I am presently taking Cosopt and Xalatan. I was taking Alphagan-P, but had to stop due to an allergic reaction to it. My doctor has prescribed a pill for me to try, and I also am scheduled to have laser surgery on my right eye in December. My eyes pressure was 27 and 28 during a recent eye exam. [ 02/25/13 ]
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.
Is high intensity focused ultrasound (HIFU), used to destroy the ciliary process, effective for glaucoma? I have read some encouraging studies from Europe. [ 02/25/13 ]
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.
Two years ago, my ocular pressure was 16. Recently, during my eye examination, the pressure registered 19. I am 51 years old and my mother has glaucoma and age-related macular degeneration. Should I be concerned about such a steep change in only two years? The optometrist was not concerned and I have no visual problems other than the usual correction for my eyeglass prescription. [ 02/25/13 ]
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.
I just had selective laser trabeculoplasty (SLT) surgery for ocular hypertension (the readings were 30 in left eye). I was able to mildly feel all of the laser 'zaps' in my eye, but I also felt mild pain in the top or back of my head as well. The doctor said he never heard of that, but the nurse told me that another patient had told her the same thing. I took some Tylenol but still had a dull headache eight hours later. What would be the physical explanation for the head pain with each laser burst, and is there any detrimental effect from the head pain? [ 02/25/13 ]
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.
My wife had selective laser trabeculoplasty (SLT) for glaucoma in her left eye and was scheduled to visit the eye doctor one week later to have the procedure performed on the other eye. The doctor mistakenly performed the procedure on the left eye instead of the right and then proceeded to work on the correct eye. Do you think we will notice any problems with her left eye due to the double procedure? [ 02/25/13 ]
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.
I am 81½ years young, have had 13 major surgeries, and had cataracts removed from both eyes in 2003. I wear glasses in bright lights or when I am outdoors. I am home bound and disabled; it is really bad most of the time, but I do read a lot. When I went to the eye doctor in October, the eye pressure in both eyes was 15. My ocular pressure has been below 18 all the time, but now it is 15. I have since quit eating everything with wheat in and lost weight, which I also think has helped me; I have less bloating and swelling. I am allergic to all sulfa drugs, dye, aspirin, and phen medications. Also, I have lost most of my intestines and stomach; have heart trouble, arthritis, and GERD. I can’t use drops without my eyes burning and getting blood red, but was curious if there is anything else I can use? [ 02/25/13 ]
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.
I have glaucoma and had a trabeculectomy in my right eye, which resulted in double vision. Glasses are required to correct that symptom. I also have had laser treatments on both eyes and the pressure is still between 12 and l6. My current problem is the inability to see when I come in from the outside; for about five minutes I seem to be standing in a dark pit until my vision adjusts. Could a retina specialist help with this rod and cone problem? [ 02/25/13 ]
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 44 years old and had glaucoma-related surgery about eight years ago. My eye pressure is good; however, the vision in my left eye is almost non-existent. Is there any chance that I can get better vision? Is there a transplant procedure that can improve my vision? [ 02/25/13 ]
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.