Ask an Expert about Glaucoma

Thank you for your question. It is not clear to me whether you actually have hypotony, a condition in which low pressure causes decreased vision, or whether you might have “low-pressure” or “normal-tension” glaucoma, a condition in which there is characteristic optic nerve damage despite having a “normal” eye pressure. If it is the latter, the only treatment we currently have for these forms of glaucoma is to lower eye pressure, even when the pressure is “normal,” and this may be why our doctor prescribed Travatan Z. I hope this answered your question.

Thank you for your question.  It sounds as though your mother has quite a complex set of problems.  Given all of her issues (glaucoma, cornea issues, and retina problems) it would be nearly impossible for me to give you any accurate answers without having seen the results of previous exams or tests, and previous operative reports to understand what surgery was done. In addition, I would need to also do an exam myself to see what type of “weeping” you are talking about.   

In general, this will not likely have anything to do with the macular degeneration as that is a problem with the retina on the inside of the back of the eye. The term “wet macular degeneration” refers to the fact that there is bleeding in the retina and has nothing to do with moisture or weeping at the front of the eye.  “Weeping,” whether it is tearing, mucus, or purulent discharge is almost always related to the front surface of the eye (the cornea or conjunctiva/sclera).  To specifically address the “weeping” it would depend on the consistency of the fluid coming from the eye.  If it is watery, it may simply be that her tear ducts are clogged and she has tearing (epiphoria).  This is less likely considering that you say her nose runs when she has this problem.  Sometimes the eye drops that we use can irritate the eyes a bit and cause watering themselves.  In addition, the doctor can also test to ensure her tear drainage system is working and he can also determine if she is making too many tears naturally.  If the “weeping” is thicker, it is important to determine whether it is related to an allergic reaction to one of the glaucoma medications (this could also account for the redness).  It would also be important to rule out the possibility of an infection as well.  Sorry I could not be of more help, but in these cases it is difficult to be of more assistance without personally seeing the patient.  I wish you the best of luck.

Thank you for your question.  I am sorry that you are having eye troubles.  This sounds a bit more complicated than just simply having glaucoma.  Without having examined your eyes or having seen the results of previous exams and tests it will be difficult for me to give you an accurate answer.  In general, we say that glaucoma is classically defined as a stereotypical pattern of damage to the optic nerve and certain layers of the retina.  In the early stages, this damage to the nerve and the retina primarily result in loss of peripheral vision and loss of contrast sensitivity.  Contrast sensitivity is the ability to see differences between shades of similar color such as two different tones of grey.  For example, you might still see dark black colors on bright white (such as the vision chart that we use in the office) but two different tones of grey may be harder to see.  This can manifest in the real world as trouble seeing when you are in a car and it is raining outside (all of the colors are muted and look similar).  In addition, if you decided that you wanted to repaint a room in your house and you went to the paint store to look at the different color swatches, it may be difficult to see a difference between similar colors.  

In glaucoma, the central vision becomes involved only when the glaucoma has progressed and become quite advanced.  In many cases, if central vision is lost due to glaucoma it can be permanent.  The most important thing is to reduce the pressure in an effort to slow or stop the progression of the disease. In your case, I would question whether or not the central vision loss is due to glaucoma.  In most cases, when a cataract is removed, hopefully the central vision will become clearer and help the patient see better.  If you saw well immediately after surgery and then things started to get worse over the next few weeks (and your pressure was in a good range), I would recommend having your eye doctor look for two different things.  First, he or she can look to see if the posterior capsule (i.e., the bag) where the lens is held is getting cloudy.  This happens in about 20 percent of patients after cataract surgery and is simply related to the way that some people heal.  It can be fixed by using a laser treatment of the posterior capsule.  Secondly, you should probably see a retina specialist.  If you have lost central vision because of “excessive scar tissue” it sounds as though you might also have macular degeneration or another retinal disease of the macula.  It is also possible to have swelling of the retina after cataract surgery that might cause changes in your central vision (this is called cystoid macular edema). I would suggest having a dilated fundus examination to see if there are any problems with the retina. 

