2020 JANUARY : simplebooklet.com

Newsletter January, 2020 During this Glaucoma Awareness Month, we focus on the diagnosis of glaucoma and the importance of going forward of every patient working together with their doctor to become well-informed about their disease and treatment needs.When diagnosed with glaucoma, the rst question many patients ask is “Will I go blind?” The good news is that with ongoing treatment, the answer is “no” for most patients. Less than 10 percent of glaucoma patients lose vision. There is no cure for glaucoma yet; it is a complex and chronic disease. But correct treatment and follow-up will stabilize the vast majority of patients with glaucoma. Asking questions is important. Here are a few that will help you work in partnership with your doctor to preserve your vision.1. If you are a new glaucoma patient, ask what your pressures are and what type of glaucoma you have. Glaucoma is a group of diseases and patients should understand what type of glaucoma they have, what pressures should be expected, and the prognosis.2. If medications are prescribed, make sure you understand why you need to take the medication, what the medication will do for you, how often and when you need to take the medication. By correctly using your eye drops and being consistent in their use, a favorable outcome will be more likely.3. Ask your doctor or your doctor’s assistant to show you how to take your eye drops properly, and what to do if you miss a dose. 4. Ask about the risks and side eects associated with the recommended treatment, and if there are any foods, drugs, or activities you should avoid. Report any side eects or allergic reactions to your doctor promptly as you go forward.5. Ask if there are any changes since your last exam and ask to see test results, for example the print-out of your visual elds – with an explanation of what those black spots mean. 6. Ask questions about anything that seems unclear to you, such as the names and purposes of tests you may undergo.7. Find out when you should return for your next exam. Between appointments, keep notes about questions you have and what you need to discuss with your doctor.6. When surgery is scheduled, there should be a conversation beforehand about post-op instructions and what drops the patient will have to take, and when. GLAUCOMA AWARENESS MONTH

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A Bulletin from the National Eye InstituteThe National Eye Institute’s (NEI) redesigned website makes it easier than ever to get accurate, up-to-date glaucoma info that you can trust. If you have questions about glaucoma or other eye conditions, nei.nih.gov has answers! Take a look at these helpful resources:• If you or a loved one has recently been diagnosed with glaucoma — or you just need a refresher on glaucoma basics — this page is a good place to start. • Learn about treatment options, like glaucoma medicines, laser treatment, and surgery for glaucoma.• Keep up with the latest glaucoma research going on at NEI — and at NEI-supported labs across the country.• Find out what you can do to keep your eyes healthy with NEI’s top eye health tips. And if you’re a health educator, NEI has tons of resources to help you raise awareness about glaucoma, like fact sheets, infographics, videos, and more.Plus, new accessibility features make the site easier for everyone to navigate and read — including people with low vision.Take a moment to explore the new and improved site at nei.nih.gov.

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Newsletter January, 2020Doctor, I Have a Question.What Should I know about Glaucoma and Pregnancy?Question Answered by Jillia E. Bird, OD, MS (Vision Sciences), St. John’s, AntiguaJanuary is Glaucoma Awareness Month in the USA and EARLY DETECTION and diligent management after a glaucoma diagnosis continues to be our message. Therefore, women approaching childbearing age ideally should already have been having regular, annual ‘well-exams.’ Glaucoma prevalence is relatively lower in this age group than in older women but once diagnosed, it’s important for women with glaucoma to work closely with their ophthalmologist and OB/GYN when thinking about having a family. By discussing plans to become pregnant, a concerted eort can be made to achieve intraocular pressure (IOP) control on minimal or no medications, minimizing risk to the fetus while safeguarding the eye. Each case has to be evaluated on an individual basis.Some patients are able to discontinue all glaucoma medications for the rst 12 weeks. This might be possible, for example, if a patient is a glaucoma suspect or has early glaucoma with limited optic nerve damage and modestly elevated IOP. Frequent monitoring is the key. In other cases, discontinuing glaucoma medications is not possible, for example, if a patient has substantial optic nerve damage or extremely elevated IOP levels and is not able to tolerate uncontrolled IOP even for a short period of time. In such cases, the physician would try to prescribe the fewest possible medications, thoughtfully selected and dosed to minimize risks to the fetus. The advent of several new glaucoma medications (e.g. Vyzulta™ and Rhopressa™) with good safety proles is a positive factor for glaucoma patients considering pregnancy. Sometimes surgery may be the best option for patients who cannot achieve an acceptable IOP level with minimal or no glaucoma medications. If possible, surgical procedures to control IOP are best performed prior to conceiving so that the IOP level can be controlled and stable throughout the entire pregnancy. If necessary, (SLT) Selective laser trabeculoplasty can be performed during pregnancy. Incisional surgery, such as trabeculectomy, is safest prior to conception. There are now a variety of FDA-approved minimally invasive surgeries (MIGS) that oer signicant advantages to the options pregnant patients faced earlier. MIGs typically are performed through a small incision in the eye with minimal tissue trauma, thereby oering a safer alternative as well as a faster recovery period.There is no data suggesting problems with labor and delivery of a newborn. Periods of extreme straining during delivery may raise IOP, but this is very brief. Nursing must be considered as well, and warrants a discussion between the patient and her doctors as glaucoma medications may also be secreted into breast milk when nursing. Decisions on glaucoma treatments during the nursing period must be carefully considered. And nally, many mothers ask if their glaucoma puts their child at risk for developing the disease. Family history is a signicant risk factor. Once a child is old enough to sit still for an eye examination, the child should get tested, and retested at periodic intervals. Be sure to let your child’s pediatrician know that you have glaucoma.

