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 drink far too much coffee and have just found out that this could be a cause of glaucoma. [ 02/25/13 ]
Thanks for your question. Studies have shown that consumption of caffeine causes transient elevation of eye pressure in patients with glaucoma and ocular hypertension. Additional population studies report higher intraocular pressures in glaucoma patients who regularly drink caffeinated beverages as compared to those who do not. Thus, most glaucoma doctors recommend avoiding heavy consumption of caffeine.
Our website has excellent information concerning glaucoma risk factors.
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? [ 02/25/13 ]
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 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 that can improve my vision? [ 11/05/12 ]
I am so sorry to hear about your vision loss. As a glaucoma doctor, I wish I could offer my patients better vision. Instead, I explain that our goal is to preserve what vision remains. There is active ongoing research around the world exploring how stem cell transplantation might be able to help glaucoma patients. However, glaucoma is a more challenging disease to treat in this way than other diseases (such as patients who have lost vision due to retina diseases). This is partly because glaucoma affects the cells of the optic nerve, and the optic nerve cells stretch all the way from the retina to the brain, a very long distance. So not only would scientists have to be able to replace the cells of the optic nerve, but also coax them to wire long distances to the right location. It is a big challenge, but I hope that in your lifetime we will be able to offer you tools to help improve your vision. You may want to explore having a low vision evaluation, if you have not done so already, where doctors can help provide tools that will help maximize the vision you have.
2. Two years ago, at age 59, I became a glaucoma suspect because my cup to disc ratio was .5 in both eyes. My eye pressures consistently are 11 and 12, corneal thickness is 547 and 538, I have a normal visual field testing, and HRT is stable. Assuming everything remains stable, would I be considered a glaucoma suspect for the rest of my life due to my cup to disc ratio, or at some point would my ratio be considered normal for me? [ 11/05/12 ]
This is a very good question and one that ophthalmologists struggle with—that is, how to identify those glaucoma suspects that really will develop glaucoma. A cup to disc ratio alone of 0.5 in both eyes could certainly be normal for you. When ophthalmologists evaluate you for glaucoma, they take into consideration risk factors in addition to what they find during an examination. For example, age is a major risk factor for glaucoma, so as you get older, you may convert from a glaucoma suspect to having glaucoma. Family history is also a risk factor, which I am assuming you do not have because you did not mention it. Other factors include high eye pressure and corneal thickness, which are normal for you. However, a cup to disc ratio of 0.5 does not give the complete story. For example, there are certain features of an optic nerve that may be very suspicious for glaucoma, and the cup to disc ratio does not capture this. Overall, given your normal visual field and optic nerve imaging test (HRT), you may very well never develop glaucoma; however, it is still important to have a yearly exam to ensure that there is no progression or change.
My mother, who is 71 years old, had a retinal detachment, and also has a diagnosis of glaucoma. The retina was reattached, but now she has developed cataracts and can see very little out of her left eye. If she were to get a corneal transplant, will it restore her eyesight? She was also told that she had optic nerve damage. Thank you for your time. [ 10/25/12 ]
I am sorry to hear about your mother's vision problems. It is not clear from your question whether she has scarring or damage to the cornea that requires a cornea transplant. When ophthalmologists make decisions about surgery, they try to gather as much data to understand what the visual potential is, because all surgery entails risk, and it sounds like your mother might need both cataract surgery and possibly corneal transplant surgery. While cataract and damaged corneas can be replaced and essentially made clear again simply by replacing the lens or cornea, damage to the retina is sometimes not reversible and damage to the optic nerve from glaucoma is generally irreversible. This is because the retina and optic nerve are composed of neurons, which are cells that transmit electrical information. So, I would seek the opinion of a retina and glaucoma specialist to see if they deem the potential vision good enough to recommend surgery.
I had an acute glaucoma attack in my right eye, which recently had a trabeculectomy. I have very little vision in the right eye, which also lost the iris. The left eye had a gonioplasty, which burnt my iris, therefore it has a permanently enlarged pupil of 5 mm, so it can't focus. All kinds of light and glare make it very difficult for me to see. Who do you suggest could best help me with the right prescription as well as recommendations for sunglasses? Should it be a low vision specialist, or a glaucoma ophthalmologist working with a low vision specialist? Do you think they can help me? [ 10/01/12 ]
Thank you for your question. I am so sorry to hear about your eye and vision problems. Not knowing how low your vision is, I would advise you to speak with your glaucoma ophthalmologist about the best resources to use. A low vision specialist can certainly be of great help in improving your vision, such as by prescribing low vision aids, optimizing your home situation, advising you on how best to optimize lighting for reading, etc. There are also contact lenses that may help reduce the glare in your left eye, but it may be more work than it is worth if sunglasses can help you. In summary, I do think you can be helped, and your glaucoma doctor should be able to advise you best. Good luck!
I am 77 years old and was diagnosed with glaucoma three years ago (60 percent in the left eye and 10 percent in the right eye). I manage the glaucoma with eye drops, and I also have a cataract, which does not require an operation. I was diagnosed with the cataract from the age of 45, which never grew; however, whenever I see an eye doctor, he/she always wants to operate on the cataract rather than treat the glaucoma. In December 2011, my pressure was 26 and 27, and in March of 2012, when I went for a checkup, the pressure was 25 and 26. Three months later, I went for a checkup at a different eye clinic, and the pressure was 10 and 11. Can the pressure drop this much in three months? Is this normal? Should I continue taking my eye drops? [ 09/28/12 ]
Thank you for your question. Without having examined your eyes personally and without reviewing the results of past exams and tests, it is nearly impossible for me to give a completely accurate answer. What I can say is that if your eye pressure was in the mid-20s in December of 2011 and March of 2012, and you continued using the same eye drop, it would be rather unusual for the pressure to drop to 10 or 11 in June of 2012 because of the drops alone. If you have been on the same drop regimen from December 2011 until now, eye pressure would not likely change that dramatically. Given that you went to a different clinic, I would wonder if the pressure was accurately taken at one or the other. I would recommend having the pressure taken again relatively soon and determine what the pressure really is. Secondly, I would ask the eye doctor to examine you for any signs of inflammation within the eye. It is always possible that there is inflammation that is decreasing the amount of fluid created in the eye (hence the lowering of the pressure). To reiterate, it is unusual to have intraocular pressure in the mid-twenties on multiple occasions, and then without changing medications have the pressure drop that much. If the readings were accurate, the doctor should be able to help you find a reason for the drop in eye pressure. I would highly advise continuing the eye drops until you can be re-examined by your eye doctor and at that point you can determine whether or not the drops should be continued. Do not stop the drops your own. I wish you the best of luck.