I experience something that I call "first morning blindness." When I wake up in the middle of the night or first thing in the morning, I turn on a light and it gets really dark for what is a noticeable period of time. Then, I recover. I was diagnosed with glaucoma 5 years ago, and now I have it in both of my eyes. I'm also very nearsighted, have a metabolic disorder called polycystic ovarian syndrome, and was recently diagnosed with Stage 2 chronic kidney disease due to long-term, high dose use of ibuprofen therapy while also taking Lasix. Now, I'm also suffering from panic, which sometimes impacts my blood pressure. I am not taking any medications except spironolactone for my polycystic ovarian syndrome. I went to my ophthalmologist a couple of months ago for my glaucoma check up and mentioned the "morning blindness" to him. At that time, it had just started, and he said that he could not find any reason for it. I am seeing him in April for my next check-up. I asked him if my incr [ 02/03/11 ]
Thank you for your question. Unfortunately, without having examined your eyes, seeing the results of the eye tests that you have taken, or examining your eyes during or just after an episode of the "first morning blindness," it is difficult to give you an accurate answer. I can tell you that in general, glaucoma does not cause these types of symptoms. Usually, glaucoma causes very gradual visual decline and it occurs so slowly that most people do not recognize that changes are happening. In addition, vision loss with glaucoma is usually permanent and does not return to normal in the matter of a few hours.
First, I suggest that you let your primary care doctor or the doctor following your kidney disease (whichever is prescribing the spironolactone) know about these problems. In addition, please let them know if you are taking any herbal medications or vitamins. Given your multiple diseases (including possible vascular disease as indicated by the chronic kidney disease and blood pressure changes), I would highly recommend that you have a carotid Doppler exam just to make sure that you do not have any vascular problems in the neck that could be causing decreased blood flow to the eyes. In addition, I would have you take your blood pressure during these episodes to help determine whether or not the blood pressure is elevated or low. Often, we can have patients that have blood pressure bottom out at night if they are taking blood pressure medications right before bedtime. This can have ocular side effects and it can cause loss of vision. Finally, I would invite you to stay in the clinic so that you could recline in the chair and sit in the dark for a while. Then, I would have you sit upright and turn on the lights to see if we could stimulate one of the "first morning blindness" episodes. If these tests were all normal, it might be worthwhile getting a referral to a neuro-ophthalmologist and/or a retina specialist to make sure they do not see any problems. They could help determine whether or not imaging of the brain is needed as well. I would definitely suggest following up with your eye doctor and primary care doctor to let them know if the episodes are continuing or getting worse. I wish you the best of luck.
I read recently that glaucoma starts in the brain. Are there supplements or enzymes that would be helpful in preventing or treating the changes that occur in the brain? Also, is there a danger for the patient when an eye technician uses high-powered lights to look inside the eye? During one test, I felt that the intern was keeping the light on longer than needed and my eye began to hurt. I told her that I was uncomfortable and that I wanted her to turn the light off, but she did not. When I got home after the exam, I found that normal print appeared fuzzy, and my vision is still not normal; I now need reading glasses. I appreciate your input. [ 01/18/11 ]
Thank you for your question. There are no supplements or vitamins that have been proven in randomized controlled trials to prevent or slow the progression of glaucoma. I believe what you probably read was the recent finding that intracranial pressure may play a role in the formation or progression of glaucoma. At this time, this is a theory that many of us are looking into and will be doing research on. Currently, the only studies completed in the United States have been retrospective chart reviews. While the data appear to support the conclusion that a decrease in intracranial pressure may be related to formation or progression of glaucoma, more studies need to be done to confirm this finding. Keep an eye out for new research announcements on this front. We should be learning more in the next few years.
