I have a worsening glaucoma problem and high pressure in both eyes. I am going to an eye surgeon for treatment and wonder what questions I should ask. [ 02/08/11 ]
Thank you for your question. Unfortunately, without knowing a bit more about your history, the treatments that you have tried, and the results of past tests, it is nearly impossible for me to know what questions you should ask the doctor. I am sorry that your glaucoma is getting worse and that you now appear to need surgery. Sometimes, depending on the type of glaucoma that a patient has, medications do not work as well in one type as they do another. The other problem is that even in patients with the same type of glaucoma (primary open-angle glaucoma, for example) every patient responds differently to the treatment. I have some patients that need one drop a day for the rest of their lives and they never have any further problems. I have other patients who try all of the medications, yet none of them seem to work. If you have used all of the medications available and you have tried laser therapy, the next option is probably surgery (trabeculectomy or glaucoma shunt tube). The good news is that most patients do very well. I suggest that you have a discussion with your new eye doctor about the risks, benefits and alternatives of each surgical option that they offer. It is very possible that after your exam with the new doctor you will get home and have more questions. I always tell my patients to write the questions down and either call me or bring them to the next exam. I know this may not exactly answer the question, but without knowing more, the best advice I can give you is to fully understand the risks, benefits, and alternatives of any or all surgical options that are available. I wish you the best of luck.
One year ago, I had a battery of tests, which indicated that I had glaucoma. I have been taking eye drops daily since then. I had my annual vision field test recently and there was only one little black box at the bottom of the grid. One year ago, the shape of a "big L" was present. The recent tests indicate that nothing is wrong. What happened to the "big L-shaped black boxes" that were present one year ago? [ 02/07/11 ]
Thank you for your question. Unfortunately, without examining the visual fields, it is nearly impossible for me to give you an accurate answer as to why the "big L" disappeared. In general, we do not believe the results of one single test in most cases, and ask patients to take the exam a couple of times to ensure that the defects are reproducible, or in your case that the lack of any indication of glaucoma is correct. Often the first time that a patient takes the test, the results are not all that accurate because there is a learning curve to taking the test accurately. It is not unusual for someone with minor defects on the first exam to actually show no defects on later exams. If your doctor is concerned, they could consider doing a special visual field test known as a SWAP visual field. In some cases, this will pick up very early glaucoma defects that the normal visual field will not (although the SWAP test is not as reliable as the standard visual field test). Also, if you have had a cataract surgery since the last test, this can clear up the entire field of vision and this could account for the change in the pattern of defects. I suggest that you repeat the exam again in the future, and make sure that you are also having dilated eye exams. If your doctor is uncertain as to whether or not you have glaucoma, I suggest that you see a glaucoma specialist for a second opinion. Often these types of cases are difficult to interpret.
During the last 5 years, my top eyelids will intermittently start to drain fluid, which streams down my face. I always use the same makeup and face cleanser. Do you know what causes this symptom? [ 02/06/11 ]
Thanks for the question. While I usually get to answer glaucoma questions, it is always fun to change gears and answer a general ophthalmology question. Tearing (also known as epiphora) happens for a couple of reasons.
First, it is possible that your eyes are creating too many tears and your tear drainage system cannot drain them off quickly enough (the tear drainage openings are located on each eyelid at the corner of the eyes nearest the nose). This is like a sink that has an open drain, but the faucet is on too high and overwhelms the capacity of the drain to take tears away. The sink eventually overflows. This can occur any time the eye is irritated and produces "reflex tears." The body doesn't know how to produce "just few extra" tears; it only knows how to turn the reflex tears on "full blast." If something is irritating the eyes (allergies) or they are dry, a tear reflex is stimulated and too many tears can be made. Yes, dry eyes can cause the eyes to water and over-run!
The second possibility is that the tear drainage system is intermittently getting clogged. This can occur at various times due to colds, sinus problems, allergies, or other problems. You can go to your eye doctor and they can test the amount of tears that you are producing, and test the tear drainage system. They will numb the eye and then irrigate the tear drainage system with some salt water. If you taste the salt water, they will know that the system is open. This is something that any eye doctor can perform, and they can also provide suggestions to alleviate the problem. I wish you the best of luck.
Does massage affect glaucoma in any way? [ 02/05/11 ]
To my knowledge (and after a quick literature search) there are no randomized clinical trials or even case reports of either benefits or adverse effects of having a massage for someone who has glaucoma. As long as you do not have a massage in which your head is lowered significantly below your heart (i.e., you are not inverted) then you should be fine. I say treat yourself and enjoy.
My brother was diagnosed with glaucoma in 1989 and has been treated with eye drops. Occasionally, his left pupil moves outwards and his vision becomes blurry. It is more noticeable now than it has ever been. He claims that he is fine but I am worried that his glaucoma is getting worse. [ 02/04/11 ]
Thank you for your question. I think that your concerns are valid, and having an examination by a glaucoma specialist might be worth his time. When the pupil moves outward (i.e., his eye turns out) and the vision is blurry this may be something called a "decompensating phoria." In laymen's terms, if the eye is getting blurry enough and the image from that eye is not useful because the other eye sees well, it is possible that the brain will begin to ignore the image. When the brain starts ignoring the image, the eye often relaxes and turns out or in.
