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My husband needs a new optic nerve because it is so damaged. Is this possible? [ 08/30/13 ]

Thank you for your question. This is actually something that I am asked quite frequently by my patients and their families. Unfortunately, even though we have made tremendous advances in research and the treatment of glaucoma, eye transplants or optic nerve transplants are not possible at this time. The most promising research in this area is stem cell research. There are several people exploring stem cell research to determine whether the stem cells can be used to help fix the optic nerve, but these studies are in their earliest stages. The use of stem cells to treat a damaged optic nerve is likely decades away. For now, our only treatment for glaucoma is to lower eye pressure by using drops, laser, and surgical methods.

I am 63 years old and my eyes have become a lot worse during the last three years. My eye doctor thinks it may be due to diabetes or my thyroid, because my vision has changed five times in my right eye and four times in my left eye. Are these changes normal? [ 06/04/13 ]

Thanks for your question. Without examining your eyes, it’s difficult to know for sure, but it is possible that you could have fluctuating vision as you described, especially if your diabetes is not well-controlled. You did not mention whether the decrease is mostly for distance or near vision, and certainly as we get older our near vision can become more and more blurry. I would recommend that you have a comprehensive examination that includes dilation to rule out any other problems. However, it is possible that you will need your glasses updated yearly. Good luck!

I am 77 years old and have suffered from open-angle glaucoma for 27 years. Both eyes had been treated with Betagan, which caused bronchial spasm; Alphagan, which caused orthostatic hypotension; and Azopt, which caused skin eruption. My left eye is worse; it had a trabeculectomy 12 years ago, and the procedure led to the loss of central vision. Now I am only using Travatan Z in my right eye. My new eye doctor said that I need a trabeculectomy performed on my right eye now. Due to central vision loss in my left eye after previous surgery, I am very nervous about getting this surgery done on my right eye, in which I have 20/30 vision. What are the odds that I will lose the central vision in my right eye after surgery this time? I also would like to know what the chances are that I will go blind in five years. Thank you. [ 06/04/13 ]

Thanks for your question. Unfortunately, the phenomenon that you describe, in which one can lose central vision after a successful trabeculectomy, is a very rare occurrence but does happen. I can certainly understand why you are nervous about having trabeculectomy performed on your right eye. It is difficult without examining your eyes to know what the risk of losing central vision in your right eye is, as some of it depends on how advanced the glaucoma and visual field loss is. Furthermore, it is hard for me to assess your risk of blindness without knowing your rate of visual field loss over the last 27 years. What we do know is that if you don’t have any interventions and your glaucoma is not well-controlled, you will eventually lose more visual field, but it is important to assess over what time period. These are questions you should certainly ask your ophthalmologist. If you don’t feel comfortable asking him or her, perhaps seeking a second opinion and asking these very questions will help you in your decision. Good luck!

In 2008, there was a study by Dr. Parisi that spoke of the very positive effects of citicoline in treating glaucoma. I recently saw that a patent for topical citicoline was just approved. How safe is it to take citicoline as a capsule supplement, in addition to Travatan Z to help treat glaucoma? If it is safe, what would be the recommended dosage? Thank you. [ 06/04/13 ]

Thanks for your question. I recently heard Dr. Parisi discuss the results of oral citicoline treatment of patients in Italy. I personally have no experience with citicoline use, as it is not FDA approved for glaucoma treatment in the U.S. It has been used for stroke and Alzheimer’s in Europe and Asia, but in the U.S. it is a dietary supplement. It is important to note that they observed regression of improvements in visual function when the drug was discontinued. This is important because we do not know the long-term effects of continued citicoline usage. Furthermore, there are side effects including blood pressure instability, chest pain, and headache. At this point, I would recommend that you speak about this with your ophthalmologist and primary care doctor in terms of the safety of taking this supplement in your particular situation. Good luck!

Why would one have to have their eye removed due to glaucoma? [ 06/04/13 ]

Thanks for your question. If the eye is completely blind from glaucoma, and painful, then it would be reasonable to consider removing the eye. However, even for blind and painful eyes, doctors can offer an injection of an agent that can reduce or eliminate the pain. This is preferable as it allows the patient to maintain the eye, even though it is blind. I would discuss this option with your ophthalmologist if this is an issue you are facing.

