I have been suffering from narrow-angle glaucoma since I was 67 years old. I underwent 3 YAG iridotomies in December of 2005. Thereafter, I was taking Xalatan and my IOP was stable at 14 - 16 millimeters of mercury. I would like to know whether Timolet can have any adverse effects on my glaucoma compared to Xalatan. I read the side effects for each of these eye drops, but would like your input on whether or not it makes sense to change eye drops. [ 04/09/11 ]
Thank you for your question. Without having examined your eyes or the results of your previous exams, it is difficult for me to provide an accurate recommendation. I will assume that your doctor was happy that your pressure was between 14 and 16 and that is your target or goal intraocular pressure.
Changing to a new medication can always put you at risk for additional adverse effects. I do wonder why you switching from Xalatan if it has controlled your eye pressures for the last 5 - 6 years. Typically, eye doctors do not change medications if they are working well. If you are having trouble with side effects from the Xalatan (the most common are change in iris color, change in skin color around the eye, redness, etc.) or the medication is too expensive, then you might want to consider changing medications. Timolet is a preparation of timolol. Timolol (a beta-bloker) is contraindicated in patients with:
- bronchial asthma
- a history of bronchial asthma
- severe chronic obstructive pulmonary disease
- sinus bradycardia
- second or third degree atrioventricular block
- overt cardiac failure
- cardiogenic shock
- hypersensitivity to any component of this product per the timolol insert.
As you have read, there are many potential side effects of this medication. These can include, but are not limited to shortness of breath, slowing of your heart-rate, lowering of blood pressure, dizziness, etc. Most people tolerate timolol relatively well and it is often less expensive than Xalatan or other prostaglandin analogs. I suggest that you discuss the change in medication with your eye doctor and determine why they have recommended that you change medications even though it appears that the Xalatan is working well for you. Overall, as long as you do not have side effects from the Timolet and it reduces the pressure to the appropriate goal, I think using it is fine. I have patients on both medications and most do relatively well. I wish you the best of luck.
I am a 60-year-old woman, and last January I started getting sharp pains in my eyes. This was accompanied by tearing, soreness, blurry vision, and swollen eyelids. It felt like I had sand in my eye. Over-the-counter eye drops provide some relief. I have many mornings where it hurts to open my eyes. I went to see an ophthalmologist, and she said that I probably had an eye infection, and to use artificial tears every day. I tried this suggestion, but the condition continues. I would appreciate your input. [ 04/08/11 ]
Thank you for your question. Unfortunately, without actually examining your eyes or seeing the results of the other ophthalmologist's previous exam, it is nearly impossible for me to give you any accurate advice. The symptoms that you describe are not specific for any one disease process, so a full dilated-eye exam would be warranted to determine the cause. The symptoms could be signs of a simple viral eye infection and artificial tears would be the treatment of choice; however, if it has been more than 7-10 days and the symptoms have not improved, it is less likely to be a simple viral “pink-eye” infection. I suggest that you return to the eye doctor for a second exam and let them know that the symptoms are not fully relieved. It may be something as simple as dry eye syndrome and continued use of artificial tears might help; however, it may also be something more involved. I am sorry that I could not be more specific, but this is best answered after a full eye exam.
I am 29 years old and have had glaucoma since I was 4 years old. I have not used Xalatan for the last 16 months because I am planning a pregnancy. I am now preparing for in-vitro fertilization and I must take hormones. Can you tell me how hormones will affect on my glaucoma? [ 04/07/11 ]
Thank you for your question, and I wish you the best with your in-vitro fertilization. Unfortunately, without knowing a bit more about the names and doses of some of the medications/hormones that you will be taking, it is difficult to give you an exact answer. Clomiphene citrate (a fertility medication) is known to be associated with some mild changes in vision in some patients; however, those changes are typically reversible once the medication is stopped. In general, stopping the clomiphene is not always necessary, but doctors will continue to watch patients closely while they are taking the hormone. If you are taking other hormones for your pregnancy, I would suggest that you find the exact names and doses of these hormones from your OB/Gyn. Take these to your glaucoma specialist and they can look up any potential side effects for you. In most cases, they are likely mild and will not be contraindicated. Due to the fact that you are not taking Xalatan, I suggest that you have routine follow-up visits with your eye doctor throughout the in-vitro process and pregnancy to watch for any elevation in eye pressure.
