week out? One month out? One year out?

Dr. Pro: One week out is too soon and if you had a problem, you may be too far away from an ophthalmologist who is comfortable dealing with post-op trabs. One month out may be okay as long as your post-op course has been stable and you avoid swimming without goggles.
Remember at all times, that if you have redness, pain, loss of vision, or sensitivity to light, you need to see an ophthalmologist as soon as possible.

P: What should a trab patient do if traveling to a foreign country?

Dr. Pro: Please bring your drops with you. It is best to ask your glaucoma specialist who to see if you have a problem and remember to write down the address. We have a network of glaucoma specialists and are often able to find help for you, but better if you give us time before your trip, to find some names.

P: Regarding homeopathic medicines and vitamins, will anything improve vision, the optic nerve, or stop vision loss?

Dr. Pro: Nothing has been clinically proven. Resveratrol, which is found in red wine and other foods, may prove beneficial, but there is no clinical proof yet.

P: If the drops are being instilled in a public washroom and the bottle falls to the floor, what should be done? What if the lid falls?

Dr. Pro: Use your best judgment, but probably best to dispose of the bottle and get a new one.

P: If a prescription is written for three times a day, do the drops need to be spaced out evenly and should the patient wake up earlier or go to bed later each night to achieve every eight hours?

Dr. Pro: Do your best to space the drops in the course of your regular day and your sleep/wake cycle.

Moderator: Thank you Dr Pro...that is all for this evening.

Dr. Pro: Okay, goodnight Viv and thanks for the great questions from the panel.

On March 17, Dr. Pro discussed "Optic Disc Imaging" in the Chat room. Click here for highlights of that meeting.

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