I am 72 years old and I have had open-angle glaucoma for over seven years. Lately, my eyes are irritated and by the end of the day they become very red; however, after three or four hours of sleep, my eyes return to normal. I have asked the doctors and they replied that this is due to the change of glaucoma eye drops. Meanwhile my right eye has suffered from optic atrophy and optic nerve cupping. Does the redness in my eyes mean I am approaching blindness? [ 04/17/13 ]
Thanks for your question. I’d like to reassure you that the redness in your eyes does not mean that you are approaching blindness. Your doctors may be correct that the redness is due to the glaucoma eye drops. You could try to switch over to preservative-free formulations that may be less irritating. Another intervention that might help is the use of preservative-free artificial tears during the day and an ointment at nighttime. You mentioned that your doctors think it is due to a change of the glaucoma eye drops, so it would be helpful for you to know which medication changed. If you know which eye drop is causing the problem you could either switch formulations (such as a preservative-free formulation) or try a different glaucoma eye drops. Please discuss these options with your eye doctor. Good luck!
I am 25 years old and I have had open-angle glaucoma for ten years, with high pressure in the left eye. I have had two surgeries on my right eye and one on my left eye. Presently, I am using BETOPTIC eye drops. Now, the doctor is saying she needs to perform another surgery on the left eye, but I am not comfortable with moving in this direction because I have not been able to see very well since the last surgery. Do you think it is necessary to have this surgery? [ 04/17/13 ]
Thank you for your question. Unfortunately it is difficult for me to advise you about the necessity of surgery without reviewing your ophthalmic history and performing an examination. I can give you some advice about what questions or options to consider prior to having surgery. Are there other eye drops that you can take without intolerable side effects and that lower your eye pressure further? Are you a candidate for glaucoma laser treatment (laser trabeculoplasty)? Have you had worsening of visual field or optic nerve structure over time at your current eye pressure? Unfortunately, it is a known side effect of glaucoma surgery that vision can sometimes decrease, often due to cataract or lens changes, but this is usually reversible. Lastly, you could consider seeking a second ophthalmologist’s opinion, perhaps from a glaucoma specialist.
I asked my doctor why they shouldn't use surgery on my eyes right away. She said that there are risks associated with the surgery and that it is better to try the drops first, since they cannot damage my eyes and do not cause any risks. What is your opinion on this? Should I try to get a surgery as quickly as possible or is trying the drops first a better approach? Does surgery lower the pressure even more than the drops? Is it worth taking the risk and get a surgery as quickly as possible? [ 04/17/13 ]
Thanks for your question. This is a difficult question to answer without knowing more of your history, examining your eyes, and getting a sense of the pace of your glaucoma progression. While it is true that surgery often lowers the pressure more than drops, your doctor is correct in that surgery has inherent risks. Eye drops (and laser) are generally used as first-line therapies because they are safe and effective, and many patients do not see a progression of their glaucoma with just using medications. Of course, there are side effects of the eye drops as well, but you will not know if you will experience them until you give it them a try. It seems reasonable (based on the limited knowledge of your situation) to try eye drops (or laser) first. If they do not work, you will not have lost much (if any) ground and can then proceed with surgery. Please follow up with your eye doctor to determine the next steps and to further discuss your concerns.
I have been found to have 50% “PSA” in my right eye and I do not want laser surgery. My only vision problem is farsightedness. If I do nothing will I absolutely get glaucoma? Why can’t the eye drops manage this problem? I am terrified of the laser procedure and I worry that I could have permanent harm from the surgery. What are the alternatives? [ 04/03/13 ]
Thank you for your question. I am not sure what “PSA” refers to, but perhaps you are referring to “PAS,” or posterior anterior synechiae. These are abnormal adhesions from the iris to the “angle” that are one cause of chronic angle-closure glaucoma. Your farsightedness is one risk factor for having narrow angles, and the suggested preventive treatment for an angle-closure attack is a laser iridotomy, which creates a hole in the iris and allows an “escape route” for fluid to drain from your eye. Drops generally cannot manage the problem; however, sometimes ophthalmologists consider the use of topical pilocarpine to make the pupil small, but this does not always prevent an angle-closure attack.
When I counsel patients who need this laser iridotomy procedure to prevent an angle-closure attack, I weigh the risks and benefits. The benefit of preventing an angle-closure attack is enormous, and the damage from such an attack is quite profound and irreversible. The risk of laser surgery is quite small in comparison; sometimes there is an eye pressure spike so patients will wait for 30-60 minutes after the surgery to ensure this does not happened. Because we are making an additional hole in the eye for light to pass through, some patients complain of glare or haloes, but this is not common. The alternative is to do nothing, which is an option. No one can predict with great accuracy whether you will have an angle-closure attack in your lifetime. The risk likely becomes greater as you get older, because your lens (I am assuming you have not had cataract surgery) will also thicken, making the angle even more narrow. I would recommend that you make a follow-up appointment with your ophthalmologist and discuss the risks, benefits, and alternatives of the procedure again before making your final decision.
I was diagnosed with glaucoma a few years ago due to taking prednisone for about six years after a kidney transplant. I also had cataracts, which were removed and I had laser surgery twice for the glaucoma. I am now taking Combigan drops, but noticed that I can’t read the text now on the TV because my vision is blurry. This same thing happened with Cosopt. Will I be able to wear corrective lenses that will clear up my vision so that I can drive? If eye drops are not effective in lowering my eye pressure, I may have to have a laser procedure. [ 04/03/13 ]
Thanks for your question. I’m sorry to her about these symptoms and I don’t think that you should have to tolerate them. So I would say that instead of wearing corrective lenses to clear up your vision, your doctor will focus on finding a medication regimen that you can tolerate and is effective. It is also possible that you could have successful repeat laser for your glaucoma. Based on what you have told me, there are still some other medications that you could try. The other issue is whether dry eye exacerbated by your glaucoma drops is what is causing the blurry vision. If you are not already using artificial tears, I would recommend talking to your doctor about using them, and also ensure that any other underlying issues that could be causing irritation of the ocular surface, such as blepharitis or chronic inflammation of the eyelids, are addressed. Lastly, there are also preservative-free formulations of many glaucoma eye drops available and sometimes this can make a big difference in a patient’s tolerance of any eye drop. Please bring this information to your eye doctor and he can discuss the options with you in more detail.
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 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.