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   Table of Contents      
ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 7  |  Page : 866-868

Therapeutic problems in ocular hypertension


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All-India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Correspondence Address:
N N Sood
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S. Ansari Nagar, New Delhi 110 029
India
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Source of Support: None, Conflict of Interest: None


PMID: 6544273

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How to cite this article:
Sood N N, Grover A K, Agarwal H C. Therapeutic problems in ocular hypertension. Indian J Ophthalmol 1983;31, Suppl S1:866-8

How to cite this URL:
Sood N N, Grover A K, Agarwal H C. Therapeutic problems in ocular hypertension. Indian J Ophthalmol [serial online] 1983 [cited 2020 May 24];31, Suppl S1:866-8. Available from: http://www.ijo.in/text.asp?1983/31/7/866/29688

Table 3

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Table 3

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Table 2

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Table 2

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Table 1

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Table 1

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Treatment for ocular hypertension remains a highly controversial subject.The dilemma of the treating physician is heightened by the widely varying, at times diametrically opposite views regarding the criteria for starting therapy, in the world literature. The consider­ations that weigh in the decision making are three fold (a) What is the risk of the patient de­veloping a field loss? (b) What is the likely ef­fectiveness of the treatment in preventing this? and (c) What problems does the treat­ment entail? The estimate of the balance of what has been termed as the benefit of injury ratio helps in deciding the course of action.


  MATERIAL & METHODS Top


A total of 69 patients with an established diagnosis of ocular hypertension after a full glaucoma work up, were the subjects of this prospective study. A number of risk factors such as age, family history of glaucoma, pre­sence'of diabetes, cardiovascular or thyroid disease, height of intraocular pressure by ap­planation tonometry, presence of pseudo exibiliation or pigment disperson were evaluated. Diurnal variation of intra-ocular pressure, response to water drinking test and facility of outflow were recorded in selected subjects. The evalu4tion of all risk factors and the likely benefit of therapy weighted in decid­ing whether the treatment should be initiated. The choice of mode of therapy was governed by a number of considerations. Pilocarpine was the first line drug in most of the patients. Epinephrine was chosen as the first line drug in young subjects, and patients with central cataractous changes. Epinephrine was also used in subjects who tolerated pilocarpine poorly because of visual blurring (by induced myopia or miosis) or subjective symptoms like headache. Care was taken to avoid epinep­hrine in patients with systemic cardiovascular problems. A combination of these drugs was required in cases,where either one did not pro­ vide a sufficient control of intraocular pres­sure. Timolol was used in cases, where both pilkocarpine and epinphrine were tolerated poorly or provided inadequate control. Sys­temic medications were rarely used, and usu­ally temporarily. Surgery had to be resorted to in one case where medical therapy failed,

Therapeutic Regimens:

The therapeutic regimen followed in the 69 cases was as indicated in [Table - 1].

Problems Encountered in Therapy:

I Side effects & Intolerance to drugs

II Tachyphylaxis

III Non compliance

IV Loss to follow up

V Psychological aspects

I - Side Effects:

Side effects to drugs were frequent and into­lerance more often encountered that in glaucomtous subjects. Probable cause for this is that the patients were more likely to be asymptomatic and less strongly motivated for treatment. Serious side effects with drugs re­quiring a change of treatment are outlined in [Table - 2].

II - Tachyphylaxis

The problems of tachyphylaxis, a decreas­ing reponse to some medication over-a period of time was encountered in 4 patients on pilocarpine therapy (out of a total of 24), 1 on epinephrine (total 10) and in 2 patients on a combination of pilocarpine and epinephrine (total 11). These patients required an increase in concentration or addition of another medi­cation or replacement by another medication or even surgery in one patient.

III - Economic Problems:

Economic aspects of starting a life long therapy in a person who may or may not be­nefit from it cannot easily be overlooked- con­sideration specially the economic status of a large majority of our population. IV - Non compliance & loss to follow up

Non compliance with therapy-resulting in an inadequate control is a frequent problem in ocular hypertensives. The motivation for therapy is even less in ocular hypertensives picked up in a survey than amongst the sub­jects who presented to a hospital,as in this series.

V - Psychological Aspects:

The psyuchological aspect of putting the pa­tient on a life long therapy is often neglected. The patients frequently tend to feel that they are harbouring a serious disease, get depre­ssed and tend a restrict their activities. A proper explanation of the situation to the pa­tient by the ophthalmoligist goes a long way in allaying this fear.

Follow up:

The 69 patients of Ocular Hypertension have been followed up for a variable period [Table - 3] vertical studies on the subjects are in progress, with a maximum follow up period of 7 years.


  Summary Top


Treatment for ocular hypertension remains a highly controversial subject. The criteria for starting therapy in ocular hypertensives very widely -in the world literature.

26% of the patients were followed up with­out any treatment, 35% were treated with var­ious strengths of pilocarpine along, 15% on epinephrine alone, 6% on timolol alone, 19% on various combinations of the above men­tioned drugs, 4% needed systemic hypoten­sive agents and 1.4% were subjected to surgery. The phenomenon of tachyphylaxis, refractive changes and other problems like poor tolerance in the regime group have been highlighted. The patients have been followed up for period upto a maximum of 7 years.



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

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