Rest assured that we are doing our best to find new ways to treat glaucoma and stop or slow the progression of vision loss.  As new advances are made we will keep our readers posted.  I wish you the best of luck.

Your husband would most likely notice side effects when taking a medication. If he did not notice any side effects while on the medication it was probably well tolerated and worked appropriately to lower the eye pressure. To our knowledge, there are no long-term side effects of taking alpha agonists (brimonidine, Alphagan, etc) without having glaucoma. In addition, to our knowledge there are no side effects associated with taking the medication for many years and then stopping. I would recommend that your husband continue to have eye pressure tests, visual field tests, and dilated fundus exams regularly by a glaucoma specialist (i.e., an ophthalmologist that has completed glaucoma fellowship training) now that he has stopped the treatment. It is possible that the eye pressure may increase slightly and go back to its normal “baseline.” It would not be unusual to see his average eye pressure go up after stopping the Alphagan because it was probably working appropriately and lowering the pressure even though he may not have had glaucoma. If the pressure elevates substantially, it may provide evidence that your husband does, in fact, have glaucoma and that he needs to restart treatment. I think stopping the medication for a period of time is fine as long as he continues to be seen regularly by his glaucoma specialist.

Thank you for your question. If you are taking steroids to treat a systemic disease, such as asthma, it is possible that your eye pressure can increase. Increases in eye pressure caused by the use of steroids are quite common. We primarily see steroid-related increases in eye pressure when patients take steroid eye drops after surgery or to treat a condition called uveitis; however, it is possible to get increases in pressure from oral steroids, inhaled steroids, or steroid creams. If you are taking any steroids, you should let your eye doctor know. The only way to determine whether or not you are a “steroid responder” (i.e., the pressure in the eye increases because of the use of steroids) is to recheck the eye pressure now that the steroids have been started. You can compare pressure to the previous eye pressure readings when you were not taking the steroids. 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. If you are going to test the pressure while on the steroids and then taper off of them and test again, it is important to discuss this both with your eye doctor and the doctor that put you on the steroids (if they are not the same person) so that they can monitor you appropriately. In the majority of cases, if there is an additional increase in eye pressure that was caused by the steroids, the pressure will drop back down when the drug is stopped. I wish you the best of luck.

Thanks for your question.  I am so sorry to hear about your wife's eye diseases.  I contacted the scientist who first reported the properties of oncomodulin for optic nerve regeneration, and unfortunately there are not yet any clinical trials.  However, they are working on better delivery methods.  You did not state the underlying cause of the right eye's retinal atrophy, but there are ongoing clinical trials of retinal prosthetic devices for retinal degenerative diseases.  Oftentimes, though, if the patient has another eye disease, such as glaucoma, they are excluded from participation.  You can search for clinical trials at clinicaltrials.gov.  I wish you the best.

It is safe for a person with glaucoma to donate blood if they are using eye drop medications. There is a short list of medications which cause birth defects that are considered during donor screening, and none of the eye drops pose a risk. Donor blood is also screened for infectious diseases such as HIV and hepatitis. In terms of donating blood, there has been some discussion about whether blood loss is a risk factor for glaucoma, but there have been no studies demonstrating that more frequent blood donations are a risk factor for worsening glaucoma.

Thank you for this question. The concern with steroid use is that some patients, particularly glaucoma patients, are “steroid responders.” However, certain routes of administration, such as eye drops, are more likely to induce a “steroid response” or eye pressure elevation. Steroids delivered by other means (inhaled steroids, steroid creams applied around the eyes, oral steroids) that access the blood stream can also elevate eye pressure, but occurs less commonly. Therefore, it is possible that the hydrocortisone suppository elevates eye pressure, but as long as your eye pressure is monitored, I would consider treating your proctitis as recommended by your physician and have your ophthalmologist monitor your eye pressure closely. Of course, if you have had previous “steroid response” to steroid eye drops or you have poorly controlled glaucoma, you will have to be especially careful.