If there is a build-up of aqueous humor in patients that have glaucoma, is it visible when you look in the mirror, or can it only be seen with specialized medical equipment? [ 11/10/10 ]
Thank you for your question, and interestingly this is something that many glaucoma patients are curious about. In the majority of patients with primary open-angle glaucoma, there are no external signs that you could see on the eye that would tell you that you have glaucoma. (This may be different in patients with acute angle-closure glaucoma because many of these patients have a rapid increase in eye pressure causing the eyes to become red, painful, and the pupil slightly dilated. In addition, the vision becomes cloudy and often has rainbow colored halos). In most cases of open-angle glaucoma, the eye looks and feels completely normal. The other problem is that glaucoma typically begins to damage the eye by hurting your peripheral or side vision. Because of this, many patients don't even realize that they have begun to lose vision. The reality is that without doing a complete exam with special instruments even the best trained ophthalmologist cannot just look at an eye to tell if it has glaucoma. In fact, a large number of patients are found to have glaucoma during a routine eye exam. That is why we recommend that all patients begin having routine exams once they hit middle age. If we can catch glaucoma before it is too advanced, hopefully we can stop or slow the disease to the point that they never know they have it. Best of luck, and please continue to see your eye doctor regularly.
What supplements should not be taken if one has glaucoma. [ 11/09/10 ]
First, before taking any supplement, you should consult with your primary care doctor as well as your eye doctor (or any other doctor that you have) to make sure that the supplements will not have any adverse reactions with prescribed medications that you are already taking. Many patients do not think of vitamins and supplements as medications because they do not need a prescription for them or because they are not regulated by the FDA. In fact, many vitamins and supplements are very potent medications and can have both beneficial effects as well as very bad side effects. Unfortunately, because they are not regulated by the FDA, this allows the producers of the vitamins and supplements to make claims regarding their usefulness for treating certain diseases that are not true. That being said, there are some exceptional studies that have shown that vitamins and supplements can have a positive effect on many diseases, one of the most well known being the AREDS study showing that vitamins and supplements can be beneficial in certain types of age-related macular degeneration. Z
To answer your question specifically, if you smoke or have a history of smoking, you should avoid beta-carotene. You should not take “high” doses of vitamin E as this can have deleterious effects on vision. Finally, we are looking into whether or not levels of selenium have any impact on glaucoma as well. There are a few studies that show increased selenium levels may be related to glaucoma; however, more studies need to be done before making a definitive statement on the issue. In general, you should not be taking any supplements without the consent of all of your doctors because they need to make sure that the vitamins or supplements will not react with your prescribed medications or cause you any harm.
I have had five surgeries in the last 2 years, including filtration surgery in both eyes, cataract surgery in both eyes and a recent shunt tube procedure in the left eye. Now, the pressure is around 25 in my right eye and the doctor said that I might need another surgery. Why didn’t the doctor do the tube surgery in the first place? I am beginning to have second thoughts about him now. [ 11/08/10 ]
Thank you for your question. Without having examined your eyes, viewed the results of all of your past studies, and viewed your chart myself, it is impossible for me to answer this exact question. I will tell you that both glaucoma shunt tube surgeries and trabeculectomy surgeries (filtration surgery) are used frequently as first line surgeries for glaucoma. In fact about ½ of my patients have gotten trabeculectomies as their first surgery while the other ½ have gotten glaucoma shunt tubes. I have had patients that do well with 1 trabeculectomy and never need any further intervention, but I also have patients that had a trabeculectomy that does not work and end up needing another trabeculetomy or glaucoma shunt. I also have patients that have gotten a glaucoma tube and it has failed to reduce the pressure enough and I have put in a second tube. During fellowship, I assisted a very well-known glaucoma specialist in taking care of one of his patients. This patient had 3 tubes in each eye (yes, 6 tubes!). In many instances the doctor has to examine the eye, know the patient history, the type of glaucoma, the patient's ability to comply with drop regimens, know the risks, benefits and alternatives for each surgery and then they have to make an educated decision on which surgery gives each patient the best “chance” at getting a low pressure and slowing or stopping the progression of glaucoma. There is never a guarantee that the surgery will work, so we always have a backup plan.
Unfortunately, glaucoma is a very difficult disease to treat, and it can be frustrating for both the patient AND the doctor. Just because the surgeries have not lowered the pressure enough, this does not mean that your glaucoma specialist is not doing an excellent job. In fact, it sounds as though they have kept a very close eye on you and have a plan of action for treating both the cataracts (a well known side effect of trabeculectomy surgery and glaucoma shunt tube surgery) and the high pressure that remains in the eye. I imagine that if you had this discussion with your eye doctor, you would find that they are equally as frustrated by the fact that the first surgery did not solve the problem. Best of luck, and I know this process is not easy.
