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Glaucoma suspect weighs using drops as proactive measure

DEAR DR. ROACH: I am 70 years old, in good health, with no family history of glaucoma. My optometrist diagnosed me a year ago as having low-pressure glaucoma, early stage. He prescribed brimonidine 0.2% twice daily. I also saw an ophthalmologist for a second opinion. The ophthalmologist diagnosed me as a “glaucoma suspect.” He does not recommend drops at this time, but does recommend monitoring every six months. I have recently had a six-month checkup with testing by both doctors. I’m “holding steady.” My ophthalmologist still does not see the need for drops, but said it’s my decision. Why not use the drops as a proactive measure? I’m left in a real quandary because of the differences of opinion of these two medical professionals. — A.H.

ANSWER: Most people think glaucoma is a disease of high pressure in the eyes, but actually, glaucoma is a disease of the optic nerve, with high pressure being the biggest risk factor. Many people have high intraocular pressures and have no damage to the nerve; others, like you, can develop damage to the nerve with normal pressures. I think that’s the source of the seemingly different messages you are getting. The term “glaucoma suspect” means a person has risk for glaucoma — especially elevated intraocular pressure, but may also include the early appearance of damage to the optic nerve, or people who have the type of visual loss associated with glaucoma, which is loss of vision in the periphery of the eye.

The most effective treatment for glaucoma is reducing the intraocular pressure. Even people with normal eye pressures can have the progression of glaucoma stopped, or at least slowed, by lowering intraocular pressure. There are several ways to do that. Medicated eyedrops are probably the most common. Prostaglandins and beta blockers are used more frequently than the medication you are using, brimonidine, which is called an alpha-2 agonist. It frequently causes red-eye symptoms. Laser treatment is another reasonable option, with surgery seldom used except in people with severe damage at the time they come to medical attention.

The decision to use drops in your case is a judgment call, but if you were to use medication, a trial of a different medicine with lower risk of side effects would be prudent.

DEAR DR. ROACH: Providing that a person has good dental hygiene, what changes should a person expect to their mouths into their 70s, 80s and beyond? — K.Z.

ANSWER: Unfortunately, many seniors lose their teeth as they get older. Over a quarter of people over the age of 65 have no remaining teeth. It is clear that regular dental visits along with brushing and flossing help preserve your teeth. Smoking is a severe risk to teeth, and so is chewing tobacco. Oral nicotine and vaping are risky but not quite as bad.

Some medical conditions and medications can cause dry mouth, which is a severe risk to dental health. 40% of people over 80 have dry mouth symptoms. Combined treatment from a person’s doctor and dentist can help prevent tooth decay and loss. Many older adults do not get routine dental care, but dental care has benefits for the teeth that extend to the rest of the body, since dental health affects overall physical health in multiple ways.

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