Should Glaucoma Treatments Continue During Hospice?

Increasing attention toward better end-of-life care has led some medical professionals in the Dubuque area and elsewhere to try a strategy called ‘de-prescribing,” where they look for ways to reduce or even remove some prescriptions for patients receiving hospice care.

The team at Above and Beyond Home Health Care is able to see this approach from several different perspectives. If a client is nearing the end of his or her life, they may no longer need certain medications that hoped to “cure” something or at least maintain certain conditions. Some people in the end stages of life may not be able to metabolize certain medications well, so these also may be less beneficial.

Other patients may like the ability to stop taking a medication that might have affected their mood or cognition or had other unpleasant side effects. If a goal of hospice is care to improve quality of life as much as possible, getting rid of some of these formerly preventive medications might be welcomed.

On the other hand, stopping certain critical medications, such as a flu shot or antibiotics, might not be a wise idea. People on hospice likely have weak immune systems and could be highly susceptible to certain diseases. Something like the flu could hit them especially hard, and perhaps include complications which could be fatal. Although they don’t have much time left, most people on hospice would prefer to spend as much of their remaining time with their loved ones and trying to make final arrangements instead of being bedridden and fighting off illness.

So that’s why it’s important to discuss vital and less vital medications with your provider, especially if you’re working with someone specializing in palliative care.

Glaucoma care

One area that should be included in these discussions is the treatment for glaucoma. Although it’s often described as one optical condition, it’s actually a group of diseases that can affect and damage the optic nerve.

The number of cases is growing worldwide and it’s now considered the second most common cause of blindness at a global level.

As part of January being National Glaucoma Awareness Month, it’s important to share that advanced glaucoma can lead to complete or partial loss of vision. The Glaucoma Research Foundation said it’s likely that both eyes will have glaucoma once it’s diagnosed but each eye usually will be at different stages.

In 2012, Today’s Geriatric Medicine newsletter reported that about 2.2 million Americans have it but only about half are aware of it.  Cases grew to 3 million in 2019, but the Glaucoma Research Foundation expects the total number to grow 58 percent to 4.2 million by 2030.

In the U.S., about 9-12 percent of those who are blind lost their vision due to glaucoma, and worldwide, 60 million people have glaucoma. It’s also the second most common form of blindness at a global level.

Risk factors can include age, including a higher possibility for people over age 60; African-Americans over age 40; family history; nearsightedness; and a diagnosis of diabetes.

What’s especially concerning is that there aren’t any warning signs or early symptoms that can be easily noticed, which is why many people may have it but not know it.

This is why regular eye exams are recommended. Although there is no universal cure or way to reverse this, a diagnosis can allow an optical care professional to learn more about the type of glaucoma and begin treatment to minimize further damage to the eyes to avoid further progression and eventual blindness. Oral medications and eye drops are common medications, and in some cases, surgery may be able to reduce pressure.

Care during hospice

If someone is being treated for glaucoma and then enters a hospice program, their eye care professional should discuss their treatment plan with their primary health provider.

Much depends on the stage of the glaucoma and how treatment has been progressing. If it’s early in the diagnosis, medical professionals may recommend stopping any medication, since the disease may not progress very far in the next few months so there’s little risk to continue. Plus, the Mayo Clinic said several types of eye drops are known to have strong side effects such as headaches or limited vision, so a patient may appreciate being done with these.

Or if the glaucoma is at the critical stage, any medication or planned surgeries may need to continue to avoid adding decreased vision or blindness to the items the patient is already dealing with.

Many in the ophthalmology profession seem to learn toward quality of life and patient needs when possible rather than continuing treatment. It may mean that the type of care may change: rather than a longer-term preventative course of medicine that could last several years, a patient might receive a stronger boost more often.

These conversations are good for doctors to have, since it shows how a patient’s needs may change over their life, rather than having one diagnosis and sticking to it for years. Eye care doctors can also be supportive and part of a palliative team if requested to offer their services in the focus on quality of life, including ways to lower pain.