Chat Highlights
Glaucoma and the Elderly
December 6, 2000

Norma Devine, Editor

On Wednesday, December 6, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma and the Elderly." 

Moderator:  The topic tonight is "Glaucoma and the Elderly" and was suggested by one of our fellow GlaucoMates.

P:  Dr. Wilson, at what point are you considered "elderly" with glaucoma? 

Dr. Wilson:  You're only as old as you feel.

P:  Are there problems associated with an "older eye?"

Dr. Wilson:  As starters, anyone over 60 has sixtimes the risk of someone under 60.  Over age 80,  the risk goes up markedly, to maybe 7% of the population, in some studies.

P:  Why are so many diagnosed when elderly?

Dr. Wilson:  The drain in the eye may well collapse slightly with the sags and bags of getting older. This may reduce the spaces in the drain. The cells that clean out the drain seem to get older and tired and do less and less of a good job.  Therefore, debris called glycosaminoglycans build up in the drain of those with glaucoma, blocking up the drain.

P:  What considerations are taken when treating the elderly?

Dr. Wilson:  Since the circulation is less in the elderly, one usually aims for a slightly lower target IOP with them.

P:  Besides the aging of the eye, don't  systemic problems also contribute to glaucoma in the elderly?

Dr. Wilson:  Circulation may play a huge role in the glaucoma of the elderly, especially normal-tension glaucoma.  Circulation falls off as one gets older.

P:  Do chances of success with surgery decrease with age?

Dr. Wilson:  No!  The chance of success increases substantially as one gets older. Bring on those 90 year olds;  they do the best.

P:  Is that because healing is slower as one ages?

Dr. Wilson:  Yes.

P:  How well do you think the elderly cope with using their eye drops as instructed?  

Dr. Wilson:  Some do very well.  Others may have trouble because of joint stiffness or lack or memory.  Since their health may be more tenuous, the drops may have more side effects.

P:  Does removing some of the bags and sags of eyelids with plastic surgery affect aqueous drainage?

Dr. Wilson:  No.  Sorry.

P:  Is there a relationship between age and speed of progression of vision loss?

Dr. Wilson:  Yes,  if age brings on contributing problems like poor circulation. 

P:  Many of the other medications older people use interact with their drops.  I  take Inderol for migraine headaches and I didn't realize it was also a beta-blocker.

Dr. Wilson:  Yes, it helps your eye pressure, but not as much as putting the drop in your eye.

P:  Does Inderol minimize the effect of the Timoptic?

Dr. Wilson:  No,  it may augment the effect a little if you use both Inderol and Timolol.

Moderator:  Can you offer any tips about installing drops for an elderly patient who has poor vision?

Dr. Wilson:  Often it is best to put a rubber band around one bottle, so the bottles can be told apart by feel.  There is also a drop guide that can be rested over the nose or around the eye that helps shaky patients get their drops in the eye.  

P:  I never knew about the drop guide. That would help me. I'm aphakic and have been using glaucoma eye drops for 11 years.  Thanks for the tip, Dr. Rick.  I  will ask about that.  You see, I miss quite a bit.  

P:  I take lots of calcium.  Is that good or bad for my glaucoma?

Dr. Wilson:  Calcium has no effect that I know of  on glaucoma. 

P:  Is there a possible neuroprotective effect from calcium channel blockers?

Dr. Wilson:  Calcium channel blockers inhibit spasm of vessels and should improve blood flow in patients who have vasospasm, typically those with migraines or Raynaud's Syndrome.

P:   This sounds a little strange, but can you tell by feeling the eyeball whether pressure is high?  I ask because the eyeball that has not had a trabeculectomy feels somewhat larger to the touch than the one that had the trab. 

Dr. Wilson:  Yes, with training, you can estimate the IOP by finger palpation.

Moderator:  I try to guess my IOP before I get it taken, and I'm usually pretty close.

Dr. Wilson:  Don't try it too much.   Pushing on the eye lowers the IOP for a bit.

Moderator:  Oh, I don't; don't worry.

P:  Is that touch method taught in medical schools? 

Dr. Wilson:  Not in medical schools, but in ophthalmology residency.

P:  That sounds like an easy way to get your pressure down.  If  touching/pressing on the eye ball will lower the IOP maybe we ought to just do that several times a day.

Dr. Wilson:  In some patients who have a trabeculectomy, that is a serious option. 

P:  Is there any type of glaucoma that is more common in the elderly and causes a rapid loss of sight? 

Dr. Wilson:  That sounds like acute angle closure or maybe normal-tension glaucoma.

On December 13th, Dr. Wilson discussed "International Glaucoma" in the Chat room. Click here for highlights of that meeting.

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