Year : 1983 | Volume
: 31 | Issue : 7 | Page : 866--868
Therapeutic problems in ocular hypertension
NN Sood, AK Grover, HC Agarwal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All-India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
N N Sood
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S. Ansari Nagar, New Delhi 110 029
|How to cite this article:|
Sood N N, Grover A K, Agarwal H C. Therapeutic problems in ocular hypertension.Indian J Ophthalmol 1983;31:866-868
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Sood N N, Grover A K, Agarwal H C. Therapeutic problems in ocular hypertension. Indian J Ophthalmol [serial online] 1983 [cited 2021 Jun 23 ];31:866-868
Available from: https://www.ijo.in/text.asp?1983/31/7/866/29688
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
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,
The therapeutic regimen followed in the 69 cases was as indicated in [Table 1].
Problems Encountered in Therapy:
I Side effects & Intolerance to drugs
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.
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.
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.