How long does it take to go blind from glaucoma if a person is not treated? Do some people progressively get worse even if they are treated? [ 09/19/12 ]
Thank you for your question. This is something that many of our readers inquire about. This simplest and most straight forward answer is that every patient with glaucoma progresses at a different rate. The goal of eye doctors is to identify glaucoma and treat it before patients ever notice any further changes. The only thing that doctors can do to slow or stop the progression of glaucoma is to reduce the pressure inside the eye. They use three different methods to decrease the pressure: medicated eye drops, laser treatments, and surgical methods. Unfortunately, neither I nor any other glaucoma specialist can predict how long a certain treatment will continue to work in an individual patient or how rapidly they will progress (or how long they will be stable with no signs of progression). In many patients, a single drop will continue to work for their entire life; however, there are also many patients that have used a drop for years and have done well, but suddenly the drop no longer maintains their intraocular pressure at the target. Your doctor will follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how your eyes respond to the treatment and ensure that you stay at your goal intraocular pressure. If the pressure is not reduced enough or your doctor ever notices advancement in your glaucoma, they will add more medications or use laser or surgery to help lower the intraocular pressure further. Unfortunately, eye doctors cannot predict if or at what rate a patient will lose vision because of the glaucoma. In some cases, despite their best efforts, eye doctors cannot stop the progression of the glaucoma and patients do eventually go blind, but this is the minority of patients. It will be important that you continue to visit your glaucoma specialist regularly, follow their advice, and maintain your eye pressure at the appropriate goal for the best chance of maintaining vision throughout the rest of your life.
I am a 38-year-old male, and had a retinal detachment in my left eye two years ago. This was the result of an injury I sustained when I was five years old. My doctor put gel in my eye to keep the retina in place. He prescribed Tobradex after the operation, as well as Cosopt and Xalatan to lower my eye pressure. After I use the Tobradex, which makes my eye feel great, the eye pressure elevates. I assume that this is because of the steroid element in the drops. Are there alternative drops that I can use in place of the Tobradex? Thank you. [ 09/18/12 ]
Thank you for your question. Without having completed an examination myself or having the opportunity to review your chart showing previous intraocular pressure readings, it is somewhat difficult to give a fully accurate answer to your question. I will have to make some assumptions. It sounds as though you had silicone oil placed inside the eye to keep the retina attached, and that is quite common. It would be important to know if the correct amount of oil was put inside the eye (too much oil can increase eye pressure, like overfilling a water balloon). The retina doctor can examine the eye and easily tell if the correct amount of oil is in the eye. While retina doctors are often very good about judging the correct amount of oil to use, and overfilling is rare, it is good to at least check this at one of your visits to rule this problem out.
I would also be curious to know if you had a scleral buckle placed on the eye as well. Depending on the location of the buckle, it can cause a slight change in the contour of the eye and the pressure in the eye to go up. If the correct amount of oil was used and the buckle is in good position, then you are correct that the increased pressure in the eye is likely related to the steroid (Tobradex). This is a “secondary” glaucoma known as “steroid-response glaucoma” and it is quite common. Doctors primarily see steroid-response glaucoma when patients take steroid eye drops after surgery or to treat a condition called uveitis; however, it is possible to get steroid response glaucoma from oral steroids or steroid creams. It is relatively rare that one needs to be on steroid drops/ointment for a long duration after retina surgery. Usually these are used immediately after surgery to decrease inflammation. At some point, I would expect the doctor to begin to taper off the steroids anyway; however, if your retina doctor feels like he/she would like to keep you on the steroids for a while, you could always try a less potent steroid (such as fluorometholone). The only way to determine whether or not you are a “steroid responder” (meaning that the pressure in the eye went up because of the steroids) is to do a trial off of steroids, if possible. Never stop any medications on your own without speaking with your doctors first. If you have been on steroids for a long time, it can be dangerous to stop them suddenly; you should taper off of steroids under medical supervision. I wish you the best of luck.
