The one question every patient should ask about their glaucoma treatment – but doesn’t

The one question every patient should ask about their glaucoma treatment is…

“What was my highest ever eye pressure measured in the clinic?”

It is crucial that all glaucoma patients or glaucoma suspects know the most accurately measured highest eye pressure for them.

Glaucoma damages the optic nerves in a particular way, but you don’t have to have high eye pressure to have glaucoma. Some people develop glaucoma even though their eye pressures have always been within the normal range. That is sometimes called normal pressure glaucoma.

Also, not all high eye pressure causes damage. Some people will have eye pressures above average for their whole life and never come to any harm from it. That is called ocular hypertension.

Currently, we can only treat glaucoma by lowering the eye pressure. It is crucial to know what the maximum untreated eye pressure is for a patient with glaucoma as this determines what the “target pressure” is. The evidence suggests that patients with glaucoma should have treatment to achieve a 20% reduction in their pressure to start with. It is much easier to achieve this pressure reduction if the starting pressure is 28mmHg than if it is 15mmHg.

When we don’t have access to that original data, we often have to stop all glaucoma treatment for 4 weeks to “wash out” the drugs so we can re-establish the maximum pressures. In some cases of ocular hypertension, the patient does not need to go back on drops – a welcome result for many. For those with glaucoma, it’s a nuisance for them and for the glaucoma specialist to have to stop treatment and re-evaluate everything in 4 weeks, but an indispensable one. In that way, we can ensure patients are on the correct treatment, and their eye pressures are low enough.

The world has become a smaller place in the 21st Century. Patients move for family or work reasons much more now than ever before, not just within the UK but across continents! I see patients all the time who have been on treatment for several years but have moved to London and stay under my care for the time that they are in the UK. They often look puzzled when I say – what were your eye pressures when the decision to start treatment was made?

I am also surprised how many patients don’t have copies of their glaucoma reports in which we can find all of this information.

I will always make it very clear what the maximum eye pressure is if you have glaucoma and will ensure that you receive copies of your reports and investigations – The glaucoma passport. You can keep this data and present it to any new ophthalmologist who needs to examine your eyes. We give pregnant women their notes to carry around with them and keep safely for the time of their pregnancy, so a glaucoma patient should be able to do the same in both the NHS & private sector.

Please, ask what your maximum eye pressures are before you start treatment and keep all copies of your medical reports. It makes managing your eye conditions much easier and much safer.