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EW GLAUCOMA 64 May 2016 ongoing basis. "In my experience, there are some patients who once they get on steroids and their pres- sure goes up, you deal with their high pressure forever, even if the ste- roids go away," Dr. Smit said, adding it is possible these are patients who are destined to develop glaucoma and somehow the steroid acts as a trigger that starts the process. Dr. Robin pointed out that it can take variable amounts of time for IOP to come down after the ste- roid is stopped. "In someone who is getting an intravitreal (steroid) injec- tion, it can take up to a year. That's not common, but it can happen," Dr. Robin said. "In someone who is getting topical application, it can take a month or 2." In cases where a glaucoma patient has responded to steroids, Dr. Robin usually opts for medica- tions first, and then if the pressure is markedly elevated, he moves on to surgery. He finds that laser treat- ments aren't usually a fruitful option here. However, in Dr. Smit's expe- rience, lasers can sometimes work surprisingly well in this population. "Personally, I try laser earlier in the course of treating these patients," Dr. Smit said. "I have found, for reasons that I don't understand, that people with a steroid response seem to respond extremely well to laser treatment, particularly to SLT." There have even been some patients in whom Dr. Smit thought that she was going to have to perform a trabeculectomy but opted to try laser first and got enough response to avoid the much more aggressive approach. Overall, Dr. Robin stressed that steroids, like any other medicine, have good and bad attributes. "You have to make sure that patients understand the reason that you use them," he said. Dr. Robin cautioned that it can be hard to determine whether or not a patient does have a steroid response or if it's just an inflammatory one. "Physicians have to be very careful because once they label a patient a steroid responder, they're making the patient less likely to get treated in the future," he said. EW Editors' note: The physicians have no financial interests related to their comments. Contact information Robin: arobin@glaucomaexpert.com Smit: barbsmit@hotmail.com High continued from page 62 Surgical markers for precise lines Oh sooo ne! Ultrane Tip Economical Twin Tip Regular/Fine Tip Visit bit.ly/eye-trial for promotional oer info13@viscot.com • www.viscot.com • 800.221.0658 • Economical - save 50%-75% vs a full size marker • Available sterile & non-sterile The Mini Surgical Marker these are potentially dangerous drugs. Also, if patients have glau- coma, practitioners might want to follow them more frequently to make sure they don't develop a steroid response, Dr. Robin advised. "If they do develop a response, you can taper the steroids or change to a weaker steroid," he said. "Also, make sure that you're aware of what's going on and that you have good baseline documentation of IOP, the optic nerve appearance, and the visual field." When Dr. Smit puts patients on steroids or a steroid/antibiotic com- bination for a chronic condition, she makes sure to carefully monitor them especially in the first month on the medication. In most cases, she finds that elevations in pressure occur in the first few months of being placed on a steroid. "Generally speaking, I would bring people back sooner than I normally would to check their pressures and make sure that [the steroid is] not having an impact," Dr. Smit said. She finds there are 2 different types of steroid responders: those whose pressures normalize once the medication is stopped and those who have to deal with this on an

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