How to manage glaucoma in tight economy

Albert Lea, MN-Economists and politicians may debate whether the recession is over, but it's undeniable that many people are still feeling the pinch of the economic downturn, and some try to economize by cutting back on medication use. This is a risky choice for patients with any health condition, including glaucoma, but there are ways to address financial concerns that are not likely to cause harm, suggested Leonid Skorin Jr., OD, DO, who practices ophthalmology at the Albert Lea Medical Center, Mayo Health System, Albert Lea, MN.

"I've been an advocate of offering patients laser treatment in glaucoma maybe a little sooner than others, instead of [treating] somebody [with a] second or third drop, especially if they have insurance," Dr. Skorin said. "Especially if they have insurance, often, it turns out to be less expensive for the patient in the long run since insurance companies will usually cover a laser procedure for a medical condition, such as glaucoma, while eye drop medications are often out-of-pocket."

Elder care

The necessity of looking for options other than eye drops becomes even more urgently necessary when elderly patients who live on fixed incomes also have mild dementia or cognitive problems that affect their ability to manage a complicated regimen of multiple drugs. The same is true for those who or have co-existing problems, such as rheumatoid arthritis, that may prevent them from opening a medication bottle or instilling eye drops properly.

Although most eye-care clinicians in the United States regard eye drops as the preferred first-line therapy for glaucoma, there is evidence to support the use of laser therapy as a subsequent therapeutic option, according to Dr. Skorin. The Glaucoma Laser Trial, which began in the mid-1980s, compared argon laser trabeculoplasty (ALT) with eye drop medication. The 2-year results, released in 1990, found that ALT was as effective as, if not more effective than, eye drops medication.

"We know that this type of glaucoma laser procedure is not only a potential cost savings measure to the patient but also has the benefit of consistently lowering the IOP for longer periods and maintaining the visual field for longer periods," Dr. Skorin said.

A 7-year follow-up study of these patients found that eyes originally treated with ALT generally needed less medication for IOP control than eyes originally treated with medication.