My doctor said I have plateau iris syndrome and I had a laser iridotomy procedure for my right eye in early September. He also prescribed Xalatan to lower my eye pressure, but it causes severe headaches and sensitivity to light. Will the laser surgery lower my eye pressure and halt the progression of glaucoma? Will the treatments impact my left eye? Are there any natural remedies to stop the progression of the disease? My doctor said that I am in the early stages of the disease and that it was detected early. [ 11/03/10 ]
Thank you for your question. Plateau iris syndrome is a relatively rare condition that can lead to a type of angle-closure glaucoma. Briefly, patients with plateau iris syndrome have an anatomic variation in which the iris (the colored part of the eye) joins the sclera (the white part of the eye) and creates a very narrow drainage angle. The iridotomy is not done to treat the plateau iris syndrome or the glaucoma, but is more of a diagnostic tool. This relieves any component of "pupillary block" that might cause pressure behind the iris and force it to bow forward and cause a narrowing of the angle. If the iridotomy is performed and the iris does not fall back, this is diagnostic of having plateau iris (the diagnosis cannot be made until after an iridotomy has been done). Again the laser iridotomy is not a treatment for plateau iris syndrome and will not lower the pressures. The procedure will not have any impact on the left eye; however, your eye doctor should complete a gonioscopy to make sure that you do not have narrow angles or plateau iris configuration in the left eye as well. He may suggest doing a laser iridotomy in that eye if needed. If you are having headaches and sensitivity to light with Xalatan, you can try one of the other prostaglandin analogs (Lumigan or Travatan) or a different type of medicine. At this time, there are no vitamins or supplements that have been proven by randomized controlled trials to treat glaucoma. Any claims otherwise are completely false or misleading.
If a parent has glaucoma, does that increase their children's risk of developing the disease? Is it wise to use glaucoma medication in a preventive fashion? Thank you. [ 11/02/10 ]
Thank you for your question. Yes, if a parent has glaucoma, it does increase the child's risk of having glaucoma in the future. In the general population, approximately 1.86% or approximately 2 out of 100 people have glaucoma. This number increases to approximately 10% in children that have a parent with open-angle glaucoma. (i.e., 1 out of 10). There are many different genes that we have identified as having a relationship to glaucoma and there is an extensive amount of research being done on this exact subject. As we begin to know more about the genetics of the disease we may be able to identify which people are at a higher risk of developing the disease in the future. Answering the second part of your question is much more difficult. At this time, there are only very rare circumstances in which we would suggest using glaucoma medications in a preventative fashion. Even though approximately 1 out of 10 children can develop glaucoma if their parent has this eye disease, this also means that 9 out of 10 will not. Given the fact that the medications that we use to treat glaucoma also have side effects, we could be putting a lot of people at risk for developing those side effects even though they would never develop the disease. This is not good medical practice. However, there are a few very special circumstances in which a patient diagnosed with ocular hypertension or as a 'glaucoma suspect' may consider taking medications before having the definitive diagnosis of having glaucoma. However, this can only be determined after the patient has a thorough examination by an eye doctor and I would even suggest that this type of decision should really be made by a glaucoma specialist.
My sister has been told that she has glaucoma and has been given three different types of eye drops as well as tablets to manage her eye pressure, which is currently at 46. Although she has been taking the drops for a while, the eye pressure is not coming down. Would you have any idea why the medication is not working and could there be anything else causing this high eye pressure? She will now have to undergo a trabeculectomy operation and she is very scared. [ 11/01/10 ]
Thank you for submitting your question. I am sorry that your sister is going through all of this. Without having examined your sister's eyes personally, it is difficult for me to give an exact answer to your question. Unfortunately, there are many different types of glaucoma that patients can get (primary open-angle glaucoma, angle-closure glaucoma, diabetic neovascular glaucoma, and traumatic angle-recession glaucoma, for example). Sometimes, depending on the type of glaucoma that a patient has, medications do not work as well for one form of the disease as they do another.
The other problem is that even in the same type of glaucoma, for example all patients with primary open-angle glaucoma, individuals respond differently to the treatment. I have some patients that need one drop a day for the rest of their lives and they never have any further problems. I have patients like your sister who try all of the medications, yet none of them seem to work. Unfortunately, we are still trying to find out what causes all of these different types of glaucoma and how to best treat each of them. It sounds as though her doctor has tried all of the drops, but they have not worked for her. The next options are either using a laser or surgery to try and treat the glaucoma. Unfortunately, with a pressure of 46, I am not sure that the laser would be sufficient. I would agree that a surgery (trabeculectomy or glaucoma shunt tube) would be the best next step. If the pressure is not lowered, your sister will eventually lose her sight in that eye. I know undergoing surgery can be very scary, but the good news is that most patients do very well. I suggest that she have a discussion with her eye doctor about the risks, benefits and alternatives of having trabeculectomy surgery. Because she is scared, this conversation may take some time, but discussing all of her fears may help put her more at ease. You might consider writing down her questions for the doctor so that you do not forget any. I wish you the best of luck.