Will the large amount of fluid required for a colonoscopy preparation cause my eye pressure to increase? Is there anything I need to talk with the gastroenterologist about concerning my glaucoma? The pressure in one eye has caused some visual field damage and I have had surgery in the other eye due to a massive amount of damage. [ 06/04/13 ]

Thanks for your question. I would definitely discuss this question with your gastroenterologist. Certainly we do know that a large amount of fluid ingested in a short amount of time can increase eye pressure, especially in patients with glaucoma. Polyethylene glycol solutions that are commonly used for bowel preps are not supposed to cause large fluid shifts or electrolyte imbalances. I recommend discussing with your gastroenterologist whether you can take a low-volume prep and divide it over several doses and/or longer time period. This should help in terms of decreasing any risk of an acute eye pressure increase. Good luck!

I have been taking antihistamines for seasonal allergies since I was four years old. I am now 57 and had Yag laser iridotomy this year. I was using Claritin and Zyrtec, and currently continue to use Flonase and Nasalcrom nose sprays without difficulty. I also took Benadryl for topical allergy due to a response to an adhesive. I had a lot of pain and dryness after using it for two or three days. Allergy season is approaching and I wanted to know if there is any medication I can still take. [ 06/04/13 ]

Thank you for your question. If I understand your question correctly, the Claritin, Zyrtec, and Benadryl have given you a lot of dry eye symptoms. Furthermore, it sounds like you have narrow angles, and this is why you had the laser iridotomy. If your eye pressure is stable, even with the use of intranasal steroids, then you can continue those medications. In terms of antihistamines, I am not aware of any antihistamine that cannot potentially have dry eye as a side effect, unfortunately. It may be worthwhile, however, to try various antihistamines to see if any of them control your allergy symptoms but also minimize dry eye symptoms. The last issue is whether or not you have itchy eyes related to your seasonal allergies. In that case, there are certainly a wide variety of different types of eye drops your ophthalmologist can prescribe to alleviate those symptoms. Good luck!

My optometrist diagnosed me with glaucoma. My eyes are very healthy and I was not given any particular treatment other than a prescription for glasses. Is there a way to look at the prescription and determine the eye pressure? Is it normal not to be on some sort of treatment if a person is diagnosed with glaucoma? [ 06/04/13 ]

Thanks for your question. No, the eyeglass prescription does not give any information about eye pressure. I suspect that if you have not been started on any treatment then your optometrist is suspicious that you have glaucoma, or considers your risk of developing glaucoma very low, and has therefore not recommended treatment. It is also possible that your optometrist wishes to follow you as a glaucoma suspect, obtain tests including an optic nerve imaging test, and then determine if you should be on treatment. Do you have follow-up scheduled? Have you had an optic nerve imaging test and a visual field? These are typical steps an optometrist or ophthalmologist will take when performing a glaucoma evaluation. Good luck!

I am 86 years old and I would like to know what caused the glaucoma and cataracts in both eyes. Are they inherited? Does eye strain cause these disorders? Can the use of dark glasses when outdoors prevent glaucoma and cataracts? What is done to remove glaucoma? Isn’t there an operation or laser treatment to correct this condition? [ 06/04/13 ]

Thank you for your question. Some forms of cataract and glaucoma are inherited, but most cases are age-related, although there are certainly genetic risk factors. Eye strain does not cause cataract or glaucoma. Wearing dark glasses will not prevent glaucoma, but it does help delay cataract formation. Certainly, sunglasses are a good idea for general eye health. While we do have cataract surgery to correct the condition of cataracts, there is no treatment that corrects glaucoma. What we do have are medications, lasers, and surgeries to lower eye pressure, which slows the progression of glaucoma. The goal of glaucoma treatment is to offer patients a well-tolerated treatment that prevents vision loss. Good luck!

Why do cataracts lenses cause “wandering” or double vision in the implanted eye? What remedies and treatments are available to help improve vision lost as a result of laser surgery performed supposedly to reduce eye pressure? [ 06/04/13 ]

Thanks for your questions. As to your first question, I am not sure what you mean by “wandering” vision in an eye that has had cataract surgery. In terms of double vision, it is important to distinguish double vision just with one eye open, or both eyes open. The implanted lens is placed in a “bag” and sometimes the bag has wrinkles or a film that grows on it, which can be resolved by performing a laser procedure in the clinic. I am not sure based on your question whether it would help your symptom, but it is certainly worth asking your ophthalmologist. Typically, laser procedures performed to reduce eye pressure should not cause one to lose vision. Without knowing any additional information, this question is hard to answer. Is it possible that you had inflammation in reaction to the laser, and this caused some decreased vision? In this case doctors could treat the inflammation and that could help with your vision. If you could provide more details about your clinical history I may be able to help you more. Good luck!

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Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

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