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.
My father is 75 years old and is taking Cosopt, Alphagan, and Travatan, yet his eye pressure is still increasing. Is it safe for him to be taking all three of these medications at the same time? [ 02/25/13 ]
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.
I recently had an eye examination as a follow-up from a recent uveitis infection in my right eye. The specialist mentioned that I showed signs of developing glaucoma in my left eye, so I will have a follow-up appointment in six months. Vision and eye pressure readings were okay, but the optic nerve was presenting differently than the other eye. I would appreciate your input. [ 02/25/13 ]
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.
My mother, who is 77 years old and lives in a rest home, has glaucoma but not Alzheimer disease. They have had an Alzheimer’s patch on her for an unknown period of time. What will this do to her and how will it impact the glaucoma? [ 02/25/13 ]
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.
I had my eyes tested and no glaucoma was detected. I then had cataract surgery in right eye, and now the doctors are telling me that I am a glaucoma suspect. Both eyes pressure are 6. Did the cataract surgery cause this? What will happen next? [ 02/25/13 ]
Thank you for your question. It is likely that you were a glaucoma suspect even before you had cataract surgery, which is why you underwent testing. After cataract surgery, the view of your optic nerve becomes clearer so this may be why you were officially deemed a glaucoma suspect after the cataract surgery. However, the cataract surgery did not cause you to become a glaucoma suspect. Your eye pressures of 6 are low, and it is possible that cataract surgery did help to lower your eye pressure. Whether the low pressure is sustained can only be determined with time.
What happens next? You will continue to be followed as a glaucoma suspect, with eye pressure checks, eye examinations, visual field testing, and optic nerve imaging. Some patients will remain glaucoma suspects for the rest of their lives, demonstrating no observable changes over time and maintaining normal visual field; others will develop signs of definite glaucoma. The most important measure you can take is to continue routine follow-up visits with your eye doctor.
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.