Living with Glaucoma
Although a diagnosis of glaucoma is not life threatening, it can bring about lifestyle changes and fears for the future. Significant vision loss at the time of diagnosis may affect driving, employment and independence. With early detection and treatment, glaucoma can be managed and loss of vision need not occur.
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Using your eyes is not harmful and they do not need to be "rested". Reading, writing, sewing, computer work and similar activities all encourage your eyes to focus up close. Focusing like this exercises the muscles inside your eyes as well as those around your eyes. Working the muscles inside your eyes helps the drain in each eye to work more effectively. Aqueous fluid can drain back to the blood stream more easily, encouraging the eye pressure to fall. If your eyes become tired with prolonged concentration, you can rest them periodically - but please don't worry that you have done them any harm. Similarly, longer distance viewing such as driving, watching TV or going to the movies does not harm your eyes.
Keeping your weight down and being physically fit helps to prevent health problems e.g. heart attacks and diabetes, and is important for your overall well-being. These same measures also help you to protect yourself from glaucoma.
This help is in two forms: firstly, any measures which maintain the health of all blood vessels (such as avoiding smoking, ensuring normal blood pressure and cholesterol levels, controlling diabetes and body weight) will enhance the blood vessel nourishment of the optic nerve fibres; and secondly, physical activity actually reduces eye pressure directly for a few hours at least.
This depends on the amount of vision loss your glaucoma has caused. Fitness to drive for a private car licence requires a best corrected visual acuity of 6/12 or better, with both eyes open. In addition there needs to be at least 120 degrees of visual field free of glaucoma defects with at least 10 degrees free of defects above the horizon. If either of these criteria are not met, a restricted licence may still be possible. Note that licensing requirements vary between states.
Please find more information about driving with glaucoma in the following two articles:
Images courtesy of Dr. Anne Hoste
Questions and Answers about Driving with Glaucoma
Q: I have glaucoma and when driving at night I get halos around the street lights, especially when it is raining. Why does that happen and can I do anything about it?
A: Glare and halos at night can be from a variety of reasons and may not be related to your glaucoma at all. Other causes could be due to cataract (cloudy lens) or an unstable tear film from having dry irritated eyes. Rarely halos around lights could be due to high pressure in the eye. All of these conditions are best discussed with your treating Ophthalmologist.
Q: I have to renew my license soon and I have to have an eye test- what tests are done?
A: Fitness to drive for a private car licence requires a best corrected visual acuity of 6/12 or better with both eyes open. Visual acuity is a measure of central vision- the ability to distinguish details and the shape of objects.
In addition there needs to be at least 120 degrees of visual field free of glaucoma defects with at least 10 degrees free above the horizon. This is tested with a special visual field test called an Esterman visual field which again is undertaken with both eyes open.
If either of these criteria are not met, a restricted licence may still be possible after assessment by a specially trained Orthoptist. Your ophthalmologist or optometrist should know how to contact and refer to them.
The restrictions of licences for larger vehicles and commercial vehicles are generally more stringent. These standards are available via the motor licencing authorities in each State and Territory.
Q: I have lost all vision in one eye, because of glaucoma. Will I still pass an eye test for driving as my good eye has perfect vision?
A: To drive a private car you only need one eye to drive! You must not drive within three months of an acute loss if vision. Provided you meet the requirements as outlined by the motor licensing authorities, you may still drive.
Q: What do I need to tell the motor registry if I am diagnosed with glaucoma or any other eye condition?
A: You are obliged to tell the motor licensing authorities if you have an eye condition limiting your vision. You will be given an assessment form that will need to be filled out either by an optometrist or ophthalmologist declaring your suitability to drive.
Q: Can I get glasses with specific driving lenses to help me refocus with near/far vision, reduce glare and/or see better in low light?
A: There are a new generation of spectacle lenses that can help reduce glare for night driving and address problems of depth perception and visual acuity. New products become available all the time so it is best to discuss options with your optometrist.
Some yoga positions may impact eye pressure in people with glaucoma. People with glaucoma may have increased eye pressure when doing head down positions, such as “downward dog”. Damage to the optic nerve occurs in people with glaucoma and one of the known causes is elevated fluid pressure inside the eye.
Read more about yoga positions and glaucoma.
Dry eye syndrome, commonly worsened by topical glaucoma medications (especially preserved medications), contributes to the overall burden of glaucoma. Dry eye syndrome can be improved by eyelid hygiene, warmth and massage, topical lubricants (ideally preservative free) and sometimes altering the topical drop regimen.
Cataract, frequently found among glaucoma patients is readily treatable by surgery.
A cataract is the process by which your natural focusing lens changes from being transparent to being cloudy.
