I have to wear glasses for close-up and distance vision. A few months ago, I found that I had to remove the glasses to drive and watch TV. I made an appointment with my eye surgeon. He told me I did not need the glasses for distance as my eyes had gotten better. He then made an appointment for an ultrasound stating that I had glaucoma. Is that possible? I thought glaucoma would interfere with sight. Do you have any thoughts about this? I am thinking that I need a second opinion. I am 76 years old and very healthy, but I have also been on Tamoxifin for 4.5 years. I understand that this medication can be detrimental to the eyes. He also told me that I do not have macular degeneration and the nerves are very healthy. Thank you for your input. [ 12/26/11 ]
Thank you for your question. Since it is difficult to ascertain the status of your eyes without examining you, I think the best approach would be to have your doctor explain why he is ordering the ultrasound test for glaucoma. But I can help you with some of your questions. Glaucoma affects peripheral vision first, so often patients do not notice any visual symptoms because one eye compensates for the other, and the decreased vision is in the peripheral regions of the visual field. Only when glaucoma becomes advanced does it affect central vision. It sounds like your optic nerves are healthy, though, and since glaucoma affects the optic nerve, it probably means that you do not have open-angle glaucoma. However, your doctor ordered an ultrasound test, and I wonder if he is concerned about narrow-angle glaucoma. In some patients with narrow angle configuration, doctors will recommend a laser procedure to prevent patients from having a narrow angle glaucoma attack. It does not actually mean that you have glaucoma, just that you have an angle anatomy that might put you at higher risk for having a narrow angle glaucoma attack. If your doctor is not able to provide you with answers to your questions, it is reasonable to get a second opinion. Good luck!
I am a fifty-year-old woman with a family history of glaucoma. I have been diagnosed with normal-tension glaucoma (15 millimeters of mercury) in the eye that is the worst. I have a large cup, a thinning retina, and a pale optic disc. What are the pros and cons of lowering the pressure in this eye below 15? Thanks so much for your input. [ 12/25/11 ]
Thank you for your question. Although the pressure is already “normal” in normal-tension glaucoma, large clinical trials have shown that lowering eye pressure decreases the rate of glaucoma progression, even in normal-tension glaucoma. That being said, the patients in various studies have different characteristics, and as doctors, we cannot simply apply these study results to all of our patients. For example, without examining you, and getting to know you over time, it is difficult to discern whether 15 millimeters of mercury is an adequate pressure for you or whether it needs to go lower—this is where building your relationship with your doctor and getting good follow-up will help. Certainly, if you can tolerate the side effects of the medications, which you can read about in previous posts on this website, there is definite benefit in lowering the pressure. If you require surgery to reach your target pressure (which is different for each individual patient), you need to have a frank discussion with your doctor about the risks versus the benefits of surgery. I hope this helps answer your question.
I have advanced low-pressure glaucoma, and have a strong family history of the disease. I was diagnosed 25 years ago, so I think I am doing pretty well to still see out of both eyes, even though one is worse than the other. I have been a good patient, have taken all of the recommended eye drops, and had the SLT when advised. Things are really improving. Is a routine eye check sufficient for our daughters, who are over 30 years old? Is there anyone looking into optic nerve degeneration and neuroprotective agents? Where should I go next for help? Thanks for this website and all the research that you fund. [ 12/24/11 ]
I am glad to hear that your glaucoma is well-managed. For your daughters, I would recommend a baseline evaluation by a glaucoma specialist. As you know, glaucoma often manifests itself over time so it would be important to have baseline documentation of your daughters' eye pressures, optic nerves, and visual fields. There is abundant research looking into optic nerve regeneration and neuroprotective agents. So far, the only treatment we have is to lower the intraocular pressure, but in the future there is hope that we will be able to tackle glaucoma by protecting the optic nerve cells and/or stimulating their survival. While it takes time for research in the laboratory to make it to clinical trials, you can see what glaucoma trials are ongoing by visiting the www.clinicaltrials.gov website and entering glaucoma in the search field. Clinicaltrials.gov is a database maintained by the National Institutes of Health that lists both government-sponsored and privately sponsored clinical trials conducted in the United States and around the world. Please also view our glaucoma medical and research news updates. You can also sign up to receive these updates via email.
