Ask an Expert about Glaucoma

I'm really worried that the pressure is building slowly in the eye that had the trabeculectomy, and I'm concern about the bleed at the back of the eye, so I would appreciate your advice. I'm currently using Ganforte and Azopt.

Thank you for your question. Without having examined your eyes personally or having had access to your previous exam results, test results, and medical history, it is nearly impossible for me to provide an accurate recommendation on what to change or do for your eyes at this point. Unfortunately, I cannot tell what type of “bleeding on the nerve” occurred. I do not know if that means that you had disc hemorrhages or if you had a vessel occlusion because the pressure elevated. Those are two very different things and would require very different measures to treat. Also without having actually seen what the trabeculectomy bleb looks like, it is impossible to make a recommendation on how to change the treatment. It sounds as though you have had a difficult time with your eyes, and it is understandable that you would be frustrated. In these cases, it is not uncommon to seek a second opinion. That is not to say that the original surgeon has done anything wrong in your care. Treating glaucoma is very difficult and everything eye doctors do comes with risks and benefits. Unfortunately, you are experiencing some of the side effects that come along with trying to treat the disease. You were obviously able to get a second opinion, so I might suggest returning to that person or calling them on the phone to ask for advice on how to proceed in your particular situation since they have examined your eyes and might know what is needed. Trusting your doctor and having a strong doctor-patient relationship is quite important especially when trying to treat glaucoma because there are usually bumps along the way. It is a very difficult disease to treat, and regardless of the fact that doctors do their best to control the pressure, sometimes the things that they try simply do not work. It sounds as though your options are limited because of an inability to travel. If you do not feel comfortable working with the original doctor, then my only suggestion is to find a way to either travel to another glaucoma specialist or to find out if there are any general ophthalmologists in the area that are comfortable treating glaucoma (some general ophthalmologists, especially in rural or unpopulated areas, do a lot of their own trabeculectomies and glaucoma implants). I am sorry that I could not be more specific, but complex situations like this really require a full exam prior to making any recommendations. I wish you the best of luck.

Thank you for your question. I am sorry that your young son and your entire family are dealing with this disease. You are correct, glaucoma tubes do typically last between five to ten years (some less and some more), and having a plan for the future is important. There are many different types of glaucoma, and they can progress at different rates. Some types of glaucoma can progress quickly if the pressure is incredibly high and it can take vision within days or weeks. The progression of other types of glaucoma is 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 son's glaucoma will take; however, the most important thing that you can do is have frequent visits to the glaucoma specialist so that you always know if things are stable or not. Given that the vision lost to glaucoma is permanent, it is important to be relatively aggressive at treating the disease if there are ever signs of advancement (especially since your son is so young and has so many years ahead of him). After each eye exam has been completed, your doctors will make sure that the eye pressure is within the target goal. Your doctor will likely follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how his eyes are responding. If it appears that the glaucoma tubes are not functioning as well at some point in the future, the pressure will have to be lowered by another means.

The only variable that we can change to slow or stop the progression of glaucoma is the intraocular pressure. To achieve this goal, there are essentially three different tools that eye doctors use to treat glaucoma: They can add medicated eye drops, use laser treatments, and possibly perform further surgical procedures, if necessary. In fact, during my fellowship I helped take care of a patient that had 3 glaucoma tubes in each eye (a total of 6). In the majority of patients, it is possible to lower the pressure enough to stop or dramatically slow the loss of vision; but this may take multiple surgeries, lasers, or medicines (and likely a combination of these three). In some cases, doctors cannot stop the progression of the glaucoma and some patients do eventually go blind, but this is the minority of patients. The best thing that you can do is find a glaucoma specialist that you have confidence in so that your child has continual care and is treated aggressively when needed. Again, I am sorry that you and your son are dealing with this eye disease, and wish you the best of luck.

Thank you for your question. The supplemental oxygen that your husband is using cannot harm your eyes in any way. I wish the best of luck to both of you.

Thank you for your question. The most likely reason that the pressure in your eye was noted as being borderline at one visit and back within the normal range at the next, is likely related to the fact that intraocular pressure is known to fluctuate over time. During a single day it is not unusual for the eye pressure to fluctuate as much as 6 mmHg (millimeters of mercury) throughout the day. There have been a lot of studies focused on looking at how pressure fluctuates not only throughout the day but also over the course of weeks, months, and years. Interestingly, however, new evidence is beginning to look at Vitamin D as a possible treatment for glaucoma. This new supplemental treatment uses topical drops and not oral supplements like you are using (and the oral supplements have a pretty low chance of actually lowering the pressure itself). One of my colleagues in the glaucoma field, Dr. Paul Kaufman, from the University of Wisconsin has been awarded a National Glaucoma Research grant from the BrightFocus Foundation to study this exact question. You can read the full story in a recent glaucoma newsletter. Obviously I would suggest continuing to stay abreast of the findings of Dr. Kaufman and the other researchers looking into this potential new treatment option. I wish the best of luck to you.

I share your concern over your son's eye. However, without examining the child, it is hard for me to ascertain whether your child has glaucoma. Some of the symptoms of childhood glaucoma are tearing, hypersensitivity to light, and squeezing of the eyelids. Sometimes we may see corneal clouding or whitening. The cornea is the clear “windowpane” of the eye in front of the iris. Your description of the “cloudiness” does not seem isolated to the cornea and may not represent a sign of glaucoma. However, it is important to have a comprehensive eye exam as there are other conditions that may need to be treated. I recommend that you bring your child to a pediatric ophthalmologist, or if there are not any in your area, a general ophthalmologist. The urgent care facility or your pediatrician can refer you to an ophthalmologist.

I am sorry to hear about your sore eye. Without observing the trauma, I am not able to answer your question definitively. However, it is possible that blunt trauma to the eye can cause some mild inflammation inside the eye. This mild inflammation may have increased your eye pressure temporarily, but would likely resolve quickly. It is also possible that the trauma during your exam did not elevate your eye pressure, and there are two separate but coincident events. If you have not had your eye pressure measured since your retina exam, I would recommend having an eye pressure check to make sure it has returned to “baseline.”

Glaucoma affects your optic nerve and visual field, but does not affect your refractive error, which is what eyeglasses correct. Of course, your eyeglass prescription may still need updating over time as the refractive power of your eye changes. For example, as we get older, everyone eventually requires reading glasses due to presbyopia (decreased ability to focus on near objects with age).

Pseudoexfoliative material can be deposited throughout the body; however, the only location in which it can have harmful effects is in the eye. Oral surgery and anesthesia will not affect the pseudoexfoliation syndrome in your eye. In general, anesthetic drugs can affect your eye pressure, but this would only be relevant if you were having your eye pressure measured while you were under anesthesia. For example, midazolam, a common agent used for anesthesia, causes a minimal to mild reduction in eye pressure. Good luck with your oral surgery!