Eye Pressure Medication Less Effective Under Stress?

Something changed between yesterday and today...

In recent weeks my eye pressure has been higher, on average. I presume that situation coincides with the meetings and discussions about my new business venture. We had casual conversations for a while, but the beginning of serious meetings and we financial negotiations, correlates closely with the increased average eye pressure values. (Of course, there could be something else that changed around this time that I'm overlooking, so I'll try to keep an open mind.)

The Timoptic, which had been working so well when I used only 1 drop in my right eye every 3-5 days, seemed to become ineffective during this recent period (beginning the last week of October through yesterday). I even switched to a brand new bottle of Timoptic just to rule out the question of whether there was a problem with the medication itself. The switch made no difference. For the first time ever, I used Timoptic two nights in a row (11/4 and 11/5). Still, on 11/6, the differential in eye pressure between my eyes was 2.7.  I'll explain what this means.

My doctors monitor the differential in eye pressure between my two eyes. This is simply the pressure in my right eye minus the pressure in my left eye. My right eye tends to have higher eye pressure (it also has more optic nerve damage). When I use 1 drop of Timoptic only in my right eye every few days, the eye pressure values in both eyes remain very close (and the differential is therefore close to zero).

The eye pressure-reducing effect of the Timoptic gel forming solution lasts several days for me. We aren't sure why, but the data has shown that a single drop in my right eye can keep my eye pressure lower for as long as 5 days. (And it actually affects both eyes, which indicates that the medication is getting into my body.)

My doctors have me on a temporary experimental medication routine for a few weeks. On this program, I use 1 drop of Timoptic and no Xalatan in my right eye on the first day. On subsequent days I use 1 drop of Xalatan and no Timoptic in my right eye. I use Xalatan in my left eye every day. As soon as the eye pressure differential goes up, I use the Timoptic in my right eye again. My medical team has been experimenting with this program and refining it over the last few months. We still have not finalized a long-term maintenance program, but the correlation between the medication and my eye pressure has been fairly clear - until these last few weeks.

I reviewed the prior data from the beginning of our research to mid-October. The prior differentials for the first day after using Timoptic are shown below. These numbers represent the average eye pressure difference between my right and left eyes for the full day following the use of Timoptic the night before:

• -1.4
• 0.6
• -1.3
• -2.4
• 0.5
• 1.4
• 0.8
• 0.4

The above values average about 0 (-0.17). Next, I look at the more recent data. Starting near the end of October, the differentials were:

• 2.0
• 0.5
• 3.1
• 2.7

With the one exception, these are more similar to the values I would expect when the Timoptic effect was "wearing off" -- about 4-5 days after application. We do not yet have an explanation for the change toward higher differential (and higher average eye pressure values). I am going to continue to guess that this is all stress related until someone gives me a better explanation.

I speculate that the extra stress related to the new business venture nearly "canceled out" the normally dramatic therapeutic effect of the Timoptic. As I said, in recent days the eye pressure data made it look like I wasn't even using Timoptic - even when I used more of it than I had in past (meaning I used it two nights in a row for the first time ever).

The first interesting point regarding today's eye pressure values is that the overall average is low again. In fact, it is slightly lower than the "good" period proceeding the recent business negotiations.

Left 14.8; Right 14.5 (differential -0.4)

The differential is near zero again also. Notice that I did not use Timoptic last night, and yet the differential has returned to a value close to zero (and the overall eye pressure is low). My best guess is that my stress has subsided some and the "extra" Timoptic (from 11/4 and 11/5) remains effective enough to produce these nice eye pressure numbers.

These are the kind of eye pressure numbers I need every day. My hypothesis is that I can achieve this goal through a combination of Xalatan, Timoptic, stress management, exercise and a healthy lifestyle. Stress seems to have the largest effect on my eye pressure of anything I can identify. Of course, my stress level is subjective as far as this data is concerned, so even though the connection seems obvious to me, it would probably not be convincing to a scientist.

I find it interesting that today's standard deviation values are much lower than prior days. One final comment I will make on today's data is that the business meeting did raise my eye pressure again, but not by much and not for long.

Here are today's eye pressure values:

Time	Left	Right	SD L	SD R	Comments
10:43	16.7	18.7	1.155	2.309	Just prior to starting work.
12:55	18.0	16.0	1.732	1.000	Working at computer.
13:10	17.0	15.7	1.732	0.577	After telephone business meeting.
14:40	17.0	14.3	1.000	0.577	Computer work.
14:57	14.3	13.7	1.155	0.577	After brushing teeth.
15:01	14.0	13.3	1.000	0.577	Deep breathing.
16:40	13.0	13.0	1.000	0.000	Reading about political candidates. Rushing so I have time to vote.
16:43	13.3	13.3	0.577	0.577	Repeated with deep breathing.
17:37	13.3	12.3	0.577	0.577	Important computer hardware failure. Minor emergency.
18:34	13.3	14.0	0.577	0.000	After voting.
22:09	16.7	17.7	0.577	0.577	After business meeting. (Not as tense as last meeting.)
23:37	13.7	13.0	0.577	0.000	Watching election results.
0:26	12.7	13.0	0.577	0.000	Watching election results.
0:30					1 drop Xalatan in each eye.