Glaucoma is usually asymptomatic: it is called the "sneak thief of sight". By contrast, cataracts often do have symptoms that may impact on your quality of life. The symptoms of cataracts, vary with the type and location of the lens opacity you have. Commonly patients complain of decreased central vision. This is noticed especially when driving and looking out into the distance.
Click here to keep reading about cataracts in patients with glaucoma.
No specific foods are particularly good or bad for glaucoma treatment. Because optic nerves health depends in part on healthy blood vessels, food that helps to maintain blood vessel health is likely to promote visual health: reduced saturated fats and increased intake of vegetables and fruit are desirable. Red wine also helps to provide extra anti-oxidants and the alcohol content tends to reduce eye pressure, even though this is only temporary. So a little red wine almost every day is not a bad idea. Your liver will not like too much however!
Low vision is defined as visual impairment that cannot be corrected by treatment or tools including glasses, contact lenses or surgery.
With poorer vision comes an increasing fear of blindness, social withdrawal and other limitations. Depression, associated with chronic disease and disability, is more common in patients with advanced glaucoma, and is associated with reduced quality of life.
If you are experiencing depression or anxiety due to your experience with vision loss, please speak to your doctor or health care professional.
Resources to assist those with low vision include:
There is some evidence that sleeping with physical pressure on an eye can accelerate glaucomatous damage. Perhaps try to avoid sleeping face down, and to consciously avoid any pressure on one or both eyes from the pillows or bedding. There is not one specific position that is the best but it is important to avoid sleeping in positions where physical pressure or strain is put on the eyes. If an individual’s glaucoma is well controlled with no sign of deterioration, the goal of treatment has been achieved and there is no need to look to other lifestyle modifications such as altering sleeping position.
Generally, flying has no effect on someone with glaucoma, other than a temporary elevation in intraocular pressure (IOP). Following a trabeculectomy there is no increased risk with flying – this also applies to any laser procedure. The only issue with flying is if a procedure has resulted in the retention of air or gas in the eye, mainly pertaining to vitreoretinal surgery. Make sure to ask your ophthalmologist if you have any specific concerns.
If you wear closed collars (with ties for example) be careful not to have them too tight as this increases pressure 4in the veins of your head and neck and thus increases eye pressure too.
If you swim with goggles, ensure they fit snugly to the bones around your eyes and do not apply pressure to the eyeballs themselves. Click here to read more about which goggles may be best for you.
If you do weight lifting, try to breathe in as you lift the weights: don't hold your breath. This avoids strain, avoids increasing the pressure in the veins of your head and neck and thus avoids increasing the pressure in your eyes. For the same reason, select more repetitions with lighter weights rather than fewer lifts with heavier weights.
You may need to stop or adjust medications for glaucoma when you are pregnant
All glaucoma patients who need treatment with drops need to consider, with their ophthalmologist, the possible benefits and potential side effects of any medication. When glaucoma affects a woman who is pregnant, breast-feeding, or considering having a baby, there are additional considerations in the strategies needed for safe treatment. Now there are two patients involved - the mother and the baby - and the ways in which a baby’s tissues and organs react to drugs may be quite different from those in adults.
As we are all aware, drugs can have harmful effects on the development of a baby’s organ systems. The earlier in pregnancy the drugs are used, the more frequent and more severe the problems can be. But even later in pregnancy, or after birth if the infant is being breast-fed, drugs can have unwanted effects.
When eye drops are instilled, some is absorbed into the general circulation, and travels all over the body. It can pass through the placenta and reach high concentrations in the baby’s blood too. If a baby is being breast-fed, it can pass into the milk, and thus get into the baby’s circulation as well.
From a glaucoma perspective, in a word yes - just don't hang head down for prolonged periods! Blood vessel health and thus visual health is also promoted by avoiding obesity, and remaining as physically fit as possible. Exercise to the limits of your comfort and ability is highly recommended. As mentioned above, a bonus is the added slight reduction in eye pressure exercise produces for some hours. The only exercises to be avoided are those in which your head is held below your waist - such a posture increases eye pressure. Yoga lovers take note.
To read more about how glaucoma can affect pregnancy, please read the following article:
Glaucoma Treatment in Pregnancy
Want to know more about what’s new in our community about living with glaucoma? Find forums, updates, a social network and valuable information on our Facebook page.
In addition to our Glaucoma News and our support line, there are two Glaucoma Australia support groups for those living with glaucoma.
Phone: 0416 074 415
Phone: 03 6234 5578
For enquiries about our support group services you can contact the coordinators directly or contact Glaucoma Australia.
Some of the information on this page can be found in the article “Living with glaucoma”