Science & Research

Thank you for your question. Unfortunately, at this point in time, there are no doctors in the United States who perform stem cell transplants for glaucoma or transplants of retinal ganglion cells. There is much research in this area (including my own research) but we are still many years from being able to safely offer such a treatment. In fact, I would say that if you do find a doctor who claims he/she can perform such a transplant, be very careful. You may have heard of stem cell transplants for other eye diseases, such as macular degeneration. However, in glaucoma, the dying retinal ganglion cell extends all the way from the eye to the brain and a “cure” for blindness from glaucoma is not as simple as just transplanting replacement retinal ganglion cells. I encourage you to continue doing research into new treatments for glaucoma but always with a careful approach.

Thank you for your interesting question. There is no test performed during a routine ophthalmologic exam that can quantify vision in percentage points. The quantitative measurements that ophthalmologists use to follow a patient’s glaucoma include visual acuity, visual field testing, and optic nerve imaging. There are quantitative measurements associated with these tests and certainly following them over time after establishing a baseline is important to monitor for progression.

Thank you for your question. Unfortunately it is difficult for me to advise you about the necessity of surgery without reviewing your ophthalmic history and performing an examination. I can give you some advice about what questions or options to consider prior to having surgery. Are there other eye drops that you can take without intolerable side effects and that lower your eye pressure further? Are you a candidate for glaucoma laser treatment (laser trabeculoplasty)? Have you had worsening of visual field or optic nerve structure over time at your current eye pressure? Unfortunately, it is a known side effect of glaucoma surgery that vision can sometimes decrease, often due to cataract or lens changes, but this is usually reversible. Lastly, you could consider seeking a second ophthalmologist’s opinion, perhaps from a glaucoma specialist.

Thanks for your question. I’d like to reassure you that the redness in your eyes does not mean that you are approaching blindness. Your doctors may be correct that the redness is due to the glaucoma eye drops. You could try to switch over to preservative-free formulations that may be less irritating. Another intervention that might help is the use of preservative-free artificial tears during the day and an ointment at nighttime. You mentioned that your doctors think it is due to a change of the glaucoma eye drops, so it would be helpful for you to know which medication changed. If you know which eye drop is causing the problem you could either switch formulations (such as a preservative-free formulation) or try a different glaucoma eye drops. Please discuss these options with your eye doctor. Good luck!

Thanks for your question. This is a difficult question to answer without knowing more of your history, examining your eyes, and getting a sense of the pace of your glaucoma progression. While it is true that surgery often lowers the pressure more than drops, your doctor is correct in that surgery has inherent risks. Eye drops (and laser) are generally used as first-line therapies because they are safe and effective, and many patients do not see a progression of their glaucoma with just using medications. Of course, there are side effects of the eye drops as well, but you will not know if you will experience them until you give it them a try. It seems reasonable (based on the limited knowledge of your situation) to try eye drops (or laser) first. If they do not work, you will not have lost much (if any) ground and can then proceed with surgery. Please follow up with your eye doctor to determine the next steps and to further discuss your concerns.

Thanks for your question. I’m sorry to her about these symptoms and I don’t think that you should have to tolerate them. So I would say that instead of wearing corrective lenses to clear up your vision, your doctor will focus on finding a medication regimen that you can tolerate and is effective. It is also possible that you could have successful repeat laser for your glaucoma. Based on what you have told me, there are still some other medications that you could try. The other issue is whether dry eye exacerbated by your glaucoma drops is what is causing the blurry vision. If you are not already using artificial tears, I would recommend talking to your doctor about using them, and also ensure that any other underlying issues that could be causing irritation of the ocular surface, such as blepharitis or chronic inflammation of the eyelids, are addressed. Lastly, there are also preservative-free formulations of many glaucoma eye drops available and sometimes this can make a big difference in a patient’s tolerance of any eye drop. Please bring this information to your eye doctor and he can discuss the options with you in more detail.

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.

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.