A little over two years ago, I had a urinary tract infection (UTI), for which I was given antibiotics and recovered completely in a week, but had lingering difficult and painful urinations — for which I was prescribed FloMax (Tamsulosin) which restored the stream but negatively impacted my vision and caused my Internal Optical Pressure (glaucoma) to rise significantly.
The literature I read that came with the FloMax did describe this very negative side effect in about 6% of the users. The medication works by relaxing the muscle that goes through the prostate gland while not effecting the prostate gland which continues to enlarge. So I made the very conscious decision to maintain my vision rather than have that better flow — but when I went for my annual checkup, and informed the doctor of that, he asked me if I wanted to try another medication — which is Finasteride, which in a smaller dose, is used to treat premature hair loss, and in the larger dose, to shrink the prostate. It seemed odd to me that that was not the medication of first resort — and I could address two birds (and more) with one stone.
Finasteride works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which causes both the hair loss, and the enlargement of the prostate, as well as several other hormonal effects associated with aging. However, those effects are much slower — rather than offering the immediate relief through the muscle relaxation. But the chemicals that cause relaxation of that muscle running through the prostate also causes that same relaxation of the muscle of the iris — thus resulting in the floppy iris syndrome among those predisposed to that condition — which the doctor who performed my cataract surgery a few months prior informed me I had. I asked him if the cataract operation would cure that as well as restoring my vision — but he informed me there was no cure for floppy iris and it was just a condition that he had to consider in performing the cataract operation.
So when I saw my glaucoma doctor and informed her of all this, she was not interested in a cure for floppy iris, but noted that my eye pressure was elevated and the next step might be glaucoma surgery — that she had to put on hold until she returned from her vacation in Hawaii. So she prescribed a medication for reducing the production of the aqueous humor of the eye — rather than just more medications and procedures to increase the drainage. That proper balance is controlled on both sides of that equation — but there is a tendency to just treat it from one side.
Long story short, there are alternatives to the standard protocols adopted as a first choice — but the patient has to do their own homework and have an input in driving those decisions. That’s unfortunately what a lot of doctors don’t let you know.
BTTT
Thank you for offering that.