I had a pressure of 34 in one eye and the doctor put me on Azopt eye drops 3 times a day. Is it necessary to see a doctor about glaucoma? My pressure is normal as measured in the treatment of retinopathy. Thank you! [ 10/08/10 ]
This is slightly difficult to answer since I have not examined your eyes myself and it forces me to make some assumptions. Judging from your question, I assume you are not talking about primary open angle glaucoma. I assume that you mean that you are being treated for diabetic retinopathy. If the diabetes is not well controlled, one of the side effects is new blood vessel growth inside the eye. Often, these blood vessels are found growing on or near the retina in the back of the eye; however, it is possible that the new blood vessels are also growing in the front of the eye.
Often these blood vessels will begin growing on the iris (the colored part of the eye) and eventually they may grow into the area of the trabecular meshwork where the fluid normally drains out of the eye. If these blood vessels begin to prevent the aqueous fluid from draining out of the eye, the pressure will build up. We call this neovascular (i.e. “new vessel) glaucoma. If the pressure was 34, then you absolutely need to continue seeing an eye doctor regularly to ensure that the pressure goes down.
It is possible that the Azopt drops will help, but your eye doctor should have a backup plan ready in case it does not. Initially, you can be seen by the retina specialist that is following your diabetic retinopathy, but if the pressure does not come back to normal, I would suggest asking your retina specialist if they are comfortable treating the increase in pressure or if they will be referring you to a glaucoma specialist. In many cases, I recommend that the retina specialist take care of the diabetic retinopathy while working with a glaucoma specialist that can treat the neovascular glaucoma. I suggest that you ask your eye doctor what plan they have in place to treat the increase in eye pressure.
I am 49 years old and have been an insulin-dependent diabetic for about 20 years. Macular degeneration runs in my family (my maternal grandma had it and so does my mother). I have noticed a spot on my right eye in the last week. I use my left eye dominantly so I don’t know how long it’s been there. It’s like looking at something bright and then looking away, except the spot isn’t as dark. It’s a long spot, kind of like a cloud. I can see through it, but is blurry. I don’t know if this is sign of glaucoma, macular degeneration or something else entirely! I already have severe nerve damage in my feet and calves. Do my symptoms sound like I have either or both of these eye diseases? Thank you for your time. Blessings! [ 10/01/10 ]
Thank you for your question. Because I did not complete a dilated examination of your eyes, it is very difficult to give a completely accurate assessment. First, I would say that it is most likely not related to macular degeneration. Because you are under the age of 50, this would be quite rare. In addition, these are not the usual presenting signs of glaucoma either. It is possible that this could be related to diabetic retinopathy. If you have had a small bleed from a vessel in the back of your eye, you could be seeing the shadow of the blood. The only way to really know is to go to your eye doctor for a dilated examination. If this is not related to the diabetes, my next best guess is that you may be simply noticing "floaters" for the first time. Floaters are simply pieces of debris or condensed vitreous that are elevated slightly above the retina and cast a shadow on the retina as light passes through the eye. If you think of your retina like the grass in your yard, the blades of grass are like the photoreceptors in the retina that detect light. If you held a piece of string over the grass in the sunlight, the shadow of the string would be cast onto the blades of grass. This is how you end up seeing floaters. Floaters are relatively common in most people. They can come as a natural process of aging and are most often seen between the ages of 60-65, but can occur earlier or later. This is usually related to a process in which the vitreous or gel inside the eye begins to condense and pull away from the attachments to the back of the eye along the retina, retinal vessels, optic nerve, and the front part of the eye called the vitreous base. As it slowly pulls away from the retina, you can get the sensation of flashing lights. This change in the vitreous is normal as we age and is known as a posterior vitreal detachment. It is often associated with flashes of light and onset of seeing new floaters. Any time new flashes of lights or new floaters are seen, you should have a dilated eye exam to make sure there is no evidence of a retinal tear. While retinal tears are rare in these cases, they are important to diagnose and treat appropriately. Because of your specific history of diabetes, I would let your doctor know that you are having these symptoms, as they may wish to dilate your eyes and make sure there is nothing else going on. In either case, these do not sound like symptoms of glaucoma.
I have heard that the Japanese have an increased risk of developing glaucoma. Is this true of all Asians or just Japanese people? Is this increased risk related to diet or genetics? By the way, I do have Chinese ancestry. [ 09/29/10 ]
Thank you for your question. Individuals of Asian descent are at higher risk of developing glaucoma; however, the exact type of glaucoma that each population is at greatest risk for is slightly different. Evidence in the literature suggests that individuals of Japanese descent are at a higher risk of normal-tension glaucoma while individuals of Chinese ancestry are at a higher risk of angle-closure glaucoma. Individuals of Asian ancestry are most likely at an increased risk of developing glaucoma for many different reasons. As we learn more, I am almost positive we will find that genetics plays a very large roll in determining our risk of developing one specific type of glaucoma instead of another. In addition, individuals of Asian ancestry may have an anatomic predisposition to developing angle closure. In many Asian individuals, the drainage angle of the eye is narrower than some other races. This may put them at an increased risk. In general, I would suggest that you have a complete exam by an eye doctor that is comfortable also completing a gonioscopy. After the gonioscopy, the doctor should be able to tell you if the drainage angle is narrow and puts you at higher risk of developing angle-closure glaucoma. In addition, the doctor will also look at the optic nerve and check the eye pressure to determine if there are any other signs of glaucoma.
