Science & Research

Thanks for your question. I hope that the laser procedure is successful in lowering your eye pressure. I am surmising that the pill your doctor prescribed is either acetazolamide or methazolamide. I do have patients who have been able to tolerate the pill for lowering eye pressure, but usually as a temporizing measure until more definitive treatment can be performed, such as laser procedures or surgery. I also take care of a small minority of patients who absolutely do not want surgery and would rather try to take the pill long-term. However, there are side effects of these pills that can affect not only health but quality of life, so most of the time patients then proceed to more definitive treatment. Please visit the treatment section of this website for more information about medication, laser and surgical procedures for glaucoma.

Thank you for your question. HIFU is a new technology designed to destroy the ciliary processes, and as such, falls in the same category of two currently utilized technologies in the United States: Trans-scleral diode cyclophotocoagulation (TDC or TCP), and endocyclophotocoagulation (ECP). Both of these technologies utilize diode laser energy to destroy the ciliary processes. ECP is advantageous in that the surgeon visualizes the ciliary processes as the target tissues are treated, whereas both TDC and HIFU are “blind” procedures. They both have the advantage of not requiring an incision to the eye, and thus no risk of infection. HIFU’s purported advantages over TDC are that a) there is decreased inflammation and b) increased accuracy when targeting the ciliary processes because of the ring-shaped design of the probe. HIFU was actually used in the 1980s with a different commercially available device but had severe complications and thus was abandoned in the 1990s. I reviewed the current published literature and to date there is one published study describing 12 patients who underwent HIFU for difficult to treat glaucoma. This preliminary study demonstrated that the eye pressure was significantly reduced at 3 months without major complications, but thus far we do not have long-term data about safety or efficacy. But certainly, this new device should be evaluated by prospective randomized clinical trials comparing it to conventional cyclodestructive procedures such as TDC and ECP.

Thank you for your question. Eye pressure fluctuates depending on time of day, your stress level, the pressure measurement device, the technique of the person taking your pressure measurement, the calibration of the device for pressure measurement, etc. It is not unusual for eye pressure to fluctuate from visit to visit, or even within the same day. And eye pressures of 16 and 19 are still within the “normal” range based on population-based studies. If you are indeed a “glaucoma suspect,” however, based on your family history and other risk factors, such as the appearance of your optic nerve, you should also have formal visual field testing and optic nerve imaging.

Thanks for your question and I am sorry to hear about your headache. When my patients come in for SLT, I instill pilocarpine eye drops in preparation for the procedure, which I warn patients might cause headache and an ache in the brow region. Most of my patients do experience that symptom, so that is one possible explanation. It is not uncommon for patients to feel the laser application a little bit during the procedure, although it should not be painful. So, I could imagine a scenario in which you were already susceptible to some head pain (because of the pilocarpine eye drops) and each laser application made it seem more acute. I do not believe there is any detrimental effect from the head pain you experienced, and I expect that it resolved in 24 hours.

Thanks for your question. I have not had experience with the situation you describe in terms of performing the procedure twice in the same eye so close together. It is possible with multiple laser treatments that there might be more inflammation after the second procedure. Generally I do not prescribe patients anti-inflammatory eye drops after the laser procedure, because I want the eye’s own healing process to take place. But perhaps your wife’s ophthalmologist elected to prescribe anti-inflammatories. One reassuring fact is that we do often re-treat the same eye after the effect of the laser wears off. So, it is possible that in the long-term there will not be any issue with having had the procedure performed twice. It is always an option for you to seek an opinion concerning your questions from another ophthalmologist who can examine your wife’s eye and review the medical records.

Thank you for your question. You didn’t mention which eye drops you are using, but certainly some eye drops are more irritating than others, and each patient is unique. I would first consider whether there are medications that you haven’t tried yet that will be tolerable in terms of side effects. It is also possible that some of your side effects are due to the preservatives contained in eye drops, and now there are some newer, preservative-free formulations of eye drops and this is certainly worth asking your ophthalmologist about. Another option is to consider laser treatment for your glaucoma. It is not a “cure” and the eye pressure lowering effect does not last forever, but it could provide you with some relief if the laser is effective and you don’t need to use eye drops anymore.

The problem you describe must certainly be very frustrating. I certainly think that seeking the expertise of a retina specialist to assess whether you have a retinal disease that is causing your symptoms is reasonable. However, I would first bring these symptoms up with your ophthalmologist or glaucoma specialist. Sometimes the symptoms you describe can be due to cataract. Another possibility is if you are on glaucoma medications that constrict your pupil. If your ophthalmologist feels you would benefit from a retina consultation, then he/she can refer you to a specialist.

I am sorry to hear about your vision loss. If your vision is also poor in the other eye, you should seek out the expertise provided at a low vision clinic.

There is not currently any transplant procedure for glaucoma. There are certainly many groups doing research in the area of optic nerve regeneration and glaucoma, but the only tools doctors currently have to lower eye pressure are medications, laser procedures, or surgery. However, in your lifetime it may be possible that newer treatments will be developed and available to patients. Let’s hope that this is the case.