Science & Research

My ophthalmologist finally told me to stop all eye drops and prescribed oral methazolamide. I have not started on the pills yet as I'm very nervous about all the potential side effects. Is there data concerning the percentage of patients that experience severe side effects from this drug? What are the long-term health effects from taking methazolamide?

I am sorry to hear about your intolerance of eye drops and your glaucoma. Methazolamide is certainly an option, and for glaucoma patients who do not desire to have surgery (which is still an option for you), eye doctors sometimes offer them long-term methazolamide treatment, if it is tolerated.

As you know, many medications have side effects, and when you read the package insert of any medication, the list of side effects can be quite daunting. Methazolamide is typically better tolerated than the other oral medication in the same class, called acetazolamide. Some common side effects of this class of medication (carbonic anhydrase inhibitors) are: nausea, loss of appetite, change in taste, diarrhea, frequent urination, dizziness, and tiredness. These often improve with time. Other side effects that are more worrisome include blood in the urine, numbness or tingling of hands/feet, painful urination, sudden decrease in amount of urine, and ringing of the ears. There are also other rare side effects that are more serious, including a very serious (but also very rare) allergic reaction or decreased blood cell production.

I cannot give you a strict percentage of patients who have these side effects, but I can tell you that as long as you and your doctor monitor any changes after you begin therapy, the drug can always be stopped if you are experiencing intolerable side effects.

As for your question about long-term health effects, unfortunately that has not been well-studied; however, many of these side effects can be monitored and are related to the dose you are taking. One option for you is to start with a low dose (discuss with your ophthalmologist first) and then increase the dose upwards if the eye pressure is not low enough and you can tolerate the medication.

I would appreciate any thoughts that you have concerning this special contact lens. By the way, I agreed to have this procedure in July.

Thank you for your question. It would help me to answer your question if you provided the name of the contact lens technology you were using. If you are using the Triggerfish system, it appears to be a non-invasive contact lens method of measuring eye pressure over a 24-hour period. It provides data about how much your eye pressure is fluctuating during that time period. Whether this actually provides truly useful information for your treatment has not been definitively proven, but it is a relatively low-risk intervention. You used the word “procedure,” however, so I am not sure if we are discussing the same technology. Please re-submit your question with more information and I would be glad to help you further.

About one year ago, she developed intermittent blurring in her right eye, and was diagnosed with ocular pucker. The retina specialist hesitated to do surgery to repair the pucker due to her experience following the trabulectomy. Mom's vision is now so blurry in her right eye that she has to use a magnifying glass to read large print books. 

How can I find a retina center that specializes in this type of surgery? Can you advise if this surgery might improve her vision or not in light of her prior experience? Is it possible that heavy exertion could have caused the pucker to occur? Finally, if surgery is not an option are there other treatments available to her?

I would ask your mother's primary ophthalmologist to refer you to another retina specialist for a second opinion. It never hurts to have your mother's eyes examined by another physician for an opinion. I am not a retina specialist, but generally speaking, there is no definite “right” or “wrong” decision to operate on macular pucker. It is a decision that the patient and surgeon must reach together. Often, if the vision measured in the doctor's office is 20/30 or 20/40, many retina surgeons are reluctant to operate because the risks of the surgery may outweigh the benefits. The retina specialist may also be reluctant because your mom sees better with her right eye. However, that being said, it sounds like the quality of your mother's vision is poor and it is affecting the quality of her life. 



Heavy exertion is not likely to have caused the pucker.



Lastly, if surgery is not an option, there are unfortunately no other medical treatments. However, you might want to consider getting a referral to a center that specializes in patients with low vision, because there may be reading and vision aids that could significantly benefit your mother.

I am 53 years old and was recently diagnosed with low-tension glaucoma. I had been under medical observation for the past two years for this condition. I have been prescribed Xalatan, which causes some slight redness, but this is a minor problem if it will save my sight. My pressure is 12 and 13 in my left and right eyes, respectively.

I am terrified of going blind and this procedure sounded similar to one that is done with people that have irregular high blood pressure, so I thought it couldn't hurt. Have you heard anything about this new treatment that is not yet being performed in the United States? I would appreciate any thoughts that you have concerning this special contact lens. By the way, I agreed to have this procedure in July.

Thank you for your question. It would help me to answer your question if you provided the name of the contact lens technology you were using. If you are using the Triggerfish system, it appears to be a non-invasive contact lens method of measuring eye pressure over a 24-hour period. It provides data about how much your eye pressure is fluctuating during that time period. Whether this actually provides truly useful information for your treatment has not been definitively proven, but it is a relatively low-risk intervention. You used the word “procedure,” however, so I am not sure if we are discussing the same technology. Please re-submit your question with more information and I would be glad to help you further.

Thank you for your question. I am not sure why you are you having pain at night, but I wonder what type of glaucoma you have. Do you have open-angle or closed-angle glaucoma? If the latter, it is possible that in dim lighting conditions you are experiencing intermittent angle closure and that is giving you pain. On other hand, when you are in bright light, your pupil constricts and typically a narrow angle becomes more open. I would ask your ophthalmologist to examine your drainage angle at your next visit and discuss these symptoms.

Thank you for your very interesting question. It is actually a question that needs more research, especially as there is growing evidence that there may be an inflammatory component to glaucoma. However, to date there is no evidence of NSAIDs causing or affecting the progression of glaucoma. There are some studies suggesting that the use of topical or oral NSAIDs may enhance the effect of eye-pressure lowering medications such as prostaglandin analogues (e.g., latanoprost). However, more work needs to be done to verify this finding and currently there is no recommendation concerning this type of treatment from the American Academy of Ophthalmology.

You can take over the counter pain killers such as ibuprofen or acetaminophen for your knee injury. Gravol contains diphenhydramine, which can sometimes cause problems for patients who have angle-closure glaucoma. Most patients in the U.S. have open-angle glaucoma, and taking Gravol should not be a problem for them, but you should discuss this issue with your ophthalmologist.

Thank you for your question. It is difficult to evaluate your diagnosis by just hearing your story, but it does sound like you may have had pigment dispersion causing elevated eye pressures, which required eye drop medications. Over time, high eye pressures can cause damage to the optic nerve, or glaucoma, which is likely why you were started on treatment. Sometimes, as the consultant doctor mentioned, pigment dispersion can “burn out” and eye pressure may be normal. Some patients, indeed, do have pigment dispersion but no evidence of elevated eye pressures or changes to the optic nerve. However, since glaucoma is also an age-related disease, I recommend that you continue follow-up and be monitored for this disease. Lastly, glaucoma often is difficult to diagnose when patients have various risk factors, such as elevated eye pressures, abnormal appearing optic nerves, or strong family history. It sounds like you had risk factors that may have made your previous doctors suspicious for glaucoma. I follow many patients whom I consider “glaucoma suspects” and it is only over time that we can determine whether the patient definitely has glaucoma requiring treatment.