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angle closure glaucoma
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angle closure glaucoma

This question concerns my father who is 90 years old. He will not consult a doctor for his medical problems.

He suffers from "eye attacks" in which the centre of his vision disappears. This small area then expands so that he has shimmering lines around a central area of his vision. In about 1/2 hour the circle expands out of his field of vision and his vision returns to normal. He has been diagnosed as having angle closure glaucoma and has had laser surgery to correct this, however the surgery apparently did not work for him.
He currently takes pilocarpine drops, which seem to control the eye attacks, however he complains that after using the drops he can't see very well. This is apparently because of severe constriction of the pupil, which becomes very small and admits little light. The poor vision after using the drops has led him to limit their use and he suffers attacks sporadically as a result. I am worried that he might be permanently damaging his vision.

My question is whether there is another class of drugs that could be used to treat his condition that didn't constrict the pupil. If that were the case I might be able to convince him to consult someone about his problem.

Note: He will not consult a GP because he doesn't want to go into a hospital, nor an eye doctor for fear that his driving licence will be cancelled. Any advice would be appreciated. Thank you.
2078052_tn?1331936700
Since driving is important to him, you might be able to convince him to see an ophthalmologist by saying that if he loses his sight, he won't be able to drive.  He really does need to see an ophthalmologist.  His episodes sound like migraine, which is unusual in a man of his age.  If he has a cataract, cataract surgery will open his angle and he won't need the pilocarpine drops.  There is no good alternative drop to pilocarpine for this; other eye meds lower the eye pressure, but do not constrict the pupil.  If he has plateau iris, this can be treated with an intraocular laser at the same time as the cataract surgery.
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