I was 12 years old when I was diagnosed with glaucoma, and always believed that glaucoma was a disease of older adults. How could I have been diagnosed with glaucoma at such a young age? [ 09/22/10 ]
Thanks you for your question. I am sorry to hear that you have been diagnosed with glaucoma at such a young age. In one respect you are correct, primary open-angle glaucoma is a disease that usually affects older adults. However, unfortunately there are many different types of glaucoma (in fact, some experts suggest that there may be hundreds or thousands of different types of glaucoma). While primary open-angle glaucoma is typically found in adults, there are other types of glaucoma that are found in younger children (juvenile open-angle glaucoma) and even babies as soon as they are born (congenital glaucoma). Because you were diagnosed at the age of 12, you most likely do not have congenital glaucoma. Because you are young, the chances of having primary open-angle glaucoma are also very small. Without having examined your eyes myself and seeing the results of your tests, giving an exact diagnosis is impossible. However, given your age, the most likely cause of your glaucoma is either juvenile glaucoma or glaucoma caused by another factor (i.e. angle-recession glaucoma after having trauma to the eye, steroid induced glaucoma if you take any medications with steroids, etc). I suggest that you discuss this with your doctor at your next visit and ask them what specific type of glaucoma you have. I wish you the best of luck.
I am a 38-year-old Asian man with serious glaucoma and a cataract. I just had conventional glaucoma surgery on my eyes. After the surgery, my eye pressure seemed to go down to 10 for a couple of weeks, but then increased to the 19 - 21 range again. My doctor said we have to fight for it, so he did some "needling" on scar tissues in my both eyes. After that, the pressure went down. A week later, however, the eye pressure had gone up to 20 again. I have been massaging the edge of my eyes every day for over 3 weeks and now the eye pressure readings are around 18. I am still using OmniPred but the doctor wants me to decrease the dose each week for the next 4 weeks, and told me to go back on Lumigan. Is an eye pressure of 18 acceptable? Can I have another surgery or some other procedure so that I don't need to depend on eye drops? [ 09/17/10 ]
Thank you for your question. Unfortunately, the post operative recovery after trabeculectomy surgery is often the most difficult period for our patients. Getting the surgery to heal slowly but not too much is a very difficult task. In some cases the trabeculectomy surgery may not work to lower the pressure enough. It is very important that during the post-operative period you take all of the medications that your eye doctor has prescribed exactly as they have instructed. It is very important not to miss any drops either. I know this can be quite difficult.
Unfortunately, without having examined your eyes and seeing the results of your previous tests (OCT, visual field, intraocular pressure, etc.), I cannot tell you if 18 is an acceptable intraocular pressure. I am quite positive that after your eye doctor completed a thorough eye exam with all of the appropriate testing, he or she set a target/goal intraocular pressure for your eyes. I suggest that you have a discussion with your eye doctor to find out what goal intraocular pressure has been set for each of your eyes. Because you had a trabeculectomy surgery, it would appear that the medications were not enough to lower the pressure in your eyes. In the majority of patients, it is possible to lower the pressure enough to reach the goal pressure and hopefully to stop or dramatically slow the loss of vision; but achieving this goal may take multiple surgeries, lasers, or medicines (and likely a combination of these three). Unfortunately, I can never promise any of my patients that any treatment (laser or surgery) can guarantee that they will be off of medications, but we always hope that happens! I wish you the best of luck.
I have been taking Beconase nasal spray for 3 months for a deviated septum. I have read that this medication can cause glaucoma, and would like to know if I should stop using it. [ 09/15/10 ]
Thank you for submitting this question. There are essentially two questions that you are asking. First, "Can Beconase (a steroid nasal spray) induce glaucoma?" The answer to that question is yes, but it is relatively rare. Probably the most common "secondary glaucoma" is steroid-induced glaucoma. It is most common if topical steroid eye drops, such as prednisolone acetate, are used. However, oral prednisone (oral steroids), nasal mist steroids, or inhaled steroids (for asthma) can also cause an increase in eye pressure in some patients. As I stated, with the nasal spray preparation, this would be a relatively rare occurrence. If you had an eye exam prior to starting the Beconase (and they checked the intraocular pressure) it would be very easy to return to the clinic and see if the pressure is dramatically different now compared to your previous visit when you were not taking this medication. If you have not had an eye exam with intraocular pressure check in the past, it would be impossible to determine if the Beconase has caused an increase in your intraocular pressure from your normal baseline. If you are concerned, I suggest that you visit your eye doctor and have the intraocular pressure checked.