I am 65 years old and do have vascular problems that are being monitored. Two months ago, I woke up with very blurry vision in my right eye. It went away in a few minutes, and although it alarmed me I forgot about it until a few days later when it happened again. The blurriness continued so I went to my primary physician and he recommended that I make an appointment with my neurologist, which I did. He did not seem too concerned as my eyes were dilating equally and told me to see an eye doctor. I made that appointment, and in the mean time I was experiencing double vision and blurriness every morning. It only lasted for a few minutes but it scared me silly. I should mention that when I get out of bed, moving my eye up and down and side to side seems to provoke these symptoms. My eye feels funny, like they are hard, and not normal. I saw the eye doctor a few days later and he said that my pressure was 26 in the good eye and 28 in eye with symptoms. [ 12/23/11 ]
He suspected closed-angle glaucoma and told me that I needed an iridotomy right away. I had this procedure performed on October, 28, and I was then told to use Timilol in both eyes twice a day. I have not had any change in my morning eye attacks and he referred me to a glaucoma specialist. My pressure has come down (19 in my good eye and 20 in the eye that is blurry in morning), but I'm really freaked and nervous beyond belief. I feel unsteady on my feet and my blood pressure that is under control with Atenolol, spiked to 201/108 recently. It did not stay that high, but it never really got normal the rest of that day. My vision in the eye is not normal either and I have to wear glasses all of the time now. The doctor said my vision has not changed according to his eye test, but it does not seem that way to me. I really would appreciate it if you could give me some input as to what you might think is going on. I'm not living a normal life now and I'm having anxiety issues daily. Thank you for your time and hope to hear from you.
I am sorry to hear that you are having so much difficulty and that it is impacting your life so much. I would like to reassure you the best I can, but of course without examining you it is difficult to determine what exactly is happening. However, it sounds like you are receiving very good care. The symptoms you described can be consistent with angle-closure glaucoma, and you have undergone the necessary procedure. However, sometimes your angles can still stay “narrow” after iridotomies. It was not clear from your question whether you have seen the glaucoma specialist and what his/her opinion is regarding your angle anatomy. If they are still somewhat narrow, there are other conditions that may be causing your symptoms. The good news is that your eye pressure is under control and you should not worry as your doctors try to figure out why you are still having symptoms. Another possibility is that you may have a cornea condition that gives you the blurry vision in the mornings but improves as the morning progresses. Lastly, it is important to observe whether your symptoms are occurring only in the right eye versus both eyes, because this changes the possible diagnoses. I recommend that you seek out a glaucoma specialist if you have not already done so, and if you have, I would emphasize that your symptoms remain and to ask him/her to address your concerns. I wish you the best of luck!
I am a glaucoma patient who had trabeculectomy surgery on both eyes. I later developed a cataract, which was removed. I was using Xalatan and Cosopt eye drops before the cataract surgery, and would like to know if I can still continue these medications? [ 11/13/11 ]
That is a great question. The answer often depends on the doctor doing the surgery. If possible, I will often times have my patients stop their prostaglandin analog (Xalatan, Travatan, Lumigan, or generic) a few days prior to cataract surgery because of a slight increased risk of swelling in the retina (called cystoid macular edema) after cataract surgery when you are on those medications.
