Ask an Expert about Glaucoma

Thank you for your question. I am sorry to hear about your eye problems. I am not sure exactly what you are referring to by +1, but if I had to guess, this may be related to your refractive error, or the power of the lens that you need in order for optimum vision. It may also be the power of the lens in order to read, as +1 implies a far-sighted correction (far-sighted means that you can see far without a problem, but have difficulty with near vision). As we get older, we all develop presbyopia, and may require reading glasses, and +1 is a common correction.

In terms of glaucoma, if you had a comprehensive eye exam your doctor would have been able to assess your glaucoma status. Certainly you have a risk factor because of the family history of the disease, but that does not mean you necessarily have glaucoma. I would advise you to speak with your doctor about your concerns.

Thanks for your question. Unfortunately, I do not have enough information to adequately answer your question. An eye pressure of 19 mmHg is actually within normal limits, but that does not mean you do not have glaucoma. Eye pressure is one significant risk factor of glaucoma, but does not determine whether you have glaucoma or not. I would recommend that you see an ophthalmologist, if you have not already done so, to determine whether you truly have glaucoma and thus should be treated. For your dry eyes, I would recommend that you first try over-the-counter artificial tears to see if this helps with your symptoms. If you also have seasonal allergies or itching is a major component of your symptoms, your eye doctor can talk with you about other types of eye drops that may be beneficial.

I am sorry to hear about your father's glaucoma. Based on your question, I am not certain that I fully understand it, but let me try to tackle it. First of all, visual field testing is quite difficult, not only because it often takes a high amount of concentration and time, but also because it is anxiety-producing. Visual field tests are often unreliable, and there are parameters that the algorithm tests for to indicate whether the test is reliable. Furthermore, there is test to test fluctuation, which may or may not indicate improvement or worsening of the visual field. So, it is possible that some of these factors may be at play as to why the right eye field results are all of a sudden “better” than the left eye field results. It is also possible that the left eye was more damaged all along—glaucoma is a disease that affects both eyes, but often one eye is worse than the other. I hope this answers your questions. You could also accompany your father to his next appointment and discuss these test results with the doctor.

This is a very good question and one that ophthalmologists struggle with—that is, how to identify those glaucoma suspects that really will develop glaucoma. A cup to disc ratio alone of 0.5 in both eyes could certainly be normal for you. When ophthalmologists evaluate you for glaucoma, they take into consideration risk factors in addition to what they find during an examination. For example, age is a major risk factor for glaucoma, so as you get older, you may convert from a glaucoma suspect to having glaucoma. Family history is also a risk factor, which I am assuming you do not have because you did not mention it. Other factors include high eye pressure and corneal thickness, which are normal for you. However, a cup to disc ratio of 0.5 does not give the complete story. For example, there are certain features of an optic nerve that may be very suspicious for glaucoma, and the cup to disc ratio does not capture this. Overall, given your normal visual field and optic nerve imaging test (HRT), you may very well never develop glaucoma; however, it is still important to have a yearly exam to ensure that there is no progression or change.

This is a very good question and one that ophthalmologists struggle with—that is, how to identify those glaucoma suspects that really will develop glaucoma. A cup to disc ratio alone of 0.5 in both eyes could certainly be normal for you. When ophthalmologists evaluate you for glaucoma, they take into consideration risk factors in addition to what they find during an examination. For example, age is a major risk factor for glaucoma, so as you get older, you may convert from a glaucoma suspect to having glaucoma. Family history is also a risk factor, which I am assuming you do not have because you did not mention it. Other factors include high eye pressure and corneal thickness, which are normal for you. However, a cup to disc ratio of 0.5 does not give the complete story. For example, there are certain features of an optic nerve that may be very suspicious for glaucoma, and the cup to disc ratio does not capture this. Overall, given your normal visual field and optic nerve imaging test (HRT), you may very well never develop glaucoma; however, it is still important to have a yearly exam to ensure that there is no progression or change.

Contact lenses are not used to treat glaucoma but rather to correct underlying problems that prevent the eye from focusing properly. There are certainly many prescribed eye drops to treat glaucoma, and I refer you to this website's comprehensive discussion about the various eye drops used to treat this eye disease:

• http://www.brightfocus.org/glaucoma/treatment/common/#medications

There are new contact lenses being developed and are not yet available that release eye medications when they are worn; however, these lenses currently only release medications for a short period of time. Glaucoma is a chronic condition that would require long-term eye medication release, or one would need to change these special contact lenses daily.

I am so sorry to hear about your vision loss. As a glaucoma doctor, I wish I could offer my patients better vision. Instead, I explain that our goal is to preserve what vision remains. There is active ongoing research around the world exploring how stem cell transplantation might be able to help glaucoma patients. However, glaucoma is a more challenging disease to treat in this way than other diseases (such as patients who have lost vision due to retina diseases). This is partly because glaucoma affects the cells of the optic nerve, and the optic nerve cells stretch all the way from the retina to the brain, a very long distance. So not only would scientists have to be able to replace the cells of the optic nerve, but also coax them to wire long distances to the right location. It is a big challenge, but I hope that in your lifetime we will be able to offer you tools to help improve your vision. You may want to explore having a low vision evaluation, if you have not done so already, where doctors can help provide tools that will help maximize the vision you have.

To answer your question about whether vision can improve at the same time one develops glaucoma, it may help to take a step back and discuss the impact of glaucoma on vision. Generally speaking, open-angle glaucoma, which is what the majority of Americans have, does not affect central vision until late in the disease. The earliest impact on vision is generally in the periphery (side vision), which can go unnoticed by patients because one eye's field of vision will overlap with the other eye's field of vision. This is why we ask patients to perform formal visual field testing one eye at a time in the office. You mention that your son is 24 years old, but it is not clear if he is nearsighted, farsighted, or does not wear glasses. It is possible for vision to fluctuate slightly from exam to exam, especially if they are a year apart. Additionally, eye pressure is only one risk factor for glaucoma, so if your son's ophthalmologist is not too concerned about the right eye pressure elevation, then it may be within normal levels of fluctuation. Your son's eye doctor can provide you with a definitive answer.