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.
Is glaucoma directly correlated with having a retinal detachment? [ 01/10/11 ]
Thank you for your question. I am not exactly sure that I understand your question, but let me try to clarify. The two possibilities are as follows:
- “If I have glaucoma, am I at an increased risk for developing a retinal detachment?”
The answer to this question is “maybe,” but it is not common. Primary open-angle glaucoma itself does not predispose you to developing retinal detachments in the future; however, one of the medications that we use to use to treat glaucoma has a known side effect of causing an increased risk of developing retinal detachment. The medication pilocarpine (it has a green cap) has long been known to have an increased association of retinal detachments, but we now have much better medications and pilocarpine is no longer commonly used to treat this eye disease. Secondly, there are a couple of special cases in which patients might develop retinal problems that can lead to both glaucoma and a retinal detachment (neovascular glaucoma from uncontrolled diabetes, for example). In these cases, they would likely occur because of the new blood vessel growth in the angle of the eye and on the retina, but the glaucoma itself still does not cause retinal detachments.
- “Can a retinal detachment cause a secondary glaucoma?”
The answer to this question is “yes.” There is a special type of glaucoma called “Schwartz-Matsuo Syndrome” in which a retinal detachment occurs and the photoreceptors (small light sensing cells in the retina) are dislodged from the retina. They float in the vitreous and aqueous inside the eye and eventually get clogged in the trabecular meshwork drainage system. If the trabecular meshwork get clogged enough, it is possible for the pressure to elevate and cause glaucoma.
I am a glaucoma suspect according to the doctors, and I recently had laser surgery in both eyes for narrow angles. After the surgery, I developed a ‘horizontal line,’ which the doctor says can be fixed with sutures; however, she does not want to do this procedure. Also, my eyes seem tired and red quite frequently. Last year, I had my eyes dilated and for 3 days I saw halos and had a bad headache; it was horrible. This year, the doctors said that they cannot dilate my eyes because there is a change in the angles. I am confused concerning whether or not the surgery helped me. Do I have to worry about getting glaucoma now? [ 01/09/11 ]
Thank you for your question. Since I have not been able to examine your eyes or view your chart with old exam notes and test results, it is nearly impossible for me to give you an accurate answer. If you had narrow angles that required a laser procedure, I would have to assume that you had a laser peripheral iridotomy (LPI or PI). One of the potential side effects of that laser procedure is seeing a line like you describe. It is usually in the lower portion of your visual field. This occurs because light is passing through the LPI hole and hitting the retina (similar to the way light goes through the pupil and hits the retina). Unfortunately, this can cause a line in the vision or even double vision. Your doctor is correct, it can be fixed with a suture, but that would reverse the laser procedure and put you back at risk for developing angle-closure glaucoma. The LPI is done to help prevent pupillary block angle closure and in most cases helps prevent the development of angle-closure glaucoma in the future.
If an LPI was completed and the angle did not deepen you may have a special anatomic variation called “plateau iris configuration.” If this is the case, then yes you are at an increased risk of developing glaucoma in the future. If your doctor feels that you have had a change in the angle and they are concerned enough that they are not willing to dilate your eyes, you need to ask for a referral to an ophthalmologist that is a glaucoma specialist. It is possible that you have a narrowing of the angle because a cataract is getting larger or it is possible that you have “plateau iris” or chronic angle closure that is slowly getting worse. In either case, you are best served by being examined by an ophthalmologist that is comfortable diagnosing and treating complex types of glaucoma. I wish you the best of luck.
My eye pressure is 22; however, my doctor has not put me on eye drops. I have an eye appointment every 4 months and my doctor is watching me closely. Should I be concerned about taking these eye drops? [ 01/08/11 ]
Thank you for your question. Because I have not examined you myself or seen the results of your tests, I have to make a few assumptions. It sounds as though your doctor has diagnosed you as having “ocular hypertension” and is following you as a “glaucoma suspect.” Follow-up for every patient diagnosed with glaucoma or diagnosed as a glaucoma suspect is completely different depending on what you find during the eye exam and the results of periodic tests. Once you have been diagnosed as a glaucoma suspect, a plan for follow-up should be established. This can be either a plan to watch your eyes closely (for the majority of patients) or to initiate treatment (for a minority of patients). All of this depends on the findings at the exam and the results of those tests. If your exam and tests are normal except for the slightly elevated pressure, then you may simply be a glaucoma suspect and have “ocular hypertension.” Following you every 4 months for a pressure check during the first year or so is reasonable. I would suggest a visual field and dilated exam every year at some point, and I would probably not recommend starting drops at this time. If you remain stable for a couple of years, I would spread your visits out to every 6 months for a while, and if you continue to be stable for a couple of years after that, I might consider going to yearly exams. If I ever saw anything of concern, I would continue to monitor you more closely and consider starting pressure lowering drops at that time. Overall, it sounds as though your eye doctor has a good plan established for you.
Our goal as eye doctors is to identify glaucoma before you, as a patient, ever notice any changes. Your eye doctor will likely follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves at different intervals to see if there is any evidence of glaucoma that presents in the future. If you have questions or concerns, do not hesitate to start an open dialog with your eye doctor and ask them to explain why they have chosen the particular monitoring plan that they have prescribed for you. If you are still concerned, it is always acceptable to ask for a second opinion from a glaucoma specialist.