The second question is whether or not you should stop using Beconase. If the pressure is in the normal range, I would not hesitate to continue using it. If the pressure is elevated, then you should consult with your eye doctor and the physician that prescribed the Beconase to determine the best course of action. In the meantime, do not stop using any medication that has been prescribed by a physician unless you talk with him or her first.
My mother has pseudoexfoliation in her eyes, and last year she had cataract surgery. She is trying eye drops to control inflammation, which she has been using since the surgery. Is inflammation normal for people who have pseudoexfoliation? Also, she is very worried about developing glaucoma. Everything we have read indicates that glaucoma related to pseudoexfoliation is harder to treat. Are treatments usually effective for this type of glaucoma? Is there a genetic test to see who is more likely to develop pseudoexfoliation later in life? [ 09/13/10 ]
Thank you for your question. Let's divide this into two parts. First, cataract surgery in a patient with pseudoexfoliative glaucoma is often more difficult. In these cases the small "zonules" or suspension cables that suspend the lens in the middle of the eye can become weakened. If the zonules are weakened, there is a higher risk that they will be too weak to hold the lens up during the surgery and the lens can fall into the back of the eye. It does not sound as though your mother had this complication during the surgery, so I would have anticipated a relatively straight forward recovery. If she has continued to have inflammation for over a year, the reason for the inflammation should be sought out. A very small piece of lens often gets trapped in an area that the surgeon cannot see during the surgery. This small piece of lens can cause some post-surgical chronic inflammation. A gonioscopic examination would reveal whether or not there is a small piece of lens that remains in the eye. If there is no lens remaining, it is possible that she was predisposed to have inflammation in the eye (uveitis) and the surgery simply unmasked this. In approximately 50% of the patients that suffer from uveitis, we never know the exact cause. Often, surgery will unmask this condition in patients predisposed to uveitis or cause re-inflammation in patients that have a previous history of uveitis. I would recommend that you ask your doctor why the inflammation has not yet resolved and see if they have done any tests to see if your mother is predisposed to having uveitis. Otherwise, I would recommend a second opinion by a uveitis specialist to help determine the cause.
As for the second part of your question regarding pseudoexfoliation, you are correct; it can be a bit more difficult to treat in some patients because they often do not respond to medication eye drops as well as open-angle glaucoma patients. There is no genetic test to determine which patients are most at risk for this; however, there are some that believe that a test known as tomography may actually be beneficial in determining if someone is at risk for developing pseudoexfoliation glaucoma. Doing tomography requires specialized equipment and a trained physician or staff member that is very good at doing this test to make sure it is accurate. There are not many centers that still offer this type of testing. It will be important for your mother to continue to see her eye doctor regularly throughout her life to make sure that the intraocular pressure does not increase. If it does, early treatment will be beneficial.
My doctor told me that she will have to perform incision surgery when she removes the cataract in my left eye, and that the two surgeries have to be performed at the same time. However, another physician told me that the two surgeries are performed at different times. I was also informed that my cataract is "complicated." Would you advise performing the two procedures at the same time or separately? [ 09/11/10 ]
Thank you for your question. The case of a patient that needs both glaucoma surgery and cataract surgery at the same time is an interesting one that we run into quite often. I assume that you mean that your doctor has recommended that you have the cataract removed by phacoemulsification (phaco) and a trabeculectomy surgery to reduce the intraocular pressure at the same time. In general, I would say that the timing of the surgeries depends primarily on the need of the individual patient. If the glaucoma is well controlled and we are not worried about progression over a few months, I will often do the cataract surgery first, allow the patient to heal and then perform the glaucoma procedure at a different time (a few months down the road). However, if the intraocular pressure is not being controlled well and there is evidence or concern for progression of the glaucoma I would not hesitate to do both surgeries at the same time (and I often do). This can occasionally make managing the trabeculetomy post-operatively a bit more complex, but none the less, I never hesitate to do both at the same time. Many of my patients are actually pleased that they were able to get both done at the same time so that they only had to recover from one surgery instead of two. If you have questions or concerns about doing both at the same time, I suggest that you have an open dialog with your ophthalmologist regarding this. The ophthalmologist should be able to tell you about your alternatives and the risks and benefits of having each surgery separately or both at once. If you are not comfortable, it is always ok to ask for a second opinion as well.
