I'm a programmer and was diagnosed glaucoma 3 years ago and I'm 30 now. My doctor prescribed me 2 medicines, tafluprost and carteolol, which cost 130 CNY per month. I see the doctor and do an air puff test once a month. This costs 80 CNY. Doing an OCT once a year requires 500 CNY, and a total of 3000 CNY (approximately 470 USD) per year. Recently, my doctor suggested that I have an operation. It may prevent me from using eye drops in the future. I am considering it.

I hesitate to provide medical advice here. But if you are 30 and you have a glaucoma diagnosis, you should really be followed by a glaucoma specialist (vs a comprehensive ophthalmologist or an optometrist.)

Thanks for your kind advice. I'm very serious about my eyes and will do my best to protect it. However my docker is considered as a glaucoma specialist in one of the best hospital in our city..(though she's also treating other eye diseases)

Ok, I’m happy to hear it. This reminds me that another important caveat re: eyecare is this — even within a country, there’s a lot of variation in how ophthalmologists treat the same condition (eg one doctor might choose to do tube surgery on a glaucoma patient, whereas another might choose to do a laser procedure for the same patient.)

I imagine that internationally the differences are even more dramatic! But this doesn’t mean that one country is more “correct” than the other; in fact, I’d hypothesize that for population specific disease variants, geography factors into the trajectory of one’s disease outcome. For example, ophthalmologists in Asia are likely much better at treating normal tension glaucoma (NTG,) which has a higher prevalence in Asian patients. So perhaps these patients tend to do better, but this is only a crude guess.

Aha, it's interesting that your example 100% fit my case, Asian and NTG.

BTW, What you guys are doing is very impressive. It could be very useful for whom not able to go to the doctor's office.

Glad that my training and knowledge base is on point, hehe.

Thank you so much for the kind words. My biggest wish is for my team to use our combined skills and expertise to bring high-impact, scalable solutions to those who can't access an eye doctor (or don't want to go into the office.)

I was diagnosed with glaucoma at the age of 17 by a doctor. It was hard for me to comprehend that I'd have to take drops for the rest of my life. I do have pretty bad myopia and astigmatism. This was in the middle east. On doing a recheck back in India, I had a very comprehensive testing with multiple doctors checking for glaucoma and retinal damage and was told that while I'm a suspect, there's no reason for me to take drops. My IOP was calculated taking into account the diameter of the pupil (I think) and Goldman test which wasn't done previously. The doctors proceeded to explain that in the west, doctors are more likely to prescribe treatment for glaucoma because of all things around insurance etc. At minimum, I recommend getting a second opinion, if possible from a country that's not riddled with such insurance schemes.

Thanks for your story. I hear what you are saying and I do plan to get a second opinion. Apparently here in the US there are some people who have had their glaucoma un-diagnosed.

But I have some confidence that its real. First, my doc wasn't eager to do it, she just suspected it at first, and we did some tests and waited for a while. But later, a followup visual field test did show some actual loss in one of my eyes, but not something I noticed.

The whole business with the drops is annoying, but its not unexpected. Still, that would be a business model worth disrupting.

There are several difficulties when it comes to managing glaucoma: 1) There are different types of glaucoma that have different diagnostic criteria 2) Different people have different risk factors for glaucoma development, disease progression, and treatment response. What works for one person may be completely ineffective for another 3) Our glaucoma data (for diagnosis, progression, treatment) is largely based on a cohort of data gathered from Caucasian patients; researchers and clinician are generating population-specific (Blacks, Asians, etc,) data, but there's definitely still a long way to go 4) There is some subjectivity that goes into diagnosing/treating/monitoring glaucoma, which is why one doctor may decide to start you on drops while another may choose to observe without intervention -- in cases that are not clear cut, either approach may be correct

Hi. Thank you for sharing your story. Vision is such a critical part of our daily lives, so receiving a diagnosis like this can be very painful.

Unfortunately, the only way to slow down the damage related to glaucoma is to lower eye pressure (IOP.) This is accomplished via medications, lasers, and surgery. Typically we start with the least invasive option, which is medications (aka eyedrops.) It sounds like you are receiving the standard of care, which is a good thing.

Re: cost of care, I think we can all agree that things need to change.

What were your symptoms? or was this only noticed during an exam and you had not realized anything was going before the exam?

> and I also have to agree to not make a claim on my insurance to reimburse me, so its all out of pocket. Its pretty shady, but they are what my ophthalmologist wants me to use, and I don't want to mess around with blindness.

I'm not too familiar with the all the inner workings of insurances but curious why you had to do this?

I did have some eye discomfort, dryness, etc. I chalked this up to allergies. I wasn't immediately diagnosed, but she said it was suspect. About a year later the visual field test showed that it had worsened, so the diagnosis became official.

As far as the drops go, its a a brand-name drug. My doc suggested that there was a generic option available but it was also clear that it wasn't her preference. The signup process was online and as part of it I had click through on an agreement that said I wouldn't try to claim it on my insurance. I don't know what happens if you violate that. Maybe they refuse to give you refills. There were other suspicious aspects and dark patterns in the UI of the signup process; it smelled like a moneymaking scheme.

Hi! I'm an optometrist. There are usually no symptoms for glaucoma, which is why it's known as a "silent thief of sight." Dryness and irritation are not symptoms of glaucoma. It is usually suspected when your doctor looks inside your eye at the optic nerve and sees that the cup in the middle of the optic nerve looks larger than they think it should be and your eye pressure (measured with either the air puff test or little probe that quickly touches your eye) seems a higher than normal. There's also a machine called the OCT which can help to see if you might be suspect for glaucoma. The visual field test checks your side vision to see if there is functional damage from the glaucoma. Your doctor may monitor it and make it an official diagnosis if they see progression on any of these things (optic nerve, OCT, visual field).

There is one kind of high eye pressure (acute angle closure) that can lead to glaucoma that may be accompanied with redness and eye pain, but this is more rare and happens more quickly. Otherwise, most forms of glaucoma (normal tension and open angle glaucoma) are extremely slowly progressing and don't have any symptoms until it's too late, when lose your side vision and are left with tunnel vision.

Quadrant Eye uses some tests which can help to screen for glaucoma even when you have no symptoms. Thank you Quadrant Eye for making a higher quality online screening! I can't wait for the entire comprehensive eye exam to be available at home and reach more people who otherwise may not have easy or convenient access to a doctor's office on a regular basis.

Wow, thanks for the detailed note of support. I agree with all of the above.

Not wanting you to make an insurance claim sounds very shady indeed. As in being ripped off.