EYE HEALTH: RELATIONSHIP OF PMR, PRED & MTX TO GLAUCOMA, CATARACTS, & DRY EYE

[DrRon]

Hello everyone. Vacillated on a title for this post. I'll bet I covered it all. I've been on my hard PMR journey for 4+ years. Currently on 4mg Pred daily & 20mg MTX weekly. PMR pain is under control. My eyes have wept for the past 2 yrs; at times, non stop. Eyedrops are the common advice from my Optometrist, GP, and Opthalmologist. I found homeopathic Similasen Allergy drops work for me. I have also been losing vision clarity for the past 2 yrs, and now I have learned that I have worrisome glaucoma and I am reducing eye pressure with drops and pending other methods, and I will have cataract surgery in the new year. The eye conditions have been generated or accelerated by the strong meds. Of course, being 81 yrs old is a contributing factor. Stressors like losing family and friends exacerbates such physical infirmities. But I am content. I have been quiet on this site for many months. I want to express my thanks and state the value of this HealthUnlocked community. There is value, understanding, compassion here. I don't act on all that I read here, but I am informed to make wise choices for myself. Thanks to you administrators & all of you condition colleagues.

[SheffieldJane]

This is a special forum. I share your gratitude. I also have very dry eyes and have to constantly treat them. I see a good well equipped optician to monitor for conditions like glaucoma and cataracts( possible side effects of Pred) and also any signs of cranial GCA, mine is non- cranial so far.

[PMRpro Ambassador]

Were you being monitored for glaucoma as you were on pred? You should have been. Will they do the glaucoma surgery when they do the cataract surgery?

Other than the raised pressures I think it is fair to say the other things may or may not be pred-related. Raised pressures are not necessarily inevitable - I've been on pred for over 14 years and have no sign of raised pressures. I only recently started to develop cataracts, I'm over 70 so could expect them anyway. The watering eyes is a symptom of dry eyes - the normal production of high quality viscous tears to keep the surface of the eye healthy is affected and large quantities of poor quality thin tears produced in a vain attempt to replace them. It is a common complaint in any autoimmune disorder and pred can make it worse in some people. And as you say - advancing age is also a factor.

[DrRon in reply to PMRpro]

Hi PMRpro, My Opthalmologist and I are too new to my condition, I have tests coming up in 2 weeks re: glaucoma, so I have no idea what the next steps will be. Cataract surgery may happen in March. As for monitoring while on Pred., I was checked only once for glaucoma and anything else when I also had a biopsy from my scalp to rule out GCA 2 yrs ago. The upcoming tests are fore Visual Field, OCT Optical coherence tomography; then ASCAN, testing the power of the intraocular lens (cataract released);

[DrRon in reply to DrRon]

Now it's Feb 26 and my left eye has had surgery, new lens; Mar 14 for right eye ... all has gone well.

[PMRpro Ambassador in reply to DrRon]

Good to hear - long may it last!

[DrRon in reply to PMRpro]

Just an update: I have now had cataract surgery for both eyes, with a follow-up laser treatment re: scar tissue etc on the left eye , and the right eye to follow in July 2024. The dry eye continues, and is manageable ... just a nuisance. I am very aware that the timing 4 yrs ago of my eye issues, of failing eye sight, and accelerated cataract development and glaucoma concerns relate directly to my prednisone intake. I am thrilled to be able to see clearly again. I take one day at a time. That sounds far more patient and accepting than I have the capacity to be. Thanks again for all you friends.

[PMRpro Ambassador in reply to DrRon]

Good to hear! And our pleasure.

[Rugger]

I have been on what I consider a relatively easy PMR & GCA-LVV 'journey' for almost 8 years. I cannot fault the care and advice I've had from my GP, Rheumatologist or the members of this forum and the Yorkshire PMRGCAuk support group. I echo your sentiments.

I have streaming eyes and use 'dry eye' drops when I remember! A year ago I was diagnosed with glaucoma in just one eye, which didn't surprise me as I have a strong family history down the female line. I opted to have laser trabeculoplasty, rather than use eye drops for the rest of my life, like my Mum did. I have just had a hospital appointment to check my eyes 8 months after the procedure and the pressures are nicely down in both eyes - even the untreated one! I mentioned to the optometrist that I am now on 1.5 / 1mg pred, rather than the 5mg when they found the raised pressures. (15,300mg cumulative dose to date!) I don't know if the reduction has made a difference to both eyes, especially the one that has had no intervention? I, too, will need cataract surgery at some point - I'm 75.

[DrRon in reply to Rugger]

thank you for engaging in this conversation ... other people's experiences, while not identical, are helpful to know

[AshPen9]

I have had a dry eye since before my autoimmune condition, DrRon. The optician said that my left eye was dangerously dry, even though I have never had discomfort. As a result I have used eye drops for several years, but I know that it's still a problem because I always have a white streak at the side of my eye. The latest optician says that drops only ever keep things at bay, and what is needed is a microwaveable eye mask, which will unblock everything and allow the glands to release the waterproof layer that normally encapsulates our tears. I am now using a Blepha Eye Bag warming eye mask. You have to massage your eyes once you have used it. Good luck with your cataract op.