Ask an Expert about Glaucoma

I am 53 years old and was recently diagnosed with low-tension glaucoma. I had been under medical observation for the past two years for this condition. I have been prescribed Xalatan, which causes some slight redness, but this is a minor problem if it will save my sight. My pressure is 12 and 13 in my left and right eyes, respectively.

I am terrified of going blind and this procedure sounded similar to one that is done with people that have irregular high blood pressure, so I thought it couldn't hurt. Have you heard anything about this new treatment that is not yet being performed in the United States? I would appreciate any thoughts that you have concerning this special contact lens. By the way, I agreed to have this procedure in July.

Thank you for your question. It would help me to answer your question if you provided the name of the contact lens technology you were using. If you are using the Triggerfish system, it appears to be a non-invasive contact lens method of measuring eye pressure over a 24-hour period. It provides data about how much your eye pressure is fluctuating during that time period. Whether this actually provides truly useful information for your treatment has not been definitively proven, but it is a relatively low-risk intervention. You used the word “procedure,” however, so I am not sure if we are discussing the same technology. Please re-submit your question with more information and I would be glad to help you further.

Thank you for your question. I am not sure why you are you having pain at night, but I wonder what type of glaucoma you have. Do you have open-angle or closed-angle glaucoma? If the latter, it is possible that in dim lighting conditions you are experiencing intermittent angle closure and that is giving you pain. On other hand, when you are in bright light, your pupil constricts and typically a narrow angle becomes more open. I would ask your ophthalmologist to examine your drainage angle at your next visit and discuss these symptoms.

Thank you for your very interesting question. It is actually a question that needs more research, especially as there is growing evidence that there may be an inflammatory component to glaucoma. However, to date there is no evidence of NSAIDs causing or affecting the progression of glaucoma. There are some studies suggesting that the use of topical or oral NSAIDs may enhance the effect of eye-pressure lowering medications such as prostaglandin analogues (e.g., latanoprost). However, more work needs to be done to verify this finding and currently there is no recommendation concerning this type of treatment from the American Academy of Ophthalmology.

You can take over the counter pain killers such as ibuprofen or acetaminophen for your knee injury. Gravol contains diphenhydramine, which can sometimes cause problems for patients who have angle-closure glaucoma. Most patients in the U.S. have open-angle glaucoma, and taking Gravol should not be a problem for them, but you should discuss this issue with your ophthalmologist.

Thank you for your question. It is difficult to evaluate your diagnosis by just hearing your story, but it does sound like you may have had pigment dispersion causing elevated eye pressures, which required eye drop medications. Over time, high eye pressures can cause damage to the optic nerve, or glaucoma, which is likely why you were started on treatment. Sometimes, as the consultant doctor mentioned, pigment dispersion can “burn out” and eye pressure may be normal. Some patients, indeed, do have pigment dispersion but no evidence of elevated eye pressures or changes to the optic nerve. However, since glaucoma is also an age-related disease, I recommend that you continue follow-up and be monitored for this disease. Lastly, glaucoma often is difficult to diagnose when patients have various risk factors, such as elevated eye pressures, abnormal appearing optic nerves, or strong family history. It sounds like you had risk factors that may have made your previous doctors suspicious for glaucoma. I follow many patients whom I consider “glaucoma suspects” and it is only over time that we can determine whether the patient definitely has glaucoma requiring treatment.

Thank you for your question. I am sorry that you are having double vision after your Baerveldt implant. Double vision can be disabling and I urge you to seek further help. Because the Baerveldt implant is a larger one, it is implanted under the eye muscles, and sometimes, although usually rarely, cause eye muscle problems that either require removal of the implant or strabismus surgery. Sometimes the eye muscle issues can improve over time as the capsule over the implant remodels, which may be why you have not been recommended for either of those options. You mention that you have exhausted ophthalmologist resources in your area, but a surgeon who performed the Baerveldt's implant knows about the potential eye muscle issues, and should be able to help you, either by referring you to another glaucoma specialist and/or a strabismus surgeon. To answer your last question, there are patients who have had strabismus surgery after glaucoma implants, and it showed that the problem can be addressed, but requires the expertise of both glaucoma and strabismus surgeons. Therefore, you may want to seek your doctor's advice and ask for a referral to an academic center where both glaucoma and strabismus surgeons have likely worked with patients who have had this problem before.

Thank you for your question. A dilated pupil exam is a routine part of any comprehensive eye exam, and is important when we manage patients with glaucoma. However, in patients who have narrow angles, sometimes the doctor will defer dilating the patient in the initial visit until that issue is addressed because dilating a pupil in a patient with narrow angles can cause the eye pressure to increase. For patients who have open angles (the majority in the U.S.), there is no harm from dilating the pupils, and, in fact, it is important for glaucoma diagnosis and management. For your second question, without knowing more of your clinical history and exam, it is difficult for me to speculate why you are having an MRI of your brain. Sometimes glaucoma specialists will order this test because they are not sure whether a patient's optic nerve appears the way it does because of glaucoma, or another reason that may be found in the brain. However, this is a question best asked of the doctor who ordered your test.

Vesicare is an anticholinergic, which are a class of drugs that can cause problems in patients who have narrow angles. If you have had recent laser trabecular surgery, then you most likely have open angles, but I would check with your doctor. Additionally, if there is a question about whether you have slightly narrow angles, you can always start the medication and have your doctor recheck your angle anatomy. In addition, you should be aware of the side effects that an anticholinergic can have if you indeed have narrow angles (for example, halos around lights and eye pain). Lastly, if you have narrow angles, your doctor can perform a laser iridotomy, which is a small opening in your iris. This reduces the risk of an angle closure glaucoma attack, although not completely. Eye doctors perform this procedure as a preventive measure for patients who have narrow angles and need to take medications that can cause narrow angle issues, however.