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 was diagnosed with glaucoma about five years ago, and I also have dry macular degeneration. Since I started taking drops, the nerves around my eyes have become more active and agitated. My eyes do not experience this agitation when I get up at night or in the morning for the first hour; however, as the day progresses, the intensity varies depending on different activities and the environment. Bright light definitely makes it much worse. It is hard to concentrate on reading, driving, and looking at a bright computer screen. Physical activity, such as bending over and walking also seems to make a difference. I wear sunglasses as much as I can, both inside and outside, but it does not completely control the symptoms. During the last six months the symptoms have been getting more intense. I have been using Cosopt and Brimonidine twice a day and Lumigan at night, in both eyes. I've had laser treatments twice in both eyes as well. Do you have any thoughts about my symptoms? [ 06/05/13 ]
Thanks for your question. I wonder if it’s possible that these glaucoma drops are irritating your eyes to the point that you experience these symptoms. Certainly we know that some patients have quite severe ocular surface disease after long-term usage of these eye drops. Your symptoms might be minimized during nighttime or early morning because your lids have been closed and the ocular surface is at its least irritated state. Bright light can certainly exacerbate symptoms of ocular surface irritation. It sounds like you’ve exhausted all medications and laser treatments, and the next step to reduce medication burden and better control your glaucoma would be surgery. Without knowing the stage of your glaucoma, I can tell you that there are now more and more options for glaucoma surgery. Please have a discussion with your ophthalmologist about whether it is time to start considering glaucoma surgical options. 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!
I was misdiagnosed for glaucoma, despite frequent visits. I have since been using several eye drops and had surgeries performed on both eyes. The vision in my left eye is now completely gone and I can no longer enjoy even my peripheral vision, which disappeared one week ago. What should I expect to happen to my vision next? Can I benefit from stem cell therapy? What are the available resources and contacts? I am desperate to have some vision to perform my duties as a pharmacist. Thank you. [ 06/04/13 ]
Thanks for your question. I am so sorry to hear about your vision loss. Unfortunately despite optimizing eye pressure, some patients still suffer from worsening glaucoma, which sounds like is the case for you. It would be worth discussing with your ophthalmologist and primary care doctor about other risk factors for worsening glaucoma, such as low blood pressure, and optimizing these risk factors, if present. In terms of stem cells, currently there is ongoing research in this area, but no product or stem cell transplantation available. However, there are clinical trials for glaucoma treatments that protect the optic nerve.
You could check clinicaltrials.gov to see if there are any trials enrolling glaucoma patients for neuroprotective treatments. I hope this helps, and good luck!
I have been diagnosed with glaucoma. My ocular pressure, before starting treatment, was generally 18 in right eye and 19 in left eye. My doctor said I had thin corneas (I had Lasik two years ago), which means my eye pressure readings are artificially low. After taking eye drops (Lumigan first and then Zioptan) my most recent pressure was 16 in the right eye and 13 in left eye. The visual field test showed progression of peripheral vision loss in left eye, however. My doctor wants to perform a selective laser trabeculoplasty in left eye (SLT). I want to be sure that there is no other problem that is contributing to the vision loss. Should the doctor suspect other causes of vision loss, such as those caused by cardiac or pulmonary issues? Should I have other tests done to see if there is poor circulation to optic nerve? [ 06/04/13 ]
Thanks for your question. Your story sounds most consistent with glaucoma progression. However, one approach you could consider is to repeat the visual field and ensure that there truly is progression. Perhaps this has already been done? I like to repeat the test to document whether there has truly been progression. Another option is to consider additional medications before SLT. But your real question is whether there are other cardiac or pulmonary issues that could be at play. One risk factor that has become more accepted is blood pressure, especially diastolic blood pressure. Your blood pressure is related to your ocular perfusion pressure, which could be a risk factor for glaucoma progression. You did not mention whether you have blood pressure issues, but if you are on medications for this condition, it may be worth ensuring that your blood pressure is not too low as this can result in decreased blood flow to the optic nerve. I hope this helps, and good luck!
I was diagnosed with open-angle glaucoma when I was 17 and apparently I have had glaucoma for two years. Now, I am a 19 years old and I have been on Travatan Z for the past two years. My doctor does not really tell me much about glaucoma, so I would appreciate your help. How can I have a more meaningful life with glaucoma? What can I do to prepare myself for the future? How soon might I go blind? Please help me; I would be so grateful. [ 06/04/13 ]
Thank you for your question. I understand why this must be frightening because you are so young. The good news is that glaucoma, if well-controlled, is a slowly developing disease. Glaucoma is a disease of the optic nerve, and the reason it is a challenging disease is that most patients do not know they have glaucoma as there are no symptoms until late in the disease. As the cells of the optic nerve die, first the peripheral vision is affected, and then slowly this can worsen until late in the disease when central vision is affected. Our goal as ophthalmologists is to slow the disease down so that patients do not experience these visual symptoms. There are plenty of people with glaucoma who live very meaningful lives. The important thing is to find a doctor you trust and always make sure you continue to follow-up with your appointments. I cannot answer your question about blindness as I do not know how severe your glaucoma is and what your rate of disease progression is. This is something that your ophthalmologist should have a sense of as he/she takes care of you and your eyes. I hope this helps, and good luck!
I am an 83-year-old female with glaucoma and I have developed cataracts. My doctor has been treating me for the past seven years and recommends their removal. He suggests Tecnis Multifocal intraocular lenses. He says I may see well enough to drive at night. My objectives are not to wear glasses but to see more clearly. So far, my personal research does not seem to encourage this lens for diseased eyes. I do appreciate your advice. [ 06/04/13 ]
Thanks for your question. As a glaucoma specialist, I do not recommend multifocal intraocular lenses for my glaucoma patients. This is because glaucoma patients already may have some difficulty with contrast sensitivity, and these lenses may exacerbate this. I would recommend that you have cataract surgery with a standard intraocular lens, which the vast majority of patients receive and subsequently see very well. However, the standard intraocular lens will only be able to give you good distance vision; you will still need to wear glasses for reading. Furthermore, if you do have astigmatism, these standard lenses do not correct that so you may still need to wear glasses for optimum clear distance vision. If you have astigmatism and want to have the astigmatism corrected (instead of wearing glasses), there are surgical maneuvers that can be done to improve this at the time of cataract surgery, or you can have a special toric lens implanted. I hope this helps, and 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!