Science & Research

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.

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.

To answer your question about whether vision can improve at the same time one develops glaucoma, it may help to take a step back and discuss the impact of glaucoma on vision. Generally speaking, open-angle glaucoma, which is what the majority of Americans have, does not affect central vision until late in the disease. The earliest impact on vision is generally in the periphery (side vision), which can go unnoticed by patients because one eye's field of vision will overlap with the other eye's field of vision. This is why we ask patients to perform formal visual field testing one eye at a time in the office. You mention that your son is 24 years old, but it is not clear if he is nearsighted, farsighted, or does not wear glasses. It is possible for vision to fluctuate slightly from exam to exam, especially if they are a year apart. Additionally, eye pressure is only one risk factor for glaucoma, so if your son's ophthalmologist is not too concerned about the right eye pressure elevation, then it may be within normal levels of fluctuation. Your son's eye doctor can provide you with a definitive answer.

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.

It is possible that your eyesight is slowly becoming worse on its own, and not necessarily related to the prescription for your glasses or the contact lenses. Given the fact that your glasses are older than your contacts, it would be worth seeing your optometrist or ophthalmologist for an updated eye exam to see if you need a new prescription for your glasses. Glasses and contact lenses have different prescriptions because of the fact that glasses are further away from your eyes and contact lenses are closer to your eyes.

Generally speaking, there are two types of laser surgeries that are more commonly used for glaucoma.

One type of laser is used to make a hole in the iris to prevent the possibility of an acute angle-closure glaucoma attack. The purpose of this type of laser is not to lower the eye pressure.

The second type of laser targets the drainage system of the eye and its purpose is to lower the eye pressure. If this is the type of laser your father had, the fact that the eye pressure did not decrease suggests that the laser may not have been as effective as the doctor had hoped. Did your father discontinue his glaucoma drops after the laser surgery? If he was able to discontinue some glaucoma drops after the surgery, then the laser may have had a positive effect. I do counsel my patients that one of the “risks” of the laser surgery is that it may turn out to be ineffective, but because it is a fairly low risk procedure, it may be worth trying first if the patient and ophthalmologist both decide that it is a worthwhile step to take. I would discuss the efficacy of the laser surgery with your father's ophthalmologist at his next visit.

Your symptoms could be due to many different causes and the best way to find out is to see your eye doctor. However, I can postulate some potential causes of your symptoms. One cause is dry eye, which can ironically cause watery eyes and sensitivity to wind. Another may be blepharitis, which is a common chronic inflammation of the glands that line the eyelids, and can result in watery, sensitive eyes. The symptoms of sensitivity in light may be due to cataract, which can cause glare and sensitivity to light despite the fact that vision may seem “normal.” I recommend that you have a comprehensive eye exam and discuss your symptoms with your eye doctor.

I'm glad to hear that your glaucoma has been fairly well-controlled over the last few years. The eye irritation you describe can certainly be due to the extensive sanding. Are you wearing goggles as you work? I would not expect, however, for the sanding to affect your eye pressure. Certainly, one set of slightly elevated eye pressures at a sixth-month visit may not represent a real increase; however, it may be worth having your eye pressure re-checked sooner than another six months from now. Please talk with your eye doctor concerning when he/she would like to measure your eye pressure again.