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.
2. Two years ago, at age 59, I became a glaucoma suspect because my cup to disc ratio was .5 in both eyes. My eye pressures consistently are 11 and 12, corneal thickness is 547 and 538, I have a normal visual field testing, and HRT is stable. Assuming everything remains stable, would I be considered a glaucoma suspect for the rest of my life due to my cup to disc ratio, or at some point would my ratio be considered normal for me? [ 11/05/12 ]
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.
My mother, who is 71 years old, had a retinal detachment, and also has a diagnosis of glaucoma. The retina was reattached, but now she has developed cataracts and can see very little out of her left eye. If she were to get a corneal transplant, will it restore her eyesight? She was also told that she had optic nerve damage. Thank you for your time. [ 10/25/12 ]
I am sorry to hear about your mother's vision problems. It is not clear from your question whether she has scarring or damage to the cornea that requires a cornea transplant. When ophthalmologists make decisions about surgery, they try to gather as much data to understand what the visual potential is, because all surgery entails risk, and it sounds like your mother might need both cataract surgery and possibly corneal transplant surgery. While cataract and damaged corneas can be replaced and essentially made clear again simply by replacing the lens or cornea, damage to the retina is sometimes not reversible and damage to the optic nerve from glaucoma is generally irreversible. This is because the retina and optic nerve are composed of neurons, which are cells that transmit electrical information. So, I would seek the opinion of a retina and glaucoma specialist to see if they deem the potential vision good enough to recommend surgery.
I am 77 years old and was diagnosed with glaucoma three years ago (60 percent in the left eye and 10 percent in the right eye). I manage the glaucoma with eye drops, and I also have a cataract, which does not require an operation. I was diagnosed with the cataract from the age of 45, which never grew; however, whenever I see an eye doctor, he/she always wants to operate on the cataract rather than treat the glaucoma. In December 2011, my pressure was 26 and 27, and in March of 2012, when I went for a checkup, the pressure was 25 and 26. Three months later, I went for a checkup at a different eye clinic, and the pressure was 10 and 11. Can the pressure drop this much in three months? Is this normal? Should I continue taking my eye drops? [ 09/28/12 ]
Thank you for your question. Without having examined your eyes personally and without reviewing the results of past exams and tests, it is nearly impossible for me to give a completely accurate answer. What I can say is that if your eye pressure was in the mid-20s in December of 2011 and March of 2012, and you continued using the same eye drop, it would be rather unusual for the pressure to drop to 10 or 11 in June of 2012 because of the drops alone. If you have been on the same drop regimen from December 2011 until now, eye pressure would not likely change that dramatically. Given that you went to a different clinic, I would wonder if the pressure was accurately taken at one or the other. I would recommend having the pressure taken again relatively soon and determine what the pressure really is. Secondly, I would ask the eye doctor to examine you for any signs of inflammation within the eye. It is always possible that there is inflammation that is decreasing the amount of fluid created in the eye (hence the lowering of the pressure). To reiterate, it is unusual to have intraocular pressure in the mid-twenties on multiple occasions, and then without changing medications have the pressure drop that much. If the readings were accurate, the doctor should be able to help you find a reason for the drop in eye pressure. I would highly advise continuing the eye drops until you can be re-examined by your eye doctor and at that point you can determine whether or not the drops should be continued. Do not stop the drops your own. I wish you the best of luck.
I had a laser procedure performed on my left eye after my doctor noticed changes in my visual field test. He said it would help lower my eye pressure. The procedure was painful and my pressure was not checked afterwards. I went home and had to keep my eye closed because of the pain and discomfort. Two days later, I called and he said I had some inflammation, so he prescribed Durazol. My symptoms got worse. It turns out that my pressure was 68 and probably had been for a few days. I have now gone to a glaucoma specialist who says that 95% of my optic nerve has been destroyed. I had a trabeculectomy, but the pressure keeps going up. The doctor says I still have effects of the inflammation from laser surgery. My guess from the comments made by three other doctors is that the laser power was too high and that I had sustained high pressure, which has caused most of my problems. Could all of this have been caused by laser power that was too high? How do they know what power to use? [ 09/19/12 ]
Thank you for your question. First, let me say that I am incredibly sorry that you have gone through all of this. Without having examined your eyes personally and without reviewing the results of past exams, tests, and procedure notes (including the laser settings used), it is nearly impossible for me to give a completely accurate answer. I don't know if it was related to the laser alone, the use of the steroid eye drops (Durezol), or a combination of both. Laser treatments, either selective laser trabeculoplasty (SLT) or argon laser trabeculoplasty (ALT), are both commonly used as treatments for glaucoma.
The appropriate power that needs to be used varies for each patient, and is mostly related to the amount of pigment in the trabecular meshwork (i.e., the drainage system) of the eye. The more pigment in the trabecular meshwork, typically the less power is needed. When eye doctors perform SLT they typically start at a relatively low power and increase it until they see tiny bubbles form at the trabecular meshwork after about 50% of the laser spots are created. When performing ALT, doctors should see a blanching of the trabecular meshwork to know that they have used enough power. Again, you start at a lower power and work up until you see the blanching so that you know that you are not over-treating.
