Old is the new young: A paradox for glaucoma patients

Abstract

AbstractOlder/mature glaucoma patients are increasingly active these days and it is a myth that glaucoma patients are all passive and sedentary. Glaucoma does not only occur in the elderly, but even those glaucoma patients who are mature are working longer and staying more active. So perceptions of the ‘normal’ glaucoma patient need to be adjusted. Quality of life is increasingly important as older patients still feel young inside and want to enjoy their daily lives and interests and treatment must therefore be effective, but also tolerable so that patients' QoL is not limited by side effects. These patients have high expectations, but at the same time, this older population has a higher incidence of ocular and systemic comorbidities which can pose challenges. For instance, to start with ocular comorbidities it is well known that glaucoma patients have a higher risk of suffering from ocular surface disease and that the prevalence of ocular surface disease increases with increasing age. In this context therapeutic choices should be focused at lowering the intraocular pressure while preserving as much as possible the health of ocular surface for example by using preservative‐free medications to minimize ocular side‐effects. We know from published studies and from clinical experience that ocular surface disease shows improvements after switching from preserved to preservative free topical medications. Since glaucoma prevalence increases with age the prevalence of age‐related ocular comorbidities increases as well such as in the case of macular degeneration with additional deterioration of vision and increased impact on quality of life.Important to keep in mind that also systemic comorbidities that may particularly impact older patients, and the effect this might have on treatment (e.g. impairment in fine motor skills that can impact their ability of self‐administering the drops).Additionally, more mature patients may experience increased prevalence of systemic comorbidities such as cardiovascular or pulmonary ones limiting the therapeutic choices. More challenges to diagnosing and monitoring the disease might be posed by increased difficulties in performing psychophysical tests such as visual field testing.In this scenario it has to be highlighted the importance of communication to assess patients' level of comprehension and ability to cooperate with treatment and monitoring schedule.