Medicating for high intraocular pressure?

U

Unregistered IOP

Guest
I've had ocular hypertension, a risk factor for glaucoma, since before I got my pilot certificate. My pressure readings have been in the low- to mid-twenties, though I had one reading at about 32 about five years ago. My readings yesterday were a little higher than normal, at 25/27. We have measured my corneal thickness, and found it to be a little higher than normal, so this has helped assuage her fears about the high IOP. Nerve fiber analyzer and visual field have been pretty stable, and there's no degeneration of the nerves, though the "margins" are a little thin.

Because of an upcoming change in medical personnel, my ophthalmologist is talking again about starting me on eye drops to lower the pressure. If she can't make sure that I'm monitored, she wants to be proactive, though she's not pushing the issue too hard.

She's recommending Xalatan. An article on studentpilot.com (http://www.studentpilot.com/articles/medical_articles/article.php?medical_id=6) doesn't indicate any FAA issues with Xalatan, but does note that it is generally an additive drug, meaning it is used in conjunction with a primary drug.

Does anyone here have any experience with Xalatan? Anything to contraindicate its use in a pilot? Any questions I should be asking?
 
Thanks Dr. Bruce! Started taking the drops last night. Eyes look bloodshot, but that's an expected side effect, at least at first.

By the way, I really like your appearances on the PilotCast productions!
 
When Xalatan first came out (probably 14 years ago), it was not approved as first line therapy. I was typically reserved for use as an additive medication, or a medication to be used if a typical first line drug (like a beta-blocker) either did not work or was contraindicated.

Over the years, Xalatan has become accepted first line therapy. It (and the other drugs in its class: Travatan and Lumigan) usually works better on the IOP than any other single agent. Xalatan in now the most prescribed glaucoma medication in the world.

I would not have a care in the world about using Xalatan. It is true that it might darken iris color, particularly in hazel eyes. It also can lead to some conjunctival redness, increased length of eyelashes, and increased pigmentation of lashes and eyelids (although these problems seem more of a problem with Travatan and especially with Lumigan).

Xalatan is still not MY first line drug, as I go with beta-blockers unless the patient has asthma, but this is due to to cost. It is a great drug, and it is typically my second choice if beta-blockers are insufficient.

Wells
(ophthalmologist)
 
Thanks Wells. I started taking the sample she provided and yes, I do have the conjunctival redness. I'm hoping that will go away with time; it looks like I'm perpetually hung over! The other side effects aren't particularly onerous. I haven't investigated the cost. I'll have to see what insurance would cover.

My understanding is that once you're on it, you're pretty much on it for life. Does that mean it loses efficacy if the course of treatment is interrupted, or just that it merely mitigates the symptoms while it's being used and doesn't correct the underlying cause?
 
Unregistered IOP said:
My understanding is that once you're on it, you're pretty much on it for life. Does that mean it loses efficacy if the course of treatment is interrupted, or just that it merely mitigates the symptoms while it's being used and doesn't correct the underlying cause?
Click to expand...

Well, you are not necessarily on it (Xalatan?) for life. Glaucoma, if one truly has it, is a lifelong condition. As such, it does require some kind of ongoing therapy, whether medical, laser, or cutting surgery. If one is being treated medically, there is a good chance you will be changed to another medicine at some point. If glaucoma worsens despite meds, meds are increased, or the person might move on to surgery.

The hardest part of treating glaucoma is actually diagnosing it, saying when and if it is present. We often follow "glaucoma suspects" for years without treatment, usually only starting treatment if we feel that there is actually some damage occurring (most of us will treat suspects for pressure alone if that pressure exceeds a certain level, typically say 30, depending on the appearance of the disc). There are instances in which an ophthalmologist might start treatment and then realize after years that there has been no progression, change his mind, and stop treatment. This is probably fairly rare, however.

As many do not fully appreciate (even many general ophthalmologists!), there is much more to glaucoma than pressure alone. Far more important is the appearance of the disc and the visual field. Pressure is the only thing we can treat, however. It sounds like you are being treated by someone with a good understanding, and it also sounds like YOU have a good understanding of the condition. Good luck!

Wells
 
wsjrmd said:
As many do not fully appreciate (even many general ophthalmologists!), there is much more to glaucoma than pressure alone. Far more important is the appearance of the disc and the visual field. Pressure is the only thing we can treat, however. It sounds like you are being treated by someone with a good understanding, and it also sounds like YOU have a good understanding of the condition. Good luck!

Wells
Click to expand...

Thanks!

Yeah, I've been very pleased with her. She also has other pilots (including airline captains) that she's treating, so she has some sensitivity to the issue as it pertains to us. Unfortunately, the medical group she's been doing some work for is expanding and bringing in a new full-time ophthalmologist, so she'll no longer be providing care for them, and I'm under their capitation. In other words, it'll be hard to continue to see her unless I do some changes in my insurance. I think it might be worth switching from my HMO to a PPO in order to do that. This uncertainty is one of the factors in at least considering starting treatment at this time.
 
Well, updating a defunct thread with more current info so others can see how things can progress. I'm now on my third opthalmologist since the one mentioned in my initial post. Along the way, my medication was changed to Travatan, I did get longer lashes (no need for mascara!), and my pressures gradually lowered to 15L/16R at the most recent reading. Visual field continues to look good. At this point, my current (new) opthalmologist did what Wells said is "fairly rare"; having me discontinue medication. We'll watch the pressures at increased frequency at first (i.e. 2 mos.) and see how things go. As long as they stay in or below the mid 20's, he's comfortable just monitoring, given the fact that I have a thicker than normal cornea.
 
Unregistered IOP said:
Well, updating a defunct thread with more current info so others can see how things can progress. I'm now on my third opthalmologist since the one mentioned in my initial post. Along the way, my medication was changed to Travatan, I did get longer lashes (no need for mascara!), and my pressures gradually lowered to 15L/16R at the most recent reading. Visual field continues to look good. At this point, my current (new) opthalmologist did what Wells said is "fairly rare"; having me discontinue medication. We'll watch the pressures at increased frequency at first (i.e. 2 mos.) and see how things go. As long as they stay in or below the mid 20's, he's comfortable just monitoring, given the fact that I have a thicker than normal cornea.
Click to expand...

It sounds like you might have a keeper in this ophthalmologist, assuming that (s)he is adept at following the optic disc and visual field for subtle changes. It is not that rare for me to stop drops that OTHER providers have started--that is actually pretty common. It is fairly rare for a given provider to reverse his own previous decision to treat.

Wells
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top