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!
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 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 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!
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 am 77 years old and have suffered from open-angle glaucoma for 27 years. Both eyes had been treated with Betagan, which caused bronchial spasm; Alphagan, which caused orthostatic hypotension; and Azopt, which caused skin eruption. My left eye is worse; it had a trabeculectomy 12 years ago, and the procedure led to the loss of central vision. Now I am only using Travatan Z in my right eye. My new eye doctor said that I need a trabeculectomy performed on my right eye now. Due to central vision loss in my left eye after previous surgery, I am very nervous about getting this surgery done on my right eye, in which I have 20/30 vision. What are the odds that I will lose the central vision in my right eye after surgery this time? I also would like to know what the chances are that I will go blind in five years. Thank you. [ 06/04/13 ]
Thanks for your question. Unfortunately, the phenomenon that you describe, in which one can lose central vision after a successful trabeculectomy, is a very rare occurrence but does happen. I can certainly understand why you are nervous about having trabeculectomy performed on your right eye. It is difficult without examining your eyes to know what the risk of losing central vision in your right eye is, as some of it depends on how advanced the glaucoma and visual field loss is. Furthermore, it is hard for me to assess your risk of blindness without knowing your rate of visual field loss over the last 27 years. What we do know is that if you don’t have any interventions and your glaucoma is not well-controlled, you will eventually lose more visual field, but it is important to assess over what time period. These are questions you should certainly ask your ophthalmologist. If you don’t feel comfortable asking him or her, perhaps seeking a second opinion and asking these very questions will help you in your decision. Good luck!
I am 63 years old and my eyes have become a lot worse during the last three years. My eye doctor thinks it may be due to diabetes or my thyroid, because my vision has changed five times in my right eye and four times in my left eye. Are these changes normal? [ 06/04/13 ]
Thanks for your question. Without examining your eyes, it’s difficult to know for sure, but it is possible that you could have fluctuating vision as you described, especially if your diabetes is not well-controlled. You did not mention whether the decrease is mostly for distance or near vision, and certainly as we get older our near vision can become more and more blurry. I would recommend that you have a comprehensive examination that includes dilation to rule out any other problems. However, it is possible that you will need your glasses updated yearly. Good luck!
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.