Ask an Expert about Glaucoma
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.
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.
Disclaimer: The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for the advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.
Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.
Last Review: 04/28/13