Can stress and strain, mental tension, fatigue and hazardous working conditions over the years cause or aggravate glaucoma? Also, does living at high altitudes for extended periods of time have any effect on a patient with either open-angle or closed-angle glaucoma? [ 09/09/10 ]
Thank you for your question. This is an interesting subject; unfortunately, what we know regarding stress and the progression of glaucoma is more theoretical than proven science. Some believe that glaucoma or more specifically, intraocular pressure, may be related to activity of the autonomic nervous system (the fight-or-flight/rest-and-rumination pathways). Some believe that activating the fight-or-flight pathway could increase intraocular pressure. In general, stress often activates this pathway on a more chronic basis. This results in increases in adrenalin and corticosteroids in the bloodstream. How this affects the normal eye or glaucomatous eyes still needs to be researched further. In general, at this time there is no evidence to prove that mental stress is a primary risk factor for developing glaucoma. Nor is there sufficient evidence to indicate that stress can aggravate glaucoma. We are continuing to do research in this area because theoretically there may be some connection that we don't yet quite understand. As a physician, I tell my patients that chronic stress is never healthy. It can do many things to the body and we don't know all the potential negative impacts it can have on our lives. I suggest a healthy diet, exercise, and adequate sleep to all of my patients, and this helps alleviate the daily stress in most of our lives.
The second part of your question is also quite interesting. This is something we discuss often and many people are still doing research on this topic. As you increase in altitude (either experimentally using a hypobaric chamber or actual mountain climbing) the intraocular pressure will change slightly. However, as you acclimate to the new altitude over a few days, the intraocular pressure will return to its previous baseline. There are some interesting studies still ongoing that are looking into this effect and this may eventually lead to a better understanding of how intraocular pressure is regulated. Living at an elevation for some time will not likely have a significant impact on the progression of glaucoma because the body responds to elevation and decreased oxygen by increasing the number of red blood cells (thus the same amount of oxygen is carried to the organs).
My mum, who is 54 years old, has glaucoma. Her right eye is over 90% damaged and the left eye is just starting to have problems. Now she is going to have the lenses in her eyes fixed. Do you think she has any chance of having her vision restored? Please help, as she is very sad about her eye condition. [ 09/07/10 ]
Thank you for your question. I am sorry that your mother is going through these eye troubles. 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. This damage to the nerve and the retina primarily result in loss of peripheral vision and contrast vision (ability to see differences between shades of similar color). The central vision becomes involved only when the glaucoma has progressed and become quite advanced. Unfortunately, in most cases, once glaucoma has damaged the eye and has caused a decrease in vision, it is permanent. However, it is important to understand that this is primarily peripheral vision until the very advanced stages. Cataracts on the other hand, affect the central vision primarily. Patients with cataracts often complain of difficulty reading, seeing the TV, seeing at night time when lights are coming toward them (glare), etc. By removing the cataract, hopefully the central vision will become clearer and help your mother with her activities of daily living even if it does not increase her peripheral vision. We would not expect the peripheral vision to change much (although it can clear some if the cataract was causing problems in the periphery as well.). I wish you both the best of luck.
I am looking for institutions that can help a 13-month-old child, with glaucoma (who was born prematurely). I cannot find a place to call or to take her for help. [ 09/05/10 ]
Thank you for your question. I am sorry that your child is having these problems at such a young age. Luckily, in many academic institutions and some private ophthalmology practices there are specialists trained in treating children with glaucoma. In many cases, ophthalmologists that have completed either a pediatrics fellowship or glaucoma fellowship have received specialized care in treating children with glaucoma. I would first start with the nearest University or Academic Ophthalmology Department that is close to where you live. I suggest that you call their office to see if they have someone that specializes in pediatric glaucoma. If they do not, they should know where they refer their pediatric glaucoma patients, and you can get that person's information.