News & Events: Member Articles

Glaucoma
By Carol R. Kollarits, MD

ELLIE M. PASSES HER DRIVER'S TEST

Ellie M. could not believe that she could not renew her driver's license. She knew that she had been having a little problem seeing the street signs lately, but she certainly had no problem seeing other cars or the occasional child that might run in front of her car when she picked her grandchildren up after school. At 72, she was spry and healthy and enjoyed being able to help her working daughter by transporting her grandchildren while their mother was still at work. She knew it had been getting harder to read the newspaper and the books she loved, but money had been tight since her husband had died, and she had been reluctant to go in for an eye exam.

When I examined her eyes, I found that she had poor vision due to a moderate cataract in each eye. Since changing the prescription in her glasses would not have improved her vision enough to allow her to pass the eye test at the license bureau, I recommended that she have cataract surgery. Three weeks later, I removed the cataract from one eye and replaced it with an intraocular lens implant. Within a day or two, she was amazed by the good vision she had, even without glasses. The surgery had only taken 10 minutes, and she had had no pain at all. She was eager to have the second eye done two weeks later. Before she came back for her final visit, she was able to pass the driver's test without glasses! When I checked her eyes several weeks after her cataract surgeries, I found that she saw well enough to drive during the day without glasses, but she would probably see better with glasses for night driving, and of course, she needed bifocals for reading, as she had for the last 30 years. Fortunately, Medicare covers about two-thirds of the cost of one pair of glasses following cataract surgery, but if she had not had Medicare, I could have referred her to Prevent Blindness Ohio, This organization will provide glasses for people who cannot afford them. If she had been too young for Medicare and had no health insurance, I could have referred her to the Lions Eye Care Foundation of Northwestern Ohio. The Lions will often pay for medically necessary eye surgery for uninsured children or adults.

Ellie M's eye problems were not fully eliminated by her cataract surgery. Although her vision was sharp and clear, I was concerned that she might have glaucoma because her mother had had glaucoma; and Ellie M's intraocular pressures were a little higher than normal. Special glaucoma tests showed early glaucoma, so I was able to start her on eye drops to prevent loss of vision from glaucoma. Unfortunately, she didn't have enough money to pay for the drops, and had some side effects (redness of her eyes) from the drops. For these reasons, I performed a mild laser treatment called selective laser trabeculopexy on one eye. This lowered the pressure in the eye so that we could stop her drops, and three weeks later I performed the same procedure on her second eye. She has now gone for more than one year with good vision and control of her glaucoma without eye drops. She encouraged her two brothers and sister to come in for glaucoma screening.

Medicare will pay for glaucoma screening because many Medicare patients have glaucoma and don't know it. I found that her older brother had early glaucoma. He would not have found out that he had glaucoma without the glaucoma screening exam. Glaucoma causes gradual loss of peripheral vision and contrary to popular belief, glaucoma usually does not cause any pain. Ellie M's younger sister and brother have no signs of glaucoma at the present time, but I intend to follow them closely, for cataracts and glaucoma, so that neither of them will have the unpleasant surprise of failing a driver's test in the future.

Carol R. Kollarits, MD
Academy of Medicine of Toledo and Lucas County