I am 59 years old, and was recently diagnosed with normal-tension glaucoma and early cataracts. I have also been taking 20 milligrams of Ritalin LA for 15 years, in addition to taking numerous medications for diabetes, hypertension and thyroid problems. I am hesitant to continue taking Ritalin now that I have a diagnosis of glaucoma. Could the Ritalin have caused the glaucoma and cataracts? [ 04/06/11 ]
Thank you for your question. There is evidence, based on a few case studies, indicating that Ritalin may, in fact, cause both glaucoma and cataracts. There have not been any long-term, randomized controlled trials studying this relationship; a larger study is required to obtain a definitive answer. It is possible that you have simply developed glaucoma and it has nothing to do with the use of Ritalin (especially considering the fact that you have been taking it for nearly 15 years with no other problems). For now, I recommend discussing the risks, benefits and alternatives of stopping the medication with your eye doctor, as well as with the doctor that prescribed the Ritalin, to determine the best course of action. Until there is more definitive evidence one way or another, I do not feel that I can give you a precise answer or recommendation. I wish you the best of luck.
Is there any significance in having asymmetrical intraocular eye pressures (12 in one eye and 19 in the other)? I was told that I have damage to my optic nerve, and every time I have my IOP checked, the technicians look worried. Last time, they ran several tests that are used in the diagnosis of glaucoma (a photograph of the inside of my eye and visual field testing). I have not been told that I have glaucoma, and I have not been prescribed eye drops. I am 38 years old and I can no longer drive at night because I cannot see well in the dark; the headlights seem to be way bigger and brighter than they should be. The sun also hurts my eyes when I go out in the daytime, and I periodically have a disturbance in my side vision where it feels like I am looking through water. It affects both eyes and lasts for 15 or 20 minutes. Last year the doctor just told me to come back in a year for another evaluation. I appreciate your input. [ 03/31/11 ]
Thank you for your question. This is a difficult case to make too many recommendations about because of how little information that you currently have. In addition, because I have not been able to examine your eyes personally, it is also difficult to give an accurate assessment. In general, you are correct to have concerns about the asymmetric pressure in your eyes. This is especially true if you have documented nerve damage. Glaucoma is classically defined as a stereotypical pattern of damage to the optic nerve and certain layers of the retina. Elevated intraocular pressure is a risk factor for glaucoma, but just because the pressure is elevated it does not mean that you have glaucoma. Often, people with elevated intraocular pressure alone, and no other signs of glaucoma, are given the diagnosis of ocular hypertension. Similarly, just because the intraocular pressure is normal, as in your case, this does not mean that someone cannot have glaucoma. We often see patients with glaucoma that have never had increased intraocular pressure, and we call this "normal tension glaucoma." With a family history of glaucoma, or any other risk factors for glaucoma, your eye doctor may give you the diagnosis of being a "glaucoma suspect." This means that they do not yet believe you have glaucoma, but that you should be watched closely for the development of this eye disease in the future. Our goal as eye doctors is to identify glaucoma before you, as a patient, ever notice any changes. Your eye doctor will likelyfollow the intraocular pressure, vision, visual fields, OCT, and the appearance of the optic nerves to see if there is any evidence of glaucoma that presents in the future.
In your case specifically, there are things that I would like to know. First, the eye pressure is usually relatively symmetric in both eyes. I would want to perform some very specific exams to determine why the pressure is different. The first thing that needs to be done is a thorough history to determine if you have ever had trauma to the eye. You need to have a gonioscopy completed (this is a very simple test that any glaucoma specialist can do) to look for any damage to the natural drainage system of the eye (especially the eye with elevated pressure). Next, I would make sure that the visual field, the OCT and the stereo disc photos are normal and do not show any signs of optic nerve damage. If there is any evidence of damage, I would suggest treating the eye and reducing the pressure to the same level as the other eye, if possible. In addition, I would want to know if you have been using any steroid drops, inhalers with steroids, or any medications that have steroids in them. This can lead to a secondary steroid-induced glaucoma.
In general, when a young person presents with glaucoma in a single eye (asymmetric glaucoma), you need to figure out why. It is difficult to determine whether the changes in vision are related to the asymmetric pressure. Often, glaucoma slowly takes vision, but it does not fluctuate noticeably over 15-30 minutes. I suggest that you be seen by an ophthalmologist that has completed a glaucoma fellowship for a second opinion and discuss all of the symptoms that you are having. If you do have glaucoma, this is not a routine case of primary open-angle glaucoma in all likelihood. If you do end up having a diagnosis of glaucoma, the doctors may also be able to tell you why. If your current eye doctor is not a glaucoma specialist, do not hesitate to ask for a second opinion. I wish you the best of luck.
I have glaucoma, and have been treated with eye injections and laser surgeries. My right eye has been completely blinded by the glaucoma and from complications associated with cataracts. I currently see very little through my left eye, and have been pronounced legally blind. I am also diabetic. My doctor inserted an implant in the left eye; however, a “film” grew over the eye and the doctor does not want to remove it. The vision in that eye is now cloudy. Does this treatment plan make sense? Is there any hope for me? [ 03/30/11 ]
Thank you for your question. Unfortunately, without having examined your eyes personally, knowing a bit more about your complicated history and seeing the results of previous exams and tests, it will be nearly impossible for me to provide an accurate recommendation. Diabetes is one of the leading causes of blindness and can be very difficult to treat. I am guessing that you have diabetes that was not well controlled at some point, which led to the new blood vessel growth in the eye and possibly the formation of cataracts.