To answer the second part of your question, the lights used in the exam are not bright enough to damage your eyes. When your eyes are dilated, the lights can appear quite bright and even cause mild discomfort. When I have my eyes dilated and examined, the bright light almost always causes my eyes to water because of the bright lights (I literally get tears running down my cheeks). It is possible that during the exam, your eyes were kept open so that the exam could be completed, and therefore the number of times that you could blink and spread tears over the surface of the eyes was minimized. This may have resulted in a transient feeling of blurred vision or even a gritty feeling in the eyes. If you notice these symptoms after your exams, the use of artificial tears for a day or two will help you feel back to normal in short order. The use of lights during the exam or the exam itself will not have long-term effects on your vision and I am certain this has nothing to do with your need for reading glasses. Presbyopia (the need for reading glasses) happens as you get older and is related to the lens in the eye getting larger and less able to change shape.
My gynecologist suggested that I take 25-50 milligrams of DHEA because of I had a hysterectomy and an oophorectomy. Is DHEA safe to take if I use 1 drop of .01% Lumigan for open-angle/normal-tension glaucoma? [ 01/17/11 ]
I do not know of any contraindications to using both DHEA and Lumigan. In addition, I used Drugs.com to check for drug interactions. In looking on their website for interactions between the two, no results are found, indicating that they have not noted any adverse reactions either. From what I can tell, there is no contraindication to using these medicines in combination. When you start any new medication, if you notice any worrisome symptoms, call your physician immediately.
I have my eyes checked approximately every 2 years because of a hereditary predisposition for glaucoma. I generally can see, except in dim light, where I need to use a flashlight to read any fine print. During my last checkup, I informed the eye doctor of this problem, and he prescribed new glasses. Will my vision continue to get worse? [ 01/16/11 ]
Thank you for your question. While one of the earliest signs of glaucoma can be the loss of contrast sensitivity (the inability to see similar shades of gray, or the inability to see detail in darker conditions), these can also simply signs of getting older in normal individuals. As you age, you will also begin to develop cataracts (a cloudiness of the natural lens in the eye) and presbyopia (the need for reading glasses). As these symptoms occur, you will notice that reading fine print will be more difficult and you will likely notice that you need to hold objects farther away from your face to keep them in focus. Unfortunately, I have finally had enough birthdays that I am starting to notice that I cannot hold things really close to my face to see their details; I now have to use a magnifying glass. So, unfortunately, your vision will likely continue to get worse over time as cataracts develop; however, this is not abnormal. Given your family history, I might suggest that once you reach 40-50 years old that you consider seeing your eye doctor once each year just to be cautious. If your vision is getting worse because of something other than cataracts and presbyopia, such as glaucoma or macular degeneration, your eye doctor should be able to recognize the signs during your dilated eye exam. I wish you the best of luck.
I have had glaucoma for about 15 years. In addition, I had a detached retina, which was treated by means of a scleral buckle. About 2-3 years after the surgery, the same eye developed an occlusion. Therefore, I have no vision at all in that eye and I lost considerable peripheral vision in the other eye. Is there a connection between the detached retina treatment and the occlusion? [ 01/15/11 ]
Thank you for your question. This is an interesting situation that many eye doctors do not think about very often early in our careers. Yes, a scleral buckle can cause a change in the structure of the eye that can lead to narrow-angle or angle-closure glaucoma. The buckle squeezes the eye and creates a ridge upon which the retina attaches and holds onto for stabilization. There are many side effects of a scleral buckle. The squeezing can cause the eye to elongate (requiring you to need a more negative prescription to see clearly). In addition, if the buckle rides forward toward the front of the eye it can cause congestion of the outflow channel or even cause narrowing of the angle to the point of causing an occlusion. Typically you would notice this relatively quickly after surgery and not 2-3 years later; however, this could still play a part. It is something that most retina specialists recognize and if they notice that the pressure is increasing, they often provide a referral to a glaucoma specialist for an evaluation. Treating glaucoma in a patient with a scleral buckle often causes unique challenges. Given that you only have one "good" eye, I suggest that you have frequent eye exams by a glaucoma specialist and a retina specialist so that if there are any changes they are caught early. I wish the best of luck to you.
