Ask an Expert about Glaucoma

Thank you for your question. I am not sure what “PSA” refers to, but perhaps you are referring to “PAS,” or posterior anterior synechiae. These are abnormal adhesions from the iris to the “angle” that are one cause of chronic angle-closure glaucoma. Your farsightedness is one risk factor for having narrow angles, and the suggested preventive treatment for an angle-closure attack is a laser iridotomy, which creates a hole in the iris and allows an “escape route” for fluid to drain from your eye. Drops generally cannot manage the problem; however, sometimes ophthalmologists consider the use of topical pilocarpine to make the pupil small, but this does not always prevent an angle-closure attack.

When I counsel patients who need this laser iridotomy procedure to prevent an angle-closure attack, I weigh the risks and benefits. The benefit of preventing an angle-closure attack is enormous, and the damage from such an attack is quite profound and irreversible. The risk of laser surgery is quite small in comparison; sometimes there is an eye pressure spike so patients will wait for 30-60 minutes after the surgery to ensure this does not happened. Because we are making an additional hole in the eye for light to pass through, some patients complain of glare or haloes, but this is not common. The alternative is to do nothing, which is an option. No one can predict with great accuracy whether you will have an angle-closure attack in your lifetime. The risk likely becomes greater as you get older, because your lens (I am assuming you have not had cataract surgery) will also thicken, making the angle even more narrow. I would recommend that you make a follow-up appointment with your ophthalmologist and discuss the risks, benefits, and alternatives of the procedure again before making your final decision.

Thank you for your question. Based on your question, it sounds like your mother-in-law’s glaucoma went undetected or was diagnosed very late. Unfortunately, glaucoma causes irreversible vision loss. However, despite the fact that she only has 5 percent vision, there are treatments to ensure that she does not lose the remaining 5 percent.

Is your mother-in-law taking eye drops? Has she had laser surgery to lower eye pressure? These two treatments should be considered first before surgery, which is also an option. You did not mention if the glaucoma is affecting both eyes equally, but every measure should be taken to ensure that her vision remains as strong as possible.

Thank you for your question. Eye pressure fluctuates depending on time of day, your stress level, the pressure measurement device, the technique of the person taking your pressure measurement, the calibration of the device for pressure measurement, etc. It is not unusual for eye pressure to fluctuate from visit to visit, or even within the same day. And eye pressures of 16 and 19 are still within the “normal” range based on population-based studies. If you are indeed a “glaucoma suspect,” however, based on your family history and other risk factors, such as the appearance of your optic nerve, you should also have formal visual field testing and optic nerve imaging.

Thank you for your question. Acute angle-closure glaucoma is a medical emergency requiring surgical intervention and must be treated immediately to prevent optic nerve damage and vision loss. Herbs or ayurvedic medicine will not help in terms of changing the anatomy of the eye; only surgical intervention can stop the attack in a definitive fashion.

Thanks for your question. Studies have shown that consumption of caffeine causes transient elevation of eye pressure in patients with glaucoma and ocular hypertension. Additional population studies report higher intraocular pressures in glaucoma patients who regularly drink caffeinated beverages as compared to those who do not. Thus, most glaucoma doctors recommend avoiding heavy consumption of caffeine.

Our website has excellent information concerning glaucoma risk factors.

Thank you for your question. Glaucoma is a very difficult condition to treat. I often tell my patients who come in with one eye having very severe glaucoma that we will do everything to treat that eye, but we must not neglect the other eye, which often shows earlier stages of the disease that can progress over time. I would first bring your concerns to your ophthalmologist, and make sure that your father is thoroughly examined to determine if there are other eye problems responsible for his vision loss. For example, are the visual problems related to a worsening cataract, which could be addressed by cataract surgery or new glasses? If it is indeed glaucoma, then it is likely that he will need more aggressive treatment than he is currently undergoing in order to halt the disease. You mention that he has had four surgeries without improvement. Unfortunately, glaucoma never “improves”; doctors can only stop its insidious progression. It may also be worth seeing a glaucoma specialist for a second opinion.

Thank you for your question. It sounds like your father has glaucoma that is difficult to control. The medications you’ve listed are all compatible to be taken at the same time, and it is safe, as long as he is tolerating any side effects. For example, Cosopt contains timolol, which is a beta blocker and has the potential side effect of lowering heart rate and/or blood pressure. It also is not well-tolerated by patients who have asthma or other lung diseases that have a reactive airway component. If his eye pressure is still increasing, it may be time to consider whether he is a candidate for laser trabeculoplasty, a laser procedure that can lower pressure in open-angle glaucoma patients. If this fails to control his eye pressure, then there are also several surgical options that his ophthalmologist can discuss with your father.

Thanks for your question and I am sorry to hear about your headache. When my patients come in for SLT, I instill pilocarpine eye drops in preparation for the procedure, which I warn patients might cause headache and an ache in the brow region. Most of my patients do experience that symptom, so that is one possible explanation. It is not uncommon for patients to feel the laser application a little bit during the procedure, although it should not be painful. So, I could imagine a scenario in which you were already susceptible to some head pain (because of the pilocarpine eye drops) and each laser application made it seem more acute. I do not believe there is any detrimental effect from the head pain you experienced, and I expect that it resolved in 24 hours.