Mr Doherty was referred for review of his advanced glaucoma.  Mr Doherty’s intraocular pressure is up 2mmHg since his last visit and is now 26mmHg. This is of concern as it suggests that his glaucoma is progressing despite treatment. Non-compliance or ineffective administration of the eye drops could be a possible contributing factor. Mr Doherty said that he sometimes runs out of drops and it might up to a week before they can have the script re-filled, but assures me that his wife is very particular about making sure he uses the drops every day.

Ophthalmoscopic examination of the anterior segment of the optic nerve shows a small degree of cupping, presumably due to the concurrent rise in intraocular pressure. This increase in pressure is likely to have caused further damage to the optic nerve, thus explaning Mr Doherty’s recent worsening of eyesight.  If intraocular pressure can be reduced with treatment, the swelling of the optic disc may reduce and result in an improvement in visual acuity for Mr Doherty.

Photo source: Moran Eye Centre 

There are also advancing areas of localised visual field loss or areas that are outside normal limits. Based on these results, Mr Doherty’s medications have been modified. He will now take Latanoprost 0.005% twice daily, administered 12 hours apart. Review is recommended in 3 months and 6 monthly thereafter.