Brimonidine tartrate and timolol maleate are the active ingredients of Combigan, the first medication I have taken since April of this year that appears to have reduced the pressure in my right eye to normal levels.
In April I had laser surgery to create a kind of drainage for the fluids in both eyes that were being blocked because of closed angle glaucoma. An angle by the way is not the term from geometry. Instead, it is the part of the eye from which normal evacuation of interocular fluids normally takes place. There is something called open angle glaucoma, a more common malady. Whichever one you suffer from, the same medication is prescribed.
I started off with Xalatan in April to try to bring down the pressure in my right eye, which was at 26 after the surgery. The left eye was at 21, close to the top of the acceptable range. Of course, my left eye has a macular pucker so it can’t be used for reading, etc. If I ever lost the use of my right eye, I’d be up shit’s creek.
After 3 months of Xalatan, I went in for a check-up and was disappointed to learn that the pressure was at 27. The doctor then switched me to Lumigan, another very commonly used medication and asked me to come in for a checkup after six weeks. That took place about 3 weeks ago. The first words out of her mouth after checking my pressure were “That’s not good.” It turned out that the pressure was back up to 37, the same reading that prompted her to schedule what amounted to emergency laser surgery.
So she switched me to Combigan. I couldn’t help shaking the feeling that I was doomed. Maybe I was resistant to medication? In early October, a documentary called Going Blind came to NY, which the NY Times described as follows:
In “Going Blind,” a documentary pegged to his own glaucoma, Joseph Lovett seems largely interested in convincing himself that losing his sight won’t be so bad. That leaves the film feeling less like a hard look at the fears and challenges of being visually impaired and more like a cheerleading exercise.
Mr. Lovett, an experienced producer of television documentaries, chronicles his failing vision and various eye operations, but the bulk of the film is devoted to what are essentially mini-features on six other people who have lost all or part of their sight to various diseases — or, in one case, to a roadside bomb in Iraq.
Occasionally these segments offer interesting tidbits on what life is like for the sight-impaired. One man, for instance, explains how the simple shutting off of an outdoor fountain in a familiar spot disorients him, because the sound of the fountain helped him navigate the sidewalks. Even more occasionally, the vignettes get at something resembling real emotion.
“It’s not the cane itself, it’s what it represents,” a woman says, explaining her reluctance to use one. “It’s telling people that I’m blind.”
I couldn’t work up the nerve to go see the movie. Despite all the assurances I had received from my doctor that medication would allow me to retain the vision in both eyes, this director had slowly been losing eyesight over a 20-year period.
Frankly, despite being addicted to Google, I can barely work up the courage to research glaucoma. I am afraid to turn up something discouraging. The review of the movie left me in a funk that has stuck with pretty much up to the time of my last check-up when I was sure I would be told that the Combigan had made no difference. Indeed, I was afraid that the doctor would report a reading in the 40s. When you get to the 50s or 60s, that’s when permanent damage to the nerves begins to take place.
On Tuesday afternoon the doctor had good news. The pressure had gone down to 16 in my right eye. It had not been that low since my trials and tribulations had begun. I have no idea what it will be when I return for a checkup in mid-February but at least there is what appears to be reversal of a frightening trend.
Over the past 8 months, I have more medical appointments than in the previous 20 years combined. It has shaken me to my foundations but I guess that’s what you have to expect when you get to be 65. This is the first time in my life when I have experienced serious health problems and I guess I have to get used to it. Fortunately, I have a pretty good insurance plan at Columbia University and am fortunate enough to be living in N.Y. where there are lots of very good doctors available through my plan.
But the experience has really made me appreciate what it might mean to be without medical insurance or in a country where health care is not provided by the state or by employer insurance plans. Glaucoma impacts African-Americans especially who have a genetic predisposition to the illness as well as suffering the economic hardships that make regular checkups unaffordable.
Something has to change.