When you state that your glaucoma has been treated with injections and laser surgery, that tells me that you do not just have primary open-angle glaucoma; it is more likely glaucoma related to the diabetes (also called neovascular glaucoma). When the diabetes is out of control, the eye creates new blood vessels to try and get oxygen to the eye. Those new blood vessels eventually grow into the front of the eye and they can block its natural drainage system. This can cause an increase in eye pressure (i.e., neovascular glaucoma). You should know that glaucoma is not typically treated by injections; however, the new blood vessel growth (a complication of diabetes) is treated by injections. This is such a complicated case that you would need a full eye exam to determine the appropriate treatment plan, and it may take a combination of doctors. If this is related to diabetic eye disease, I would make sure that you are seeing a retina specialist that can examine the retina and treat the diabetic complications as well as a glaucoma specialist that can treat the increases in eye pressure caused by diabetes. You are dealing with a very serious disease and if you do not get your diabetes and eye pressure under control, you will likely continue to lose vision and could easily become blind in both eyes. I am sorry that you are having all of these difficulties, and I know it can be scary. I wish you the best of luck.
I have secondary glaucoma due to cataract surgeries, and the doctors suspect that I also have Marfan syndrome. The glaucoma was diagnosed when I was 36, and I currently take Xalatan and bromonidine. I hope to continue driving and working, so I would like to know how long I can expect to maintain my vision. [ 03/29/11 ]
Thank you for your question; it sounds as though you have been through quite a bit at a relatively young age. There are a lot of different types of glaucoma, and they can progress at different rates. Some types of glaucoma, like angle-closure glaucoma,can progress quickly if the pressure isincredibly high, and vision loss can occur within days or weeks. Other types of glaucoma are quite slow and it may take months or years before there is any evidence of vision loss. It is difficult to predict what course your glaucoma will take; that is why it is important to seethe eye doctor regularly and not miss the appointments. Once a thorough eye exam has been completed,the eye doctor will often set a target or goal intraocular pressure. The only variable that doctors can change to slow or stop the progression of your glaucoma isthe intraocular pressure, and to achieve this goal, there are essentially three different tools available: medicated eye drops, laser treatments, and surgical methods. Your doctor has started you on two eye dropsand willfollow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how your eyes respond. If the pressure is not reduced enough or your doctor ever notices advancement in your glaucoma, they will add more medications or use laser or surgery to help lower the intraocular pressure further. In the majority of patients, it is possible to lower the pressure enough to stop or dramatically slow the loss of vision; however, this may take multiple surgeries, laser treatments, or medicines (and likely a combination of these three).
Given that you are quite young and likely have decades of life ahead of you, it will be important to maintain a close watch on the intraocular pressures for the rest of your life and keep them very well controlled. Unfortunately, any vision that is lost due to glaucoma cannot be regained, so this is something that you will be dealing with the remainder of your life, and it is important to aggressively lower the pressure now and not wait to see evidence of further damage. I wish you the best of luck.
I wanted to know if moderate alcohol consumption can, in any way, affect the longevity of a trabeculectomy. [ 03/28/11 ]
Thank you for your question. I have been asked many times whether or not alcohol consumption causes glaucoma, but never its effect on trabeculectomy longevity. Unfortunately, the short answer to your question is that after searching the literature, I could not find any studies that have addressed this subject. In general, when my patients ask about the connection between alcohol consumption and glaucoma, I tell them the following:
First, the most recent large study looking at the risk of alcohol consumption and the diagnosis of glaucoma were published in 2007 out of Harvard Medical School. The study examined 80,486 female nurses followed from 1980 to 1986 as part of the prospective, longitudinal Nurse's Health Study, and 42,251 male healthcare professionals who were followed from 1986 to 2002. The final conclusion of this study was that the amount of alcohol consumed by an individual did not influence the risk of being diagnosed with glaucoma.
This brings up a second different question however, and that is whether or not alcohol consumption has an impact on intraocular pressure. The answer to that question is yes. Alcohol consumption can lower intraocular pressure for a short time; however, it should never be used as a method of treating glaucoma or increased intraocular pressure. This is important for patients with glaucoma or patients that are currently being followed because the eye doctor is concerned that the patient may develop glaucoma in the future (i.e., a 'glaucoma suspect'). It is important that you do not consume alcohol prior to your doctor's visit as this may falsely lower your intraocular pressure and make monitoring or diagnosing glaucoma more difficult.
I am sorry that I could not answer your question directly, but to my knowledge, there are no studies that have ever addressed that specific issue. I hope that the other information is helpful.