I have blurriness in the left eye, and my glasses do not correct the problem. My vision appears to be similar to what a patient with glaucoma might see in the intermediate stages of the disease, except that the entire eye is blurry rather than just the edges. This eye is also 'dimmer' than the right eye, meaning that the right eye sees things more brightly. This disparity appears to be getting worse with time. My eyes were checked using the standard tests within in the last 6 months, and the results were normal. Approximately 8 years ago, one test showed a spike in the eye pressure, but not high enough to worry the physician. What should I do? [ 01/14/11 ]
Unfortunately, blurriness and dimness are not stereotypical of any single eye disease. You are correct; blurriness of your central vision and the peripheral vision at the same time is not typical of glaucoma. Given that you notice a subjective "dimness" that continues to progress, I suggest that you visit an ophthalmologist and have a completed dilated eye exam. (If your current eye doctor is an ophthalmologist, then I suggest getting a second opinion). At this time, they will check everything from the front of the eye to the back of the eye. Your problem may be anywhere along the visual axis. This could involve the cornea, the lens (cataracts), the retina, or the optic nerve. Literally, any of these or a combination may be causing your problems. Without completing the eye exam myself, it is impossible to even begin to guess what may be causing the problem. I wish you luck in finding the cause of these problems.
My doctor says that I have mild glaucoma in one eye, for which he prescribed Lumigan. I also have mild high blood pressure and take 1 Ramipril tablet nightly. My doctor expressed concern that the two drugs may counteract each other if taken at the same time, and wants me to take the Ramipril during the middle of the day. It seems to me that the drugs are complementary, and there's good reason to take both at bedtime. Are you aware of this particular issue concerning Lumigan and Ramipril? [ 01/13/11 ]
Thank you for your question. In general, the two drugs will not necessarily counteract each other. Lumigan is a prostaglandin analog used to lower intraocular pressure through the uveoscleral pathway. Ramapril is an ACE inhibitor used to lower blood pressure and treat congestive heart failure. To my knowledge, there are no contraindications to using these two medications. This was confirmed by my search for drug interactions at Drugs.com which indicate "No Results Found" when looking for adverse interactions. What your doctor may be referring to is the fact that we often prefer our glaucoma patients to be quite careful about lowering their blood pressure too much at night. The Lumigan is used at bedtime to lower eye pressure, and if Ramipril is used at bedtime as well, it can lower the blood pressure quite substantially. If blood pressure decreases too much at night, there is a small chance of adverse effects on the eye. In general, I ask my patients to try and avoid taking the blood pressure medications right before bedtime unless their primary care doctor or cardiologist is opposed to them taking them earlier in the evening (dinner time). I hope this sheds some light on the subject. I wish you the best of luck.
My 5-year-old son is waiting to receive a Baerveldt shunt to treat his glaucoma. After the operation, how long should he stay out of school? When can he engage in normal activities again, such as running or swimming? [ 01/12/11 ]
Thank you for your question. I am sorry that you and your family are going through this with your child. You should plan on your son being out of school for 1 week at a minimum. The time period could be longer if for some reason the healing process is slowed, or there are complications after the surgery. During this week, he should avoid lifting, bending or straining (I know this is a bit difficult for 5 year old boys, but do your best). I typically give them “couch duty” with all of the video games, movies, and TV they can stand. You just want to avoid problems, if possible. Your eye doctor will have to let you know when he can go back to routine activity. This is often quite variable depending on how the surgery is performed (is the tube tied off, is a “ripcord” put in the tube, etc.) and how the individual patient heals. There is never an exact answer, unfortunately. I would assume that he will be back to his routine activities within a month or so, but again this depends on how he heals. Play it by ear and follow the directions of the doctor that does the surgery. At each exam, the directions will likely change and he will slowly get back to his routine activities.