Alternatives for lowering eye pressure for patients with pigmentary glaucoms

I am 61 and have had pigmentary glaucoma since I was in my mid-20s.  Until the past couple of years, my eye pressure has been managed with eye drops.  Through testing by an allergist, I found that I am highly allergic to preservatives, and I've had problems with many commonly used eye drops because of the preservative content.  I've been on multiple drops and they caused major irritation.  Currently, I am on Travatan Z, which I tolerate fairly well, but my eye pressure is continuing to gradually rise.  I have had 2 SLT procedures in the past 2 years.  I am currently scheduled to have cateract surgery because my vision has gotten so poor.  I am concerned that the cateract surgery may further raise my eye pressure.  Are pills a viable option in addition to the drops?  I've asked my doctor about pills, but he doesn't seem to be aware of their use.  I have optic nerve damage in my left eye, and want to explore all options to keep my IOP as low as possible.  

[Houman Vosoghi, MD]

Pills have side effects and are usually not used as a long term solution just for a few weeks at a time (some are on it long term and do fine).  Cataract surgery may elevate your pressure acutely (first two days after surgery) but may even help lower the pressure a bit long term.  Important to check your pressure the afternoon of the cataract surgery if possible to take pills if pressure does go up or you could just take the pills just in case depending on your doctor's preference.  In addition to Travatan Z which has a different preservative than routine eye drops, you could also try the preservative free formulation of Timolol.  Some people also tolerate brand name Alphagan P which has a different preservative too.  Lastly, if your pressure continues to be less than ideal after cataract surgery, I would make sure you are seeing a glaucoma specialist who could offfer other procedures to lower the pressure.

HV