As you have noticed, if the eye is starting to turn out more often, it could be an indication that the vision is getting worse. Given that he has glaucoma, it is possible that the disease process is getting worse and he has lost some more vision in that eye. Only by having a complete eye exam (including a visual field exam, dilated fundus exam, and possibly an OCT), the glaucoma specialist can compare the results of this exam to old exams and tell if there has been any progression. I hope your brother takes time to visit his glaucoma specialist. I wish you the best of luck.
I experience something that I call "first morning blindness." When I wake up in the middle of the night or first thing in the morning, I turn on a light and it gets really dark for what is a noticeable period of time. Then, I recover. I was diagnosed with glaucoma 5 years ago, and now I have it in both of my eyes. I'm also very nearsighted, have a metabolic disorder called polycystic ovarian syndrome, and was recently diagnosed with Stage 2 chronic kidney disease due to long-term, high dose use of ibuprofen therapy while also taking Lasix. Now, I'm also suffering from panic, which sometimes impacts my blood pressure. I am not taking any medications except spironolactone for my polycystic ovarian syndrome. I went to my ophthalmologist a couple of months ago for my glaucoma check up and mentioned the "morning blindness" to him. At that time, it had just started, and he said that he could not find any reason for it. I am seeing him in April for my next check-up. I asked him if my incr [ 02/03/11 ]
Thank you for your question. Unfortunately, without having examined your eyes, seeing the results of the eye tests that you have taken, or examining your eyes during or just after an episode of the "first morning blindness," it is difficult to give you an accurate answer. I can tell you that in general, glaucoma does not cause these types of symptoms. Usually, glaucoma causes very gradual visual decline and it occurs so slowly that most people do not recognize that changes are happening. In addition, vision loss with glaucoma is usually permanent and does not return to normal in the matter of a few hours.
First, I suggest that you let your primary care doctor or the doctor following your kidney disease (whichever is prescribing the spironolactone) know about these problems. In addition, please let them know if you are taking any herbal medications or vitamins. Given your multiple diseases (including possible vascular disease as indicated by the chronic kidney disease and blood pressure changes), I would highly recommend that you have a carotid Doppler exam just to make sure that you do not have any vascular problems in the neck that could be causing decreased blood flow to the eyes. In addition, I would have you take your blood pressure during these episodes to help determine whether or not the blood pressure is elevated or low. Often, we can have patients that have blood pressure bottom out at night if they are taking blood pressure medications right before bedtime. This can have ocular side effects and it can cause loss of vision. Finally, I would invite you to stay in the clinic so that you could recline in the chair and sit in the dark for a while. Then, I would have you sit upright and turn on the lights to see if we could stimulate one of the "first morning blindness" episodes. If these tests were all normal, it might be worthwhile getting a referral to a neuro-ophthalmologist and/or a retina specialist to make sure they do not see any problems. They could help determine whether or not imaging of the brain is needed as well. I would definitely suggest following up with your eye doctor and primary care doctor to let them know if the episodes are continuing or getting worse. I wish you the best of luck.
I read recently that glaucoma starts in the brain. Are there supplements or enzymes that would be helpful in preventing or treating the changes that occur in the brain? Also, is there a danger for the patient when an eye technician uses high-powered lights to look inside the eye? During one test, I felt that the intern was keeping the light on longer than needed and my eye began to hurt. I told her that I was uncomfortable and that I wanted her to turn the light off, but she did not. When I got home after the exam, I found that normal print appeared fuzzy, and my vision is still not normal; I now need reading glasses. I appreciate your input. [ 01/18/11 ]
Thank you for your question. There are no supplements or vitamins that have been proven in randomized controlled trials to prevent or slow the progression of glaucoma. I believe what you probably read was the recent finding that intracranial pressure may play a role in the formation or progression of glaucoma. At this time, this is a theory that many of us are looking into and will be doing research on. Currently, the only studies completed in the United States have been retrospective chart reviews. While the data appear to support the conclusion that a decrease in intracranial pressure may be related to formation or progression of glaucoma, more studies need to be done to confirm this finding. Keep an eye out for new research announcements on this front. We should be learning more in the next few years.
To answer the second part of your question, the lights used in the exam are not bright enough to damage your eyes. When your eyes are dilated, the lights can appear quite bright and even cause mild discomfort. When I have my eyes dilated and examined, the bright light almost always causes my eyes to water because of the bright lights (I literally get tears running down my cheeks). It is possible that during the exam, your eyes were kept open so that the exam could be completed, and therefore the number of times that you could blink and spread tears over the surface of the eyes was minimized. This may have resulted in a transient feeling of blurred vision or even a gritty feeling in the eyes. If you notice these symptoms after your exams, the use of artificial tears for a day or two will help you feel back to normal in short order. The use of lights during the exam or the exam itself will not have long-term effects on your vision and I am certain this has nothing to do with your need for reading glasses. Presbyopia (the need for reading glasses) happens as you get older and is related to the lens in the eye getting larger and less able to change shape.
My gynecologist suggested that I take 25-50 milligrams of DHEA because of I had a hysterectomy and an oophorectomy. Is DHEA safe to take if I use 1 drop of .01% Lumigan for open-angle/normal-tension glaucoma? [ 01/17/11 ]
I do not know of any contraindications to using both DHEA and Lumigan. In addition, I used Drugs.com to check for drug interactions. In looking on their website for interactions between the two, no results are found, indicating that they have not noted any adverse reactions either. From what I can tell, there is no contraindication to using these medicines in combination. When you start any new medication, if you notice any worrisome symptoms, call your physician immediately.