A recent article reported by Dr. Dexter Leung of the Chinese University of Hong Kong found via a brain scan that there was an increased incidence of silent cerebral infarct blockage in small blood vessels of the brain in people with normal-tension glaucoma. I have normal-tension glaucoma and my mother had vascular dementia. My glaucoma is progressing even though my pressures are controlled so I am looking at other causal factors. However, when I asked my consultant about brain scans for silent cerebral infarcts, I was told that they could not be detected by a scan. What are the tests and treatments for silent cerebral infarct? I would like to have this scan, if possible. [ 09/28/10 ]
Thank you for your question. I read over Dr. Leung's article and found it very interesting. I will continue to follow this research and think it may provide us with some promising information regarding normal-tension glaucoma. Let me first directly answer your questions as best I can. As a disclaimer, the questions that you ask are probably best answered by a neurologist or a radiologist; however, I will give you my best understanding of current neurological and neuroradiological practices.
What are the tests and treatments for silent cerebral infarct? Different studies have placed different limits on what they consider positive evidence of a silent cerebral infarct. It appears that most studies rely on magnetic resonance imaging (MRI) of the brain to look for silent cerebral infarcts. These were studies specifically looking for the incidence of silent cerebral infarcts in normal patients or certain populations of patients. To my knowledge, neurologists do not recommend screening MRIs in normal patients and we as ophthalmologists do not yet recommend MRIs as a diagnostic tool in our glaucoma patients. In terms of treatments, any patient at risk of cerebrovascular disease (vascular dementia, atherosclerosis, stroke, etc.) should be monitored and treated for high blood pressure, high cholesterol, and diabetes among other things. If you are concerned about your individual risks of cerebrovascular infarcts, I suggest you speak with your primary care physician or a neurologist to determine the best course of action.
While Dr. Leung puts forth an interesting hypothesis, I think it is important to establish a more clear body of evidence to support the findings. I would assume similar studies are now being created to reproduce his results at other institutions. Every study has its strengths and weaknesses. I was a bit concerned by a few of the limitations of this study. First, this group used CT scans instead of MRI to define silent cerebral infarcts. It is my understanding that CTs are not as accurate when looking for silent cerebral infarcts. Second, he used Anderson's criteria rather than more conservative measures to define visual field progression. I would rather see slightly different criteria for progression. The study only enrolled Chinese patients, so it is very possible the outcome could be different in Caucasian, African American, African, Indian, or Hispanic patients. Finally, I would need to discuss whether or not the appropriate statistics were used in this analysis and if the results were interpreted correctly. In all, I agree this is a very interesting and promising study, it simply needs confirmation by a few other studies before we would ever recommend that our patient begin getting MRIs to look for silent cerebral infarcts.
Can depression cause glaucoma? [ 09/27/10 ]
Thank you for submitting your question. This is a very interesting topic for patients with glaucoma. Currently, there is no evidence to indicate that depression can cause glaucoma. However, research in the field of neuroscience is truly in its infancy. There are many things that we do not yet understand about how the brain works. It is possible that over time, we may eventually find a link. While there is no evidence that depression can cause glaucoma, the opposite is likely very true. We have a growing body of evidence to suggest that our patients with glaucoma may have an increased risk of developing depression and/or anxiety. This is not hard to imagine considering how dependent many of us are on our eye sight. The thought of having a disease that can potentially cause the loss of vision can be frightening. In addition, patients with advanced glaucoma and loss of vision often lose the ability to complete their activities of daily living independently (grocery shop, drive to appointments, cook, etc). Our patients often feel they are a burden to family members or friends because they must rely on them for assistance. This can easily lead to feelings of anxiety and depression. If you have any of these feelings, do not hesitate to discuss this with your eye doctor. We understand that having glaucoma can have impacts on our patients' lives beyond just the loss of sight. There are resources in the mental health area that can offer patient assistance, so do not hesitate to ask your eye doctor for help if you believe you are experiencing depression or anxiety as a result of having glaucoma.
I have open-angle glaucoma. It has been suggested by my doctor that I have tube surgery on my eyes. Can you give me some more information on this type of surgery? [ 09/24/10 ]
Thank you for your question. A glaucoma tube or glaucoma shunt is a two-part device that is used to reduce intraocular pressure. The plate of the shunt is placed between the white part of the eye (the sclera) and the conjunctiva (the "saran wrap" layer surrounding the sclera). The shunt tube is then routed from inside the eye to the shunt plate. This allows the fluid to be drained off, hence lowering the pressure. There are many different types of shunts, but the two most common are the Baerveldt shunt (a non-valved shunt) and the Ahmed shunt (a valved shunt). Each of these shunts comes in different sizes. Valved and non-valved shunts each have advantages and disadvantages, and the choice of which to use and which size to use is often dependent on the patient and the need. I am often asked "What are the short-term and long- term outcomes of glaucoma shunt surgery?" and "What are the possible complications of glaucoma shunt implant surgery?" To answer those questions completely would take a very long time. There are individual studies that are published that show the short-term and long-term effectiveness and complication rates of of Baerveldt 250, Baerveldt 350, Baerveldt 500, Ahmed S-2, and Ahmed FP-7 shunts as well as others (but these are the most commonly quoted and used in practice). Without knowing which your history and type of glaucoma that you have, it is impossible to give you a completely accurate estimate of the effectiveness or complication rates associated with each shunt. Complications most commonly listed are cornea decomposition, formation of choroidals (blood or fluid between the white part of the eye and the retina), double vision, uveitis, a membrane on the retina that can cause it to wrinkle, retinal detachment, blockage of the tube, the pressure being too low, bleeding, erosion of the tube through the conjunctiva (tube exposure), loss of vision, etc. The rate of those complications varies. I suggest that you have a discussion with your surgeon before the surgery regarding the risks, benefits and alternatives of having the shunt surgery.
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.