I am 77 years old and was diagnosed with glaucoma three years ago (60 percent in the left eye and 10 percent in the right eye). I manage the glaucoma with eye drops, and I also have a cataract, which does not require an operation. I was diagnosed with the cataract from the age of 45, which never grew; however, whenever I see an eye doctor, he/she always wants to operate on the cataract rather than treat the glaucoma. In December 2011, my pressure was 26 and 27, and in March of 2012, when I went for a checkup, the pressure was 25 and 26. Three months later, I went for a checkup at a different eye clinic, and the pressure was 10 and 11. Can the pressure drop this much in three months? Is this normal? Should I continue taking my eye drops? [ 09/18/12 ]
Thank you for your question. Without having examined your eyes personally and without reviewing the results of past exams and tests, it is nearly impossible for me to give a completely accurate answer. What I can say is that if your eye pressure was in the mid-20s in December of 2011 and March of 2012, and you continued using the same eye drop, it would be rather unusual for the pressure to drop to 10 or 11 in June of 2012 because of the drops alone. If you have been on the same drop regimen from December 2011 until now, eye pressure would not likely change that dramatically. Given that you went to a different clinic, I would wonder if the pressure was accurately taken at one or the other. I would recommend having the pressure taken again relatively soon and determine what the pressure really is. Secondly, I would ask the eye doctor to examine you for any signs of inflammation within the eye. It is always possible that there is inflammation that is decreasing the amount of fluid created in the eye (hence the lowering of the pressure). To reiterate, it is unusual to have intraocular pressure in the mid-twenties on multiple occasions, and then without changing medications have the pressure drop that much. If the readings were accurate, the doctor should be able to help you find a reason for the drop in eye pressure. I would highly advise continuing the eye drops until you can be re-examined by your eye doctor and at that point you can determine whether or not the drops should be continued. Do not stop the drops your own. I wish you the best of luck.
I am a 74-year-old female, and at times I have forgotten the exact time that I put the first drop of Combigan in my eyes, which my doctor recommended that I use only twice each day. If I accidentally used the drops less than 12 hours apart, was that harmful to my eyes? [ 09/07/12 ]
No, it is not harmful if you have spaced it less than 12 hours apart. But, like any medication, the dosing is designed to maximize its effectiveness, based on how long it lasts in your system. Of course, each patient is unique and different, so I would not worry too much about the scenario that you described. It is more important that you are using the medication consistently. If you can remember to space it 12 hours apart, that is ideal, but again, it is more critical that you take both doses in a given day.
An optometrist suggested that I should go to an ophthalmologist since he was concerned about the possibility of glaucoma. Now, a year later, I've finally made an appointment with an ophthalmologist. Apart from the eye pressure that I'm starting to feel, there is a light yellow excretion. Is this a symptom of glaucoma? Every morning when I wake up, my eyelashes are "glued" together. If so, what can I do? My eyes are also tearing, as if I'm crying all the time. [ 09/07/12 ]
Thank you for your question. I am glad that you are seeing an ophthalmologist soon to help answer your questions. I am unclear about the light yellow excretion. If you are referring to discharge, that sometimes does build up overnight. First, it is important that you determine the cause of the excretion when you meet with the ophthalmologist and ask him/her if the following would be helpful to manage the discharge:
There are steps that I have provided to my patients to improve the condition of their eyelids and manage the discharge. The process is called “lid hygiene”—I think of it like flossing your teeth—and it is a step that one should take in the morning and at night, if possible. Sometimes my patients just start once a day, while they are in the shower, for example. They can take a warm towel and place it on their eyelids, to liquefy the secretions that the glands of their eyelids are excreting. Then, they take a cotton swab, dip it in warm water, and gently clean along the eyelid margin (both the bottom and the top eyelids). Some of my patients use a 1:1 mixture of warm water and baby shampoo. There are also over the counter products (look for “lid scrubs) but I think these simple steps explained above may help you.
