My six-year-old son has glaucoma and he is put under anesthesia twice each year for his eye pressure checks. Is it necessary to be sedated for something this minor? I have read that there will be an at-home pressure test pen. Is this true, and would it be a good option for us? [ 03/27/13 ]
Thanks for your question. Given that your son is six years old, he may be at the age at which soon he will be able to hold still and tolerate an eye pressure measurement in the clinic. But each child is different, so if he is not yet able to tolerate this in the clinic, then yes, he would need to have anesthesia for the pressure check. A frightened child who is squeezing his eyelids shut will not yield an accurate measurement and will render it meaningless. Many pediatric glaucoma specialists do have experience in measuring eye pressure in young children and are able to put them at ease. There are home tonometry units available now; however, given that your son is nearing an age for which in-office measurements should be possible, I would discuss this option with your ophthalmologist.
I have been diagnosed with glaucoma and I am only 19 years old. I am currently taking eye drops to reduce the eye pressure. How much progress is being made in regenerating optic nerve cells to restore the lost vision? How many years do you think it will take before that cure has been discovered and can be used to treat patients? I am personally very worried, since I am very young and want to keep my vision for the rest of my life. [ 03/27/13 ]
Thanks for your question. Many researchers, including myself, are working on regenerating optic nerve cells. It is a daunting challenge because the optic nerve cells reside in the retina of the eye, and travel a great distance to the appropriate targets in the brain. The optic nerve cells would have to link up with the correct cells in both the eye and the brain. I do not think it is an impossible task, but it is a long-term project. I do think that there are other promising approaches to treating glaucoma that will be more achievable in the short-term. For example, all of the medications, laser, and surgery we have to offer patients are aimed at lowering eye pressure; however, we know that for some patients that is not enough. I believe that in the next 10 years we should have other “neuroprotective” treatments that protect the optic nerve cells from dying in glaucoma and this will be of great help to many patients.
I have glaucoma in both eyes (it is more severe in my left). Are researchers working on regenerating the cells that are damaged in glaucoma? [ 03/27/13 ]
Thanks for your question. Many researchers, including myself, are working on regenerating optic nerve cells. This area of research is very exciting and moving quickly. However, even once the optic nerve cells are regenerated, they have to link up with the correct cells in both the eye and the brain. The optic nerve cells transmit a great deal of visual information and replacing them will not be as simple as injecting the replacement optic nerve cells into the eye. I do not think it is an impossible task, but it is a long-term project.
I am 17 years old and I have a severe pain in my right eye. The eye is really watery, I see zigzag lines, a gray blind spot, and sometimes the visual field appears has a greenish hue. What could be the cause of these symptoms? Could it be glaucoma? I know I have migraine but why is my eye hurting? Please help me; I don’t know what to do. [ 03/27/13 ]
Thanks for your question. The easiest way to answer the question about whether this could be glaucoma is to have an ophthalmologist perform a thorough eye examination. Without this examination, I can only speculate. Some of your symptoms, such as zigzag lines, sound consistent with ophthalmic migraine. However, other symptoms, such as eye pain, are harder to diagnose. Certainly, I would recommend that you have a comprehensive eye exam to answer your questions.
I am 78 years old and have been told that I have narrow-angle glaucoma that needs a laser iridotomy procedure. My eye pressure was always fine except for one time when I was receiving cortisone shots for a knee injury, and the pressure increased to 20/21. Since that episode, for the last three years, my pressure has remained at 11/12. I have read that I may have some serious problems if I undergo the laser procedure and this frightens me. There is a history of narrow-angle glaucoma resulting in blindness on my father's side of our family. Right now my vision is 20/20 with glasses and I don't want to ruin it. Can you tell me what the side effects are of this procedure and what the potential long-term effects will be on my vision? [ 03/27/13 ]
Thanks for your question. Yes, while it is true that laser iridotomy can have side effects, let me first start out by saying that overall it is a fairly low-risk procedure. As you know from reading medication labels, many side effects will be listed but it is hard to tell which ones are most common. I usually advise my patients about the following issues, although this is not an exhaustive list.
There can be an eye pressure spike after the procedure, but I usually treat this in the clinic and have my patients wait 30-60 minutes after the procedure so we can check for this. I also tell my patients that the eye is like a camera, with the pupil acting as the aperture. After the laser you will have an extra “aperture” so theoretically stray light can enter the eye and cause halos, double or blurred vision, and glare. I generally place these holes superiorly, as long as the eyelid completely covers the hole created in the iris. Others will place the iridotomy at the 3 or 9 o’clock positions. There is also the side effect of inflammation, which is why I ask my patients to use a short (one week) course of topical steroids (or non-steroidal anti-inflammatory eye drops if they are very sensitive to topical steroids). Of course, there are other side effects that you will come across if you read a great deal, but overall I would say that if you have narrow angles (and a family history of narrow-angle glaucoma resulting in blindness) the benefit would outweigh these risks.
Ultimately, it might be helpful for you to bring the information presented above to your eye doctor and have a thorough conversation with him/her about the laser iridotomy procedure, so that you can feel that all of your questions are adequately answered.
I have Graves’ disease and I have been taking one eye drop of Travatan nightly. Are there any possible side effects from continual usage of this medication? [ 03/27/13 ]
Thanks for your question. There are side effects related to Travatan, which is a prostaglandin analogue. These include redness and irritation, which generally improves over time. In the long term, there can be increased pigmentation around the eyelids. There are also changes to the eye color that can occur, especially in hazel-eyed people. I can list even more side effects, but these are some of the more common ones. I certainly would monitor any side effects that you believe may be related to Travatan and discuss them with your ophthalmologist. There are always other eye drops with less (or different) side effect profiles. Sometimes there is a period of trial and error to figure out the most effective medication with the least amount of side effects.
My question pertains to glaucoma that is associated with nail-patella syndrome. My father and I both have glaucoma, and my daughter, who will be 3 in March, already has optic nerve cupping. Has any research been done recently on this disorder? When I was diagnosed four years ago, the pressure in my left eye was 33 and was 46 in the right eye. Eye drops and surgery were unsuccessful. I am 33 years old and despite medications my left eye seems to be getting rapidly worse. Any input would be appreciated. [ 03/27/13 ]
Thank you for your question. I am sorry to hear about the progression of your glaucoma. If your current medications and prior surgery seem to be failing, I would recommend asking your ophthalmologist what else can be done medically or surgically, or perhaps even obtain a second opinion. In terms of research for nail-patella syndrome, there has been a genetic mutation in a gene called Lmx1b that has been linked to some patients with nail-patella syndrome and glaucoma. You could talk with your eye doctor about genetic testing, but any genetic testing has ramifications that need to be carefully considered. I would also seek to ensure that your daughter is followed by a pediatric glaucoma specialist, if she is not already being seen by one.
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.