I believe that Xalatan will be available in a generic version in November of 2010. Do you know the name of the generic version? [ 10/19/10 ]
Thank you for your question. Many glaucoma specialists and our glaucoma patients are anxiously awaiting the release of a generic version of Xalatan (or any of the prostaglandin analogs). To my knowledge, the generic for Xalatan will not be available until after March 2011, although I may be incorrect about that. I am mainly going by a July 6, 2004 decision by Judge Stanley R. Chesler of the United States District Court for the District of New Jersey. The legal finding was that Pharmacia's patent on formulations and uses of latanoprost (Trade Name Xalatan) covered under U.S. patent# 5,296,504 that expires in March 2011 was valid, infringed upon and enforceable against Par (a drug company trying to make a generic). Further, the court issued an injunction blocking the approval of Par's drug application until the March 2011 expiration of patent #5,296,504 (the Xalatan Patent). Simply put, I would assume that any other generic produced before March 2011 will be found to infringe upon the Pharmacia's patent on Xalatan. The generic will most likely be sold under the compound name Latanoprost and will likely still be 0.005% concentration. I do not yet know who will distribute the generic, but it will be someone other than the Pharmacia & Upjohn Company Division of Pfizer, Inc, New York, NY 10017 as they are the parent company that makes Xalatan.
I am a 24-year-old male and was diagnosed with glaucoma in my right eye. I have been told that I may lose sight in my eye. What are the chances that glaucoma will affect my other eye? [ 10/18/10 ]
Thank you for your question. Unfortunately, without having examined your eyes myself or having seen the results of your previous tests, I cannot give you an accurate estimation of the chances that you will eventually develop glaucoma in your left eye. There are many things that I would need to know. First, developing primary open angle glaucoma at the age of 24 would be quite unusual (although not impossible). Therefore, I would have to assume it is caused by some other reason. If the glaucoma is secondary to trauma in the eye, then there is no increased risk of developing glaucoma in the left eye compared to the average person (unless it also had trauma). If the glaucoma is caused by new blood vessel growth secondary to diabetes (i.e. neovascular glaucoma), then it is possible that the new vessels could begin growing in the left eye as well. This may increase your risk for developing glaucoma in that eye. As I said, unless I knew more, I could not give you an accurate assessment. I suggest that you discuss the cause of your glaucoma with your eye doctor and ask them the risk of developing glaucoma in the left eye. Because they are familiar with your case and your history, they should be able to give you an accurate assessment of the risk of developing glaucoma in the left eye.
I am 45 years old and had trabeculectomies in both eyes around 2 years ago. I know that the key for the bleb to keep functioning is for the fistula to stay open. In theory, wouldn't a poorly functioning trabecular meshwork, (one that is really clogged up), force more fluid through the fistula and help keep the bleb functioning? [ 10/15/10 ]
Thank you for the interesting (but quite complex) question. The full answer is beyond the scope of this blog and would take a full discussion of fluid dynamics, eye physiology, and glaucoma pathophysiology to answer appropriately. I will do my best to try to give you an adequate answer; however, I am afraid this answer may not be 100% accurate due to the constraints of time and length. Answering the question as written is difficult, so I am going to try to clarify it a bit by changing it slightly. First, “Would a poorly functioning trabecular meshwork force more fluid through the fistula?” The answer is likely yes. The fluid will primarily take the path of lesser resistance until that pathway is at its maximal outflow capacity. If the trabecular meshwork is completely clogged, there are essentially two methods left for the aqueous fluid to escape. If there is a trabeclectomy, the aqueous can go through the fistula to the conjunctival bleb and be reabsorbed. Otherwise it may be absorbed through a second pathway that uses the ciliary body for reabsorption (the uveoscleral outflow pathway). Continued flow though the fistula and into the bleb is important for its continued functioning; however, is by no means the only factor in determining whether the bleb will continue to function or fail.
Further, the goal of trabeculectomy surgery is not to create a functioning bleb, the goal of trabeculectomy surgery is to lower intraocular pressure to a point that the optic nerve damage does not progress (i.e. if the bleb is perfectly functional but not sufficient to get the pressure low enough by itself, then the glaucoma will continue to progress, and we have not met our actual goal). So if you asked me “If a trabeculectomy has been completed, would you be better off completely blocking the trabecular meshwork at the same time so that all of the fluid is forced through the bleb in an attempt to keep the bleb functioning better.” The answer to that is probably not. After a trabeculectomy is completed, some fluid continues to escape through the trabecular meshwork (the conventional pathway), some travels though the uveoscleral pathway, and some through the fistula to the bleb. All three of these pathways are utilized in concert to give us the best chances of achieving the goal of maintaining the intraocular pressure at a lower target goal. I hope this comes close to answering the question. Best of luck.
If I need eyeglasses to see well, does that mean that I will develop glaucoma later in life? [ 10/14/10 ]
Thank you for your question. The easiest answer that I can give you is “Absolutely Not”. While there is some growing evidence that needing to wear glasses, whether you are hyperopic (far sighted) or myopic (near sighted), may put you at a slight increased risk of developing certain types of glaucoma (i.e. hyperopia is associated with a higher incidence of angle closure in some patient populations), this in no way indicates that because you wear glasses you will absolutely develop glaucoma in the future. In fact, the vast majority of people wearing glasses never develop glaucoma. Similarly, the fact that someone does not wear glasses is not a guarantee that they cannot develop glaucoma. In short, your glasses prescription cannot predict whether or not you will eventually develop glaucoma; but someday with more research, we might be able to understand how a person's glasses prescription changes their risk of developing glaucoma.
I had Lasik surgery to correct my vision approximately 4 years ago, and would like to know if that procedure could have caused my glaucoma? [ 10/13/10 ]
Currently, there is no evidence in the literature to indicate that Lasik surgery can cause glaucoma. At times, we will occasionally see patients that have a slight increase in pressure just after surgery if they have to use steroid eye drops to help reduce inflammation; however, this usually goes away after stopping the steroid eye drops (we call this steroid induced glaucoma). To our knowledge, simply having Lasik surgery does not directly cause glaucoma nor does it put you at an increased risk of developing glaucoma in the future.