I am 55 years old and my dad had glaucoma. During my last visit to the ophthalmologist, my pressure was 22. My field test showed 'some' changes compared to the previous test. The doctor put me on timolol (one drop before bed). My main problem is glare and I can't get used to it. I never had this problem prior to the eye medications. Should I stop the eye drops? I'm being referred to a glaucoma specialist for follow up. I've never been formally diagnosed with glaucoma yet and would like to know what to do in the meantime. The glare is so annoying and I feel like I can't focus. [ 09/07/12 ]
Thank you for your question. I would first call and speak with the prescribing ophthalmologist and discuss with him/her whether it is appropriate to stop timolol; however, it is unusual to have glare symptoms from this medication. You could ask your doctor about using the medication only in one eye, and test out if it really is causing you to have the problems with glare. Sometimes patients notice problems coincidentally when they change their routine, and the glare may be caused by a different issue altogether. Certainly this is an important issue to discuss with your ophthalmologist and glaucoma specialist, and please do not make changes to your medication regimen until you talk with your eye doctor(s).
I had a trabeculectomy approximately four years ago and I am now having trouble seeing. I have good vision in both eyes (20/50 left and 20/20 right), yet I strain to see. I have an aversion to bright light, trouble keeping my eyes open, and pressure and pain in both eyes occasionally. My pressure is 11 in left and 12 in right, but I am having trouble reading and watching television. I use non-preservative eye drops in both eyes every hour to prevent dryness. Is this a common problem after having this type of surgery? My eyes seem to be failing. [ 08/30/12 ]
Thank you for your question. It is certainly possible that after having a trabeculectomy, or even after having been treated with glaucoma drops for a long time, it is possible that you have ocular surface disease. There are also other underlying problems that could be exacerbating your It is great that your eye pressure is now well-controlled, but how frustrating it must be to feel that you cannot see as well. It is known that trabeculectomy (and most types of intraocular surgery) will slowly accelerate cataract formation. Have you had your eyes checked for glasses recently? You may also benefit from seeing a cornea specialist in conjunction with your glaucoma doctor with regards to your ocular surface disease symptoms. Once an underlying cause is identified, steps can be taken to overcome your problems.
I was diagnosed with Posner-Schlossman syndrome in January 2012. In a routine test, the eye pressure in both eyes was measured as 40 and 45. Two days later, the pressure was measured at 17 and 21 without any medication. Since that time, I have been applying Combigan eye drops two times daily. My field vision tests were normal but the CD ratios are high (0.8) in both eyes. What are the chances of successfully controlling my glaucoma and protecting my vision? [ 07/09/12 ]
Thank you for your question and I am sorry that you are going through all of this. The eye doctor's goal is to identify glaucoma before you, as a patient, ever notice any changes. While it sounds as though your visual fields are full, the optic nerves may have early damage from the glaucoma (hence the increased cup to disc ratio). Therefore it is important to get the pressure lower so that further optic nerve damage and vision loss does not occur in the future. Eye doctors use three different methods to decrease the pressure:
- medicated use medicated eye drops (such as Combigan)
- laser treatments
- surgical methods to lower the intraocular pressure.
Your doctor will follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how your eyes respond to the treatment and ensure that you stay at your goal intraocular pressure. If the pressure is not reduced enough or your doctor ever notices advancement in your glaucoma, he or she will add more medications or use laser or surgery to help lower the intraocular pressure further.
If someone is diagnosed with glaucoma very early, the goal is to begin treatment and hopefully prevent the person from ever noticing any changes in vision. Unfortunately, doctors cannot predict if or at what rate a patient will lose vision because of the glaucoma. In some cases, despite the best efforts, doctors cannot stop the progression of the glaucoma and patients do eventually go blind, but this is the minority of patients. It will be important that you continue to visit your glaucoma specialist regularly, follow their advice, and maintain your eye pressure at the appropriate goal for the best chance of maintaining vision throughout the rest of your life. I wish you the best of luck.