Ask an Expert about Glaucoma

Thanks for your questions. To answer your second question, it is unlikely that your ophthalmic migraines are affecting your eye pressure. However, in some patients with glaucoma who have “normal” eye pressure, it is thought that migraine can be a risk factor. In terms of vitamins or supplements, I would recommend a healthy diet with plenty of green leafy vegetables and healthy fats from cold water fish rich in omega-3s, for example. If you are concerned about your dietary health, you can always take a multivitamin. There is no scientific evidence at this juncture demonstrating that special supplement formulations to be of benefit for those with glaucoma.

Thanks for your question. Many researchers, including myself, are working on regenerating optic nerve cells. It is a daunting challenge because the optic nerve cells reside in the retina of the eye, and travel a great distance to the appropriate targets in the brain. The optic nerve cells would have to link up with the correct cells in both the eye and the brain. I do not think it is an impossible task, but it is a long-term project. I do think that there are other promising approaches to treating glaucoma that will be more achievable in the short-term. For example, all of the medications, laser, and surgery we have to offer patients are aimed at lowering eye pressure; however, we know that for some patients that is not enough. I believe that in the next 10 years we should have other “neuroprotective” treatments that protect the optic nerve cells from dying in glaucoma and this will be of great help to many patients.

Thank you for your question. I am sorry to hear about the progression of your glaucoma. If your current medications and prior surgery seem to be failing, I would recommend asking your ophthalmologist what else can be done medically or surgically, or perhaps even obtain a second opinion. In terms of research for nail-patella syndrome, there has been a genetic mutation in a gene called Lmx1b that has been linked to some patients with nail-patella syndrome and glaucoma. You could talk with your eye doctor about genetic testing, but any genetic testing has ramifications that need to be carefully considered. I would also seek to ensure that your daughter is followed by a pediatric glaucoma specialist, if she is not already being seen by one.

Thanks for your question. The easiest way to answer the question about whether this could be glaucoma is to have an ophthalmologist perform a thorough eye examination. Without this examination, I can only speculate. Some of your symptoms, such as zigzag lines, sound consistent with ophthalmic migraine. However, other symptoms, such as eye pain, are harder to diagnose. Certainly, I would recommend that you have a comprehensive eye exam to answer your questions.

I am sorry to hear about your vision loss. If your vision is also poor in the other eye, you should seek out the expertise provided at a low vision clinic.

There is not currently any transplant procedure for glaucoma. There are certainly many groups doing research in the area of optic nerve regeneration and glaucoma, but the only tools doctors currently have to lower eye pressure are medications, laser procedures, or surgery. However, in your lifetime it may be possible that newer treatments will be developed and available to patients. Let’s hope that this is the case.

The problem you describe must certainly be very frustrating. I certainly think that seeking the expertise of a retina specialist to assess whether you have a retinal disease that is causing your symptoms is reasonable. However, I would first bring these symptoms up with your ophthalmologist or glaucoma specialist. Sometimes the symptoms you describe can be due to cataract. Another possibility is if you are on glaucoma medications that constrict your pupil. If your ophthalmologist feels you would benefit from a retina consultation, then he/she can refer you to a specialist.

Thank you for your question. It is likely that you were a glaucoma suspect even before you had cataract surgery, which is why you underwent testing. After cataract surgery, the view of your optic nerve becomes clearer so this may be why you were officially deemed a glaucoma suspect after the cataract surgery. However, the cataract surgery did not cause you to become a glaucoma suspect. Your eye pressures of 6 are low, and it is possible that cataract surgery did help to lower your eye pressure. Whether the low pressure is sustained can only be determined with time.

What happens next? You will continue to be followed as a glaucoma suspect, with eye pressure checks, eye examinations, visual field testing, and optic nerve imaging. Some patients will remain glaucoma suspects for the rest of their lives, demonstrating no observable changes over time and maintaining normal visual field; others will develop signs of definite glaucoma. The most important measure you can take is to continue routine follow-up visits with your eye doctor.

Thank you for your question, and congratulations on your new career. Yes, you can still wear contact lenses while using eye drops, although the drops can affect the ocular surface and your tolerance of contact lenses. The post-nasal drip is unlikely to be related to your glaucoma, although it would be helpful to know the list of medications that you have been prescribed for this condition. For example, intranasal steroids or inhaled steroids can have an impact on eye pressure. The Latisse has the same medication component as an eye drop for lowering eye pressure, but because its application is on the eyelashes, it will not help in lowering your eye pressure.