Science & Research

Thank you for your interesting question. I am assuming that the patch you are referring to is an anticholinesterase inhibitor. One of the medications that is less commonly used for glaucoma, pilocarpine, has a similar (although not the same) mechanism of action. Other medications that have a similar mechanism of action to the Alzheimer’s patch have been used to treat glaucoma in the past. So, if anything, I would surmise that this patch is not harming your mother’s glaucoma and could be potentially lowering her eye pressure. However, I would have a discussion with your mother’s physician about the purpose of the Alzheimer’s patch.

Thank you for your question. Based on your description, it sounds like your ophthalmologist thinks you may be a “glaucoma suspect,” based on the appearance of the optic nerve. There are characteristic features of the optic nerve that make one suspicious about glaucoma, and ophthalmologists have to weigh the evidence in suggestive but not definitive cases. For example, you will likely undergo formal visual field testing and optic nerve imaging. In addition to the information gathered from the tests, your doctor will consider whether you have other risk factors, such as family history, thin corneas, or topical steroid use. Follow-up visits with your ophthalmologist are important for your care, as the diagnosis of true glaucoma will be made over time.

Thank you for your question. It sounds like your father has glaucoma that is difficult to control. The medications you’ve listed are all compatible to be taken at the same time, and it is safe, as long as he is tolerating any side effects. For example, Cosopt contains timolol, which is a beta blocker and has the potential side effect of lowering heart rate and/or blood pressure. It also is not well-tolerated by patients who have asthma or other lung diseases that have a reactive airway component. If his eye pressure is still increasing, it may be time to consider whether he is a candidate for laser trabeculoplasty, a laser procedure that can lower pressure in open-angle glaucoma patients. If this fails to control his eye pressure, then there are also several surgical options that his ophthalmologist can discuss with your father.

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.

Thanks for your question. When we measure retinal nerve fiber layer thickness, the patient’s data is compared to a database of “normal” patients. For children, this does not yet exist. There is a recent publication from a group in Texas that examined “normal” children, so now we do have some guidance as to what is “normal” or “abnormal” in children, such as your daughter. In answering your question, it would be helpful to know her eye pressure and cornea thickness, any other risk factors such as family history or other ocular conditions, and the appearance of her optic nerve. Based on what you’ve written, I would recommend continued follow-up with your ophthalmologist. Often, the diagnosis of glaucoma is made over time, as doctors evaluate any progressive changes that may occur.

Thanks for your questions. In terms of your first question, there are certainly benefits to slowing the loss of vision by treating any underlying low-tension glaucoma. This has been demonstrated in several large, randomized controlled trials. Age is not a factor in determining whether there is benefit in cataract surgery as long as the risks of anesthesia and surgery are not too great in terms of your general health and you are willing to undertake the risks of cataract surgery. However, the retinal schisis (which I am assuming is related to your acquired optic nerve pitting) may indeed limit your best visual acuity after cataract surgery. There are some simple tests that can be done in the office to determine what your potential acuity might be after cataract surgery. I would ask your ophthalmologist to perform this testing prior to electing to undergo cataract surgery.

Thanks for your question. I am not sure what your treatment of “eye drops due to allergies” means, but in answer to your main question, it is possible that you were treated as a glaucoma suspect as opposed to someone who has definite glaucoma. I have many patients in my practice who are glaucoma suspects, and over time the patient either develops glaucoma or simply remains a glaucoma suspect. It is possible that you had certain risk factors that prompted your first eye doctor to begin treatment with eye drops, but after reviewing your tests and examining your eyes your second eye doctor does not believe you have glaucoma. I know this may be frustrating, but this is why I always emphasize follow-up with my patients who are glaucoma suspects. Often the diagnosis of glaucoma is very clear and definite, but other times the diagnosis is less certain.

Thanks for your question. Unfortunately, I do not have enough information to adequately answer your question. An eye pressure of 19 mmHg is actually within normal limits, but that does not mean you do not have glaucoma. Eye pressure is one significant risk factor of glaucoma, but does not determine whether you have glaucoma or not. I would recommend that you see an ophthalmologist, if you have not already done so, to determine whether you truly have glaucoma and thus should be treated. For your dry eyes, I would recommend that you first try over-the-counter artificial tears to see if this helps with your symptoms. If you also have seasonal allergies or itching is a major component of your symptoms, your eye doctor can talk with you about other types of eye drops that may be beneficial.