Is high intensity focused ultrasound (HIFU), used to destroy the ciliary process, effective for glaucoma? I have read some encouraging studies from Europe. [ 02/25/13 ]
Thank you for your question. HIFU is a new technology designed to destroy the ciliary processes, and as such, falls in the same category of two currently utilized technologies in the United States: Trans-scleral diode cyclophotocoagulation (TDC or TCP), and endocyclophotocoagulation (ECP). Both of these technologies utilize diode laser energy to destroy the ciliary processes. ECP is advantageous in that the surgeon visualizes the ciliary processes as the target tissues are treated, whereas both TDC and HIFU are “blind” procedures. They both have the advantage of not requiring an incision to the eye, and thus no risk of infection. HIFU’s purported advantages over TDC are that a) there is decreased inflammation and b) increased accuracy when targeting the ciliary processes because of the ring-shaped design of the probe. HIFU was actually used in the 1980s with a different commercially available device but had severe complications and thus was abandoned in the 1990s. I reviewed the current published literature and to date there is one published study describing 12 patients who underwent HIFU for difficult to treat glaucoma. This preliminary study demonstrated that the eye pressure was significantly reduced at 3 months without major complications, but thus far we do not have long-term data about safety or efficacy. But certainly, this new device should be evaluated by prospective randomized clinical trials comparing it to conventional cyclodestructive procedures such as TDC and ECP.
Can people who have glaucoma study just like those who do not have this eye disease? Also, how is glaucoma treated? [ 02/25/13 ]
Thank you for your question. Yes, people with glaucoma can study just like those who do not have eye disease. Glaucoma first affects your peripheral vision and spares central vision, so most people with glaucoma can read well. Sometimes glaucoma patients have decreased contrast sensitivity or color vision, which can affect reading Please visit the treatment section of this website for more information about medication, laser procedures, and surgical techniques for glaucoma.
I have been treated for seven years for glaucoma with eye drops due to allergies. My eye doctor sent me to a surgeon because I did not do well on a field vision test. The specialist said that he does not believe that I have or ever had glaucoma. I am very confused. Have you heard anything like this? [ 11/27/12 ]
Thanks for your question. I am not sure what your treatment of “eye drops due to allergies” means, but in answer to your main question, it is possible that you were treated as a glaucoma suspect as opposed to someone who has definite glaucoma. I have many patients in my practice who are glaucoma suspects, and over time the patient either develops glaucoma or simply remains a glaucoma suspect. It is possible that you had certain risk factors that prompted your first eye doctor to begin treatment with eye drops, but after reviewing your tests and examining your eyes your second eye doctor does not believe you have glaucoma. I know this may be frustrating, but this is why I always emphasize follow-up with my patients who are glaucoma suspects. Often the diagnosis of glaucoma is very clear and definite, but other times the diagnosis is less certain.
My right eye became worse after glaucoma surgery four weeks ago. The eye constantly leaks and barely opens. It also feels painful at times like there's something in my eye. The doctor said it's because I have diabetic retina, but if that's the case why did all these problems happen after the surgery? At this point, I cannot see out of my right eye due to the extreme blurriness. [ 11/27/12 ]
Thank you for your question. It would help to know what type of glaucoma surgery you had. I can tell you that your tearing, swelling, and feeling of something being in your eye are certainly consistent with glaucoma surgery (unfortunately), and are not necessarily related to diabetic retina. Most glaucoma surgeries require the use of dissolvable sutures, which can cause irritation, tearing, swelling, and the feeling of something being in your eye. On the other hand, these symptoms should have been improving over the four weeks since surgery; they should not be worsening. Sometimes my patients have more comfort with the use of ophthalmic ointments, which your surgeon can prescribe. The blurriness that you are experiencing may be related to your diabetic retina, especially if your surgery has caused more swelling in your retina. That being said, there are a multitude of reasons why your vision may be blurry, and it would be best to have these concerns addressed by your surgeon.
Is it necessary for me to take timolol maleate and latanoprost eye drops if I am 82 years old and have glaucoma and cataracts? [ 11/27/12 ]
Thank you for your question. Your question is a difficult one to answer without more information about your optic nerve status and field of vision. But I do understand your question in the context of glaucoma as a slowly progressive disease. If you have seen an ophthalmologist you trust and he/she feels that you have glaucoma that would benefit from eye pressure lowering, it is certainly reasonable to take timolol maleate and latanoprost. You certainly can have a discussion with your eye doctor concerning how the quality of your life will be impacted by the glaucoma for the rest of your expected lifespan, and if there are treatments available that do not interfere with the quality of your life.
I experience pain in my eyes when I go outside in the daylight; it is also difficult for me to see things because they are not clear and are out of focus. Are there any treatments that can help? [ 11/27/12 ]
Thank you for your question. This is a difficult question to answer since there are many possible causes for your symptoms. Certainly, if you are older, cataracts could be causing your symptoms, especially the glare or the eye pain you experience during daylight. Cataracts also cause objects to be blurry and out of focus. However, in addition to cataracts, there are other possibilities for your constellation of symptoms. I described the symptoms of cataract because they are the most common cause of your symptoms in older individuals, but I recommend a comprehensive exam with an ophthalmologist in order to fully assess your condition.
In acquired optic nerve pitting and low-tension glaucoma, are there benefits to slowing loss of vision and are there visual acuity advantages to cataract surgery in someone who is 69 years old? The sub-retinal schisis (separation) is at fovea. [ 11/27/12 ]
Thanks for your questions. In terms of your first question, there are certainly benefits to slowing the loss of vision by treating any underlying low-tension glaucoma. This has been demonstrated in several large, randomized controlled trials. Age is not a factor in determining whether there is benefit in cataract surgery as long as the risks of anesthesia and surgery are not too great in terms of your general health and you are willing to undertake the risks of cataract surgery. However, the retinal schisis (which I am assuming is related to your acquired optic nerve pitting) may indeed limit your best visual acuity after cataract surgery. There are some simple tests that can be done in the office to determine what your potential acuity might be after cataract surgery. I would ask your ophthalmologist to perform this testing prior to electing to undergo cataract surgery.
I was diagnosed with buphthalmos when I was six months old and had surgery on both eyes. I got my vision back in the right eye when I was still a baby, but they could not do anything for my left eye. Is there any chance that I can get my vision back in my left eye? I am 18 years old now. [ 11/27/12 ]
Thank you for your question. It is a difficult one, but one that keeps me and many others motivated to discover ways in which we can repair the optic nerve. Unfortunately, the neural connections that needed to develop good vision during your childhood were interrupted by glaucoma. Based on your question, it sounds like the optic nerve was severely damaged by glaucoma when you were an infant. Once the cells of the optic nerve have died, there is currently no way to revive these cells. But there is ongoing research to discover ways in which to restore vision due to many different eye diseases using stem cells. Although glaucoma is a difficult disease to treat using stem cells, you are young and there is a chance that during your lifetime there hopefully will be a therapy in the future that might help your vision.