HISTORY: This pleasant 75-year-old lady with a history of glaucoma is being treated with Xalatan OU q.h.s. and Cosopt OU q.12h. She has had laser iridotomies for narrow angles. No subjective change. Her medical history includes osteoarthritis and thyroid nodule with a goiter. Elevated liver function tests most likely secondary to autoimmune hepatitis, chronic maxillary sinusitis and she is being treated for hypertension.

PHYSICAL EXAMINATION: On exam, vision with her glasses is 20/25 in the right eye and 20/30 minus in the left eye. This is unchanged. External exam shows dermatochalasis of both upper lids. Extraocular movements are full. Conjunctivae are clear. Corneas are clear. Anterior chambers are slightly shallow and clear with a patient laser iridotomy in each eye. Pupils are equal, round and reactive to light. Applanation tension is 15 in each eye at 12:30 p.m., which is very nice. When I saw her in January, pressures had gone up to 19 in each eye. Her usual pressures run in the 16 range.

DFE shows hypertensive retinal vascular change with no hemorrhages or exudates. Maculas are normal for her age. Discs are unchanged with a 0.35 central cup in the right eye and a 0.45 cup in the left eye. Lenses show 1-2+ nuclear sclerosis with mild peripheral cortical changes.

DIAGNOSES:
1. Open-angle glaucoma, both eyes.
2. Narrow angles status post laser iridotomies.
3. Mild incipient cataracts.
4. Dermatochalasis.

PLAN: I discussed the situation with her. She will continue her present drops and return to see me in July. Incidentally, she says that she is planning a trip to Hawaii in June 2006.