Laser surgery is relatively well tolerated; however, it is a surgery. Before any surgery, your eye doctor should discuss the risks, benefits, and alternatives before you agree to have any procedure performed in the office or in the operating room. There is a small risk that the laser procedure can cause an increase in the eye pressure and that is always something I discuss with my patients. I have my patients wait approximately 20-30 minutes after the procedure and I check the pressure before they leave to make sure that it has remained stable. If the pressure goes up immediately, this can often be reversed in the office with a couple of additional pressure lowering drops and in most people the elevated pressure does not last long. It is very common to have a slight headache after the laser procedure, and patients may not feel like doing much that evening, but extreme pain is unusual. There is often a small amount of inflammation that occurs in the eye after the procedure, and it is not uncommon that doctors prescribe an anti-inflammatory eye drop for approximately one week. Unfortunately, I am not sure if you will ever really know why the pressure went up. Hopefully your eye doctor can get the pressure under control and work to preserve as much vision as possible.
I am a glaucoma patient who had trabeculectomy surgery on both eyes. I later developed a cataract, which was removed. I was using Xalatan and Cosopt eye drops before the cataract surgery, and would like to know if I can still continue these medications? [ 11/13/11 ]
That is a great question. The answer often depends on the doctor doing the surgery. If possible, I will often times have my patients stop their prostaglandin analog (Xalatan, Travatan, Lumigan, or generic) a few days prior to cataract surgery because of a slight increased risk of swelling in the retina (called cystoid macular edema) after cataract surgery when you are on those medications.
Often the choice of whether or not to restart the medication after surgery is dependent on what the pressure in the eye is after cataract surgery. There has been some interesting new data that shows there is an approximate 2 mmHg drop in intraocular pressure that lasts for about two years after cataract surgery (there is not a full understanding of why this happens, but many researchers are currently looking into it). If the pressure has dropped sufficiently after the cataract surgery, it may not be necessary to restart the prostaglandin analog (Xalatan in your case) unless the pressure goes up again above your goal intraocular pressure. In other cases, even if there is a small drop in pressure, it may not be low enough to achieve your goal intraocular pressure, so the doctor will likely restart all of the glaucoma medications after a certain time period after surgery. Again, this is all dependent on the doctor's preferences and how your eye responds to the cataract surgery. Keep your regularly scheduled appointments and the doctor will monitor your pressure and make adjustments to your glaucoma medications accordingly. I wish you the best of luck
I am living in Japan and seeking SLT surgery to lower my eye pressure (it is between 18 - 20 mmHg). My ophthalmologist states that SLT can cause a sustained rise in eye pressure and does not think it is called for unless my visual field is noticeably worsening. All the literature that I am reading seems to indicate that it is a very safe procedure with few side effects. I received a second opinion from another doctor and was told the same thing. How common is a sustained rise in eye pressure as a result of SLT laser surgery? [ 11/11/11 ]
Thanks for your question. Of course it is difficult without examining you to tell if you should have SLT, but I can address your questions about eye pressure rises after SLT. While I certainly always warn patients of this risk when I talk with them about this procedure, it is generally infrequent, on the order of 3 - 5 percent, and it is not usually sustained. I have heard a few anecdotal cases of sustained eye pressure rises requiring surgery, but these situations are uncommon. There are also several maneuvers your ophthalmologist can do to minimize the risk of an eye pressure spike with SLT. I always give my patients a drop of apraclonidine (or brimonidine) before the procedure to reduce the risk of an eye pressure increase. I titrate the laser power so that I am using the minimum amount of energy to achieve an effect. I usually treat 360 degrees of the drainage system, but some ophthalmologists will only treat 180 degrees to minimize an eye pressure spike, although to my knowledge this has not been definitively shown to be of benefit. I also always have my patients wait 30 – 60 minutes after the procedure so that I can re-check the eye pressure. If there has been a spike, we control it with medications and then re-check the pressure again. Of course, one must weigh the risks and benefits of laser surgery, but I would say that overall SLT is a relatively safe procedure. I have not discussed all of the side effects of the procedure here, but you should have a conversation with your surgeon about the risks, benefits, and side effects before you proceed.
I have been using Xalatan for six months and my sleeping habits are not consistent. How important is it for me to take the drops before bedtime? Can I take them when I do not plan to sleep? I may go to bed at 8 p.m. one night and midnight or later the next night. What should I do? [ 11/09/11 ]
Thanks for your question. I think a lot of patients run into your dilemma. The reason that Xalatan is dosed at bedtime is because it begins working 3-4 hours after instillation, peaks at 8 -12 hours, and persists for 24 hours. Because we know that eye pressure is highest in the morning, taking the drop at bedtime puts you in a situation in which the drug is most likely to be peaking at the time when the eye pressure is also peaking. The most important thing is for you to be consistent about taking your drops, so if it is easiest for you to remember to put them in right before you go to bed, then that is what I would recommend. If, however, you know that you will not be going to bed until midnight or later, and you can remember to take the drops around 9 p.m., then it is reasonable to do schedule it then. Alternatively, if you go to bed at 8 p.m., I would not set an alarm clock to wake yourself up and take the drop at 10 in the evening! I hope this helped to answer your question.