Prednisolone, GCA and Glaucoma dilemmas

[Roltuba]

The recent thread about GCA and Glaucoma has made me concerned that people think that Glaucoma is a minor detail compared with GCA. Please be assured that this is not so - Glaucoma also causes irreversable blindness and can be difficult to control (believe me I know!) Everyone should make sure their eye pressures are monitored while on steroids, particularly if they already have a history of increased eye pressure. This was never mentioned by my GP, even though my existing Glaucoma damage was known about. There is a mention of Glaucoma in the Pred leaflet, embedded in the long list of warnings. Do make sure that everyone you see about all issues takes notice of the steroids/eye pressure combination! It must be an awful dilemma if you have GCA and Ocular Hypertension. (Wrtten by my wife who is also affected by all this).

[Joyful13]

Thanks Rotuba. I have GCA and glaucoma. I am in a flare up right now with the GCA. i just saw my opthamologist who said the pressures have gone up again. I am on 3 different meds for the glaucoma. The prednisone 40 mg really affects my pressures.

Yes, it is a constant battle with these two conditions. Take care. Hope you are doing pretty ep well.

[Ronnie101]

Thanks for the warning. For those of us with GCA, it seems it's a constant tightrope between the eye related problems with using pred and the positive effect it has on inflammation. I, for one, am struggling daily with the dosage decision, given I am continuing to have eye problems ( and low grade headaches), and my rheumy consultant is of no use whatever - all he says is "well your bloods are excellent - continue to reduce the pred dose" and my eye consultant says "no, the high pressures are due to age, not pred".

The fact is no one knows, and we're all different.

This forum has discussed many times the lack of any inflammation markers in the blood not being a definitive sign, but my rheumy doesn't seem to have read that.

My gut reaction is to reduce pred as quickly as I'm able to, but every day I think "is the GCA still active, and is my sight still at risk?"

Rock and hard place...

[DorsetLady PMRGCAuk volunteer in reply to Ronnie101]

Hi Ronnie,

Eye consultant is partially right, eye pressures are more likely to rise with age, but as said - Pred can exacerbate the symptoms. As it can with cataracts. I had both when on high doses of Pred, fortunately cataract was operated on successfully and pressures did reduce back to normal once I got down to about 9mg Pred. However, they were never high enough to warrant drops, so maybe I was just lucky.

As for Rheumy, as we know blood markers should be okay so long as your Pred dose is right! As we also know, go by your symptoms, or lack of them.

As you say ...rock and hard place... but don't reduce too quickly and go past "your" correct dose. It is a fine balancing act, but with my history I'm always going to say don't take risks.

Take care.

[MisOg50]

Snap. GCA and PMR diagnosed last October with pre-existing glaucoma which had jogged along nicely with nightly eyedrop reducing pressures successfully for several years. Between October and now I have lost much of the vision in my left eye and some in my right. Had a trabeculectomy on the right 3 weeks ago to save what there is and on urgent list for placement of a stent in the left. At the weekend had Pred down to 10 mg

but began having GCA symptoms. GP said back to 30mg but fortunately I am still in the 6 weekly post op period so will be seeing ophthalmologist on Wednesday. Also have AFIB and heart failure and seeing cardio

today for first time since PMR GCA diagnosis. Wonder what the news will be from him. Oh yes, have also tipped into prediabetes in those few months. Would glaucoma well controlled have become so aggressive without Pred? Was I on my way to diabetes anyway? Who can say but I know what I think.

[PMRpro Ambassador]

There is a lot of thought that in most cases pred merely accelerates what would probably happen anyway eventually. Much of the diabetes problem stems from weight gain - and for most people that can be managed if you are determined enough, even if it is boring.

The local hospital eye specialist told me at my last check that I probably don't need to worry too much after nearly 8 years of pred as either patients on pred develop raised pressures fairly soon or they don't. Because of the system here I can't simply go along to my optician for a check - I have to make a hospital appointment some 4 months in advance because of the demand. If we were all having to that the waiting list wouldn't just be 3-4 months, it would be 6 months!