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Checking in with Ryan GedneyWhen we rst met Ryan Gedney two years ago, he was a 26-year-old, second-year med student at the Medical University of South Carolina (MUSC). Ryan was born with open-angle glaucoma. Congenital glaucoma is often dicult to diagnose. He considers himself so fortunate to have parents who were determined to gure out what was going on with his eyes – it was their research that led to the right diagnosis, he says. The doctor who treated Ryan throughout his childhood and teen years “was a great doctor and was the reason why I wanted to be a doctor.”Giving back and making a dierence have long been tenets of Ryan’s life. After college, he volunteered at local eye clinics and started a program called the Young Eyes Project - collecting glasses in local schools and making these glasses available to children who could not otherwise aord them. Today he is involved in the Charleston chapter, based at the medical school, of ReSpectacle, a national nonprot organization that uses the power of the Internet to facilitate redistribution of quality, used eyeglasses to underserved communities worldwide. “Glasses are donated by members of our community,” Ryan explains. “They are then cleaned, categorized, and loaded into the online database based on their prescription. Charleston’s chapter remains one of the highest donating chapters and will hopefully continue to make an impact in the community for years to come.”Ryan will graduate medical school in May and begin his residency in July. “It took me a while to come to the decision, but I have decided to apply to vascular surgery residency programs as I have developed a new passion for the eld of vascular surgery over the past couple of years.” During his earlier years in medical school, after graduating from Clemson University with a degree in bioengineering, he worked in medical device design – specically on neuro (brain and nervous system) devices. “Given my engineering background, passion for vascular disease, and goals for the future, I decided that would be the best t for me, the area where I could make the most dierence.”Asked about his glaucoma, Ryan continues to see his ophthalmologist every four to six months. “Today my pressure is stable, and I’ve had no major problems.” His advice to others: “Don’t stop looking for answers. Don’t take your vision for granted!“

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Newsletter January, 2020PROTECT YOUR EYES THIS WINTERWinter can wreak havoc on your eyes. Fortunately, following a few winter eye tips can help keep your eyes safe.• Heaters and dry wind can aggravate dry eyes during the winter months. Dry eye syndrome, particularly common among older adults, is mostly caused by a deciency in the tear glands, and a common preservative in many glaucoma medications can worsen the symptoms. The main treatment for relief is the use of lubricating articial tears, available as over the counter eye drops, to replace natural tears and also provide an articial protective coating for the eye. Leave at least fteen minutes between applications of the eye drops used to treat glaucoma and the articial tears to keep from washing the glaucoma drop out of the eye. Generally, the articial tear should be used after the glaucoma eye drops. Lubricating eye drops are generally safe to use as often as you need them if they do not have preservatives. Many eye doctors recommend not using articial tears with preservatives more than four times a day. For more severe cases, a thicker gel or ointment can be used at night, or a prescriptive eye drop is available. Using a humidier in your home may also be helpful. • It’s important to wear sunglasses in the winter to protect your eyes from dry, cold conditions and from the sunlight that reects o of snow and ice. Look for a label that says “100% protection against both UVA and UVB” or “100% protection against UV 400.” Choose larger frames that cover the eyes and surrounding skin. Frames that wrap around the sides of the face oer the greatest protection. Also, note that cost, lens color or tint, lens darkness, mirror-coating and polarization do not play a role in UV protection.• If you participate in sports like ice skating, skiing, and snowboarding, consider wearing special goggles that can provide even more protection for your eyes. It’s also a good idea to wear a hat to help deect the sun’s rays and, if possible, to avoid skiing or hiking behind other people to help cut down on the amount of snow and debris that can y into your face.

2020 JANUARY

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