Often the choice of whether or not to restart the medication after surgery is dependent on what the pressure in the eye is after cataract surgery. There has been some interesting new data that shows there is an approximate 2 mmHg drop in intraocular pressure that lasts for about two years after cataract surgery (there is not a full understanding of why this happens, but many researchers are currently looking into it). If the pressure has dropped sufficiently after the cataract surgery, it may not be necessary to restart the prostaglandin analog (Xalatan in your case) unless the pressure goes up again above your goal intraocular pressure. In other cases, even if there is a small drop in pressure, it may not be low enough to achieve your goal intraocular pressure, so the doctor will likely restart all of the glaucoma medications after a certain time period after surgery. Again, this is all dependent on the doctor's preferences and how your eye responds to the cataract surgery. Keep your regularly scheduled appointments and the doctor will monitor your pressure and make adjustments to your glaucoma medications accordingly. I wish you the best of luck
I am living in Japan and seeking SLT surgery to lower my eye pressure (it is between 18 - 20 mmHg). My ophthalmologist states that SLT can cause a sustained rise in eye pressure and does not think it is called for unless my visual field is noticeably worsening. All the literature that I am reading seems to indicate that it is a very safe procedure with few side effects. I received a second opinion from another doctor and was told the same thing. How common is a sustained rise in eye pressure as a result of SLT laser surgery? [ 11/11/11 ]
Thanks for your question. Of course it is difficult without examining you to tell if you should have SLT, but I can address your questions about eye pressure rises after SLT. While I certainly always warn patients of this risk when I talk with them about this procedure, it is generally infrequent, on the order of 3 - 5 percent, and it is not usually sustained. I have heard a few anecdotal cases of sustained eye pressure rises requiring surgery, but these situations are uncommon. There are also several maneuvers your ophthalmologist can do to minimize the risk of an eye pressure spike with SLT. I always give my patients a drop of apraclonidine (or brimonidine) before the procedure to reduce the risk of an eye pressure increase. I titrate the laser power so that I am using the minimum amount of energy to achieve an effect. I usually treat 360 degrees of the drainage system, but some ophthalmologists will only treat 180 degrees to minimize an eye pressure spike, although to my knowledge this has not been definitively shown to be of benefit. I also always have my patients wait 30 – 60 minutes after the procedure so that I can re-check the eye pressure. If there has been a spike, we control it with medications and then re-check the pressure again. Of course, one must weigh the risks and benefits of laser surgery, but I would say that overall SLT is a relatively safe procedure. I have not discussed all of the side effects of the procedure here, but you should have a conversation with your surgeon about the risks, benefits, and side effects before you proceed.
I have been using Xalatan for six months and my sleeping habits are not consistent. How important is it for me to take the drops before bedtime? Can I take them when I do not plan to sleep? I may go to bed at 8 p.m. one night and midnight or later the next night. What should I do? [ 11/09/11 ]
Thanks for your question. I think a lot of patients run into your dilemma. The reason that Xalatan is dosed at bedtime is because it begins working 3-4 hours after instillation, peaks at 8 -12 hours, and persists for 24 hours. Because we know that eye pressure is highest in the morning, taking the drop at bedtime puts you in a situation in which the drug is most likely to be peaking at the time when the eye pressure is also peaking. The most important thing is for you to be consistent about taking your drops, so if it is easiest for you to remember to put them in right before you go to bed, then that is what I would recommend. If, however, you know that you will not be going to bed until midnight or later, and you can remember to take the drops around 9 p.m., then it is reasonable to do schedule it then. Alternatively, if you go to bed at 8 p.m., I would not set an alarm clock to wake yourself up and take the drop at 10 in the evening! I hope this helped to answer your question.
I would like to find a glaucoma expert in Athens, Greece who can use a laser to treat narrowing of the cornea. Do you have any suggestions for how to find such a person? [ 09/24/11 ]
Thank you for your question. I assume that you mean that you would like someone to use a laser to treat you for narrowing of the drainage angle, and not the cornea. While I personally do not know any glaucoma specialists that are in Athens, Greece, I might suggest contacting the Athens University Department of Ophthalmology. The department may be able to recommend someone in the area for a consultation.