My father has lost his eyesight in one eye due to a retinal detachment. Years later, he suffered the same problem in the other eye. Fortunately, an operation saved his vision. However, he cannot see clearly and now he is suffering from glaucoma. What should he do to prevent his eyesight from deteriorating further? [ 11/07/10 ]
Thank you for your question, and I am sorry that your father is having these problems. It is not unusual to develop glaucoma after other eye surgeries. Your father should be seen regularly by a retina specialist to make sure that the retinal detachments do not reoccur. Further, I would suggest that your father be seen by an ophthalmologist that has finished a glaucoma fellowship. The glaucoma specialist will need to complete a full eye exam and likely do several different tests to determine what caused the glaucoma to develop (it is possible that it is not related to the previous eye surgeries). This is a special circumstance that warrants the care by a specialist that is familiar with complicated glaucoma cases. Once they examine your father's eyes, the glaucoma specialist will create a plan of care. The goal of the glaucoma specialist will be to reduce the eye pressure to the point that the glaucoma damage does not progress. This may require eye drops, laser treatment, or surgery. He or she will work with the retina specialist if needed as well. It will be important for your father to be seen regularly by both of these doctors for the rest of his life. I wish the best of luck to you and your father.
I am a Vietnam veteran who was exposed to Agent Orange. As a result, I have diabetes, peripheral neuropathy, and was recently diagnosed with glaucoma in both eyes. None of my family has suffered from these disorders. I have been told that there are studies linking glaucoma and diabetes, and was wondering if this was the case. If so, is the research available to the public? The reason for asking is that my Veteran Service Officer would file for additional benefits if we can produce what is called a "Nexus Letter," which I presume is a written doctor's opinion. Thank you! [ 11/06/10 ]
First, thank you. As the son of a Vietnam veteran and the grandson of a WWII veteran, I have a great admiration for all of the men and women who have served our country.
Currently, the VA recognizes the following conditions as being related to Agent Orange exposure:
- Acute and Subacute Peripheral Neuropathy
- AL Amyloidosis, Chloracne (or Similar Acneform Disease)
- Chronic Lymphocytic Leukemia and Other Chronic B Cell Leukemias
- Diabetes Mellitus (Type 2)
- Hodgkin's Disease
- Ischemic Heart Disease
- Multiple Myeloma
- Non-Hodgkin's Lymphoma
- Parkinson's Disease
- Porphyria Cutanea Tarda
- Prostate Cancer
- Respiratory Cancers
- Soft Tissue Sarcoma (other than Osteosarcoma)
- Kaposi's sarcoma
Some new associations are being examined currently, but no ruling has been made to my knowledge. To date, I do not believe that the VA recognizes that Agent Orange exposure is a primary cause of glaucoma. Your question pertains to whether or not patients with type 2 diabetes (which is recognized by the VA) is an independent risk factor for glaucoma (hence a possible connection). There are several studies that do support this conclusion, but they are slightly controversial. In general, the more often a patient goes to the eye doctor the more often the doctor can examine the eyes and catch glaucoma if it is present. It is possible that because patients with diabetes go to the eye doctor more often (to have their eyes dilated for diabetic eye exams); their doctors are seeing them more often and can make the diagnosis more often. The problem with glaucoma is that approximately ½ of the people that have glaucoma do not know it because they do not go to the eye doctor for regular eye exams. For your benefit, I have included references to the three primary studies that argue for a connection between diabetes and glaucoma. They were all published in the medical journal "Ophthalmology" hence they are available to the public.
- P. Mitchell, W. Smith, T. Chey and P.R. Healey, Open-angle glaucoma and diabetes: the Blue Mountains Eye Study, Australia, Ophthalmology 104 (1997), pp. 712–718
- L.R. Pasquale, J.H. Kang and J.E. Manson et al., Prospective study of type 2 diabetes mellitus and risk of primary open-angle glaucoma in women, Ophthalmology 113 (2006), pp. 1081–1086
- B.E. Klein, R. Klein and S.C. Jensen, Open-angle glaucoma and older-onset diabetes: the Beaver Dam Eye Study, Ophthalmology 101 (1994), pp. 1173–1177.
I will caution you that these studies are suggestive, but not conclusive of a link between the two. Further, my willingness to provide this information is by no means a physician's written opinion stating that I believe that the connection exists. If asked, I would have to say that the evidence is suggestive but not conclusive for the reasons I stated above. At this time, there is no definitive evidence proving a connection. It is possible that a connection exists, but we just don't have the data to support it conclusively quite yet. We are still looking and hopefully that information will be available in the near future. I wish you the best of luck.
I had glaucoma surgery last December, and I am still having headaches and feeling nausea. Why is this happening? [ 11/05/10 ]
If you are still having headaches and nausea this late after your glaucoma surgery, it is very possible that they are not related to the glaucoma surgery itself. First, I would want to make sure that the pressure in your eye is well controlled. If the pressure is elevated, it is very possible that you can get headaches and nausea. If the pressure is normal, then this would be very rare. If you started any new eye medications after the surgery, it is possible that the medications could be causing these symptoms, but that would also be relatively rare. I suggest that you discuss these symptoms with your doctor. If he/she cannot find any connection to the pressure in your eye, the surgery, or medications that you are taking, I suggest that you be seen by your primary care doctor for a physical examination. They may refer you to a specialist to see why the headaches and nausea are present.
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.