Treat glaucoma with price drops

Eye drops can halt the damage resulting from glaucoma, but cost up to €90 a month

LOSING YOUR sight because you can’t afford eye drops might sound like a Third World problem, but for some Irish people with glaucoma it’s becoming a reality.

A disease of the optic nerve that damages sight if left untreated, glaucoma affects some 3 per cent of Irish people over the age of 50. Eye drops can halt the damage but cost up to €90 a month – for many it’s just too expensive.

Declan Fagan is one such patient. Aged 42, a trip to the optician revealed symptoms of glaucoma. Caused when more fluid is produced than the eye can drain away, the resulting pressure can damage the optic nerve, causing sight loss and possible blindness. Referred to the Royal Victoria Eye & Ear Hospital, Fagan’s glaucoma was confirmed.

“Luckily, I hadn’t any sight loss at that stage,” says the Arklow man. “I was prescribed drops and I was okay.”

But as a self-employed worker, when work slowed down he found he could no longer afford the medication.

“You don’t get social welfare or medical aid of any sort when you are self-employed. The drops were costing €90 a month. They were just too expensive. There was no money there for them, food was more important.”

Only when he got work again, six months later, could he resume taking the drops, but he had suffered some sight loss in the interim.

His ophthalmic consultant Dr Aoife Doyle says his story is not unique. With some 80 per cent of glaucoma patients prescribed drops, for an increasing number of them the cost has become too much.

“We’re having more and more people coming in to us saying they have difficulty affording the drops,” says Doyle.

“I’ve had two patients this week who are paying between €52 and €90 a month for drops. For people with limited resources who don’t qualify for a medical card, that’s an awful lot of money.”

Not taking the drops has irreversible consequences. “If it’s not treated properly and on time, you can’t recover any of the vision that has been lost,” says Dr Doyle. “From the time of diagnosis, all you are doing is preventing any further loss of vision, so treatment is critical.”

She says while patients can apply for a “medication only” medical card, they are difficult to get, and with the application process taking so long, the patient’s sight can continue to deplete irreversibly during the wait.

With surgery bringing potential complications, she says eye drops are by far the preferable form of treatment for the majority of glaucoma patients.

“Surgery is effective but there are risks associated with it, so we save it as a last resort when we’ve exhausted all other options,” she says.

“There is a gradual fall-off in the efficacy of the surgery over time . . . if you are young when you get your surgery done, you are facing surgery again later in life, and that’s another reason it’s a pity to operate early.”

Some patients are now having surgery because they can’t afford the eye drops. “I have another patient at the moment in his early 40s, and the only reason he is having surgery is the price of the eye drops,” says Doyle.

“He’s a working man, but is not earning enough to afford the medication – so he is rapidly losing vision.

“That kind of thing happens in undeveloped countries, but in a developed European country like Ireland, even in a small number of patients, it is absolutely shocking.

“To be operating because of the cost of the drops, where there are potential complications to the surgery – it’s really a retrograde step.”

A friend now buys the drops for Fagan in Newry, where his prescription is accepted. “It’s less than half the price and it’s only a few miles up the road,” he says.

“They cost €80 and €90 down here depending on the pharmacy, and it’s around €30 up there. It’s just ridiculous. The prices in Spain are a fraction of that again,” he says.

Having done some of her training in France, Doyle agrees prices are cheaper anywhere but here. “Drops that might cost €60 to a patient in Ireland cost about €23 in France,” she says.

Hopes of a fall in cost in the Republic when one of the most prescribed drops brands came off patent in January were dashed, with generic equivalents priced at just €2 less, she adds.

With an ageing population, cases of glaucoma in Ireland are expected to rise by 33 per cent in the next 10 years. Doyle says the patients on her roster unable to afford the drops are only the tip of the iceberg.

“The drops are still too expensive and it’s very disappointing,” she says. “Our hope is that the Government will put some pressure on in terms of how they are priced. These medications are far cheaper in other countries.”

To mark World Glaucoma Week, which is supported by the Association of Optometrists Ireland, the Irish College of Ophthalmologists and the National Council for the Blind of Ireland, more than 200 independent opticians across the country are offering free testing for the disease until March 17th. Regular eye checks are recommended for those aged over 50