Would an eye transplant work for a glaucoma patient? [ 04/30/11 ]
Thank you for your question. This is a question that often comes up in our clinic, especially given the new advances we have begun to make in research. Unfortunately, at this time, an eye transplant is impossible. Millions of individual cells in the retina (called retinal ganglion cells) collect and exit the back of the eye to carry light and vision information to the brain. Once these cells travel out of the eye and carry visual information to the brain, they are collectively called the optic nerve. The retinal ganglion cells (i.e., the optic nerve) are damaged in glaucoma. Those cells project back to very specific areas in the brain, and unfortunately, once they have died we cannot make them function again. In addition, in order for an eye transplant to work we would have to connect the new eye either to a healthy optic nerve (and get all of the millions of connections correct) or get the connections back to the correct cells in the brain (again, this is millions of cells that would have to connect to the correct targets). Unfortunately, we just are not there yet. The good news is that there is currently a lot of research using stem cells, and they show great promise in this area of research. Hopefully, some of this stem cell work will eventually allow regeneration of nerve tissue or allow eye transplants; however, I would estimate we are decades (and maybe even a century or two) from that concept becoming a reality. I am sorry I don't have better news for you.
Is it unusual for a 21-year-old woman to have acute glaucoma? Can she survive this disease? [ 04/29/11 ]
Thanks you for your question. The simple answer to your question is that glaucoma can happen at any age for a variety of reasons. In one respect you are correct to question the timing because primary open-angle glaucoma is a disease that usually affects older adults. It would be unusual for her to have this form of glaucoma at this age, but not impossible. Unfortunately there are many different types of glaucoma (in fact, some experts suggest that there may be hundreds or thousands of different types of glaucoma). While primary open-angle glaucoma is typically found in adults, there are other types of glaucoma that are found in young adults, younger children (juvenile open-angle glaucoma) and even babies as soon as they are born (congenital glaucoma). Because she was diagnosed at the age of 21, she most likely does not have congenital glaucoma. Without having examined her eyes myself and seeing the results of her tests, giving an exact diagnosis is impossible. However, given her age, the most likely cause of her glaucoma is either a juvenile-like glaucoma or glaucoma caused by another factor (i.e., pigmentary glaucoma, angle-recession glaucoma after having trauma to the eye, or steroid-induced glaucoma if she takes any medications with steroids, for example). I suggest that you discuss this with your doctor during the next visit and ask what specific type of glaucoma she has.
To answer the second part of your question, I assume that you mean to ask if she will lose her vision, because glaucoma is not a fatal disease. Once a thorough eye exam has been completed, eye doctors often set a target or goal intraocular pressure. The only variable that doctors can change to slow or stop the progression of glaucoma is the intraocular pressure. To achieve this goal, they can employ the use of medicated eye drops, laser treatments, and surgical methods. Your doctor will follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how her eyes respond. If the pressure is not reduced enough or her doctor ever notices advancement in your glaucoma, they will add more medications or use laser or surgery to help lower the intraocular pressure further. If someone is diagnosed very early, the eye doctor's goal is to begin treatment and hopefully prevent the person from ever noticing any changes in vision. For those that have worse glaucoma, it is often possible to lower the pressure enough to stop or dramatically slow the loss of vision; however, this may take multiple surgeries, lasers, or medicines (and likely a combination of these three). In some cases, we cannot stop the progression of the glaucoma and our patients do eventually go blind, but this is the minority of patients. I wish the best of luck to both of you.
Does oxidation treatment to the eyes work for glaucoma patients? I have glaucoma in both eyes; my left is really bad and I am now losing the sight in my right eye as well. I would appreciate your advice. [ 04/29/11 ]
Thank you for your question. I have this discussion with many of my patients, and interestingly it has now become commonplace for many of them to come for their first visit taking both prescription medications as well as over-the-counter (OTC) supplements, such as vitamins. Unfortunately, many of our patients do not consider these OTC supplements as medications since they were not prescribed by a doctor, and they do not list them on our introductory questionnaire. We now specifically ask about any supplements (vitamins, antioxidants, etc.) that patients are taking so that we can watch for potential side effects or interactions with our prescribed medications. Unfortunately, our current literature does not have any conclusive evidence that allows us to recommend the use of supplements for the treatment of glaucoma (as opposed to macular degeneration in which we recommend an AREDS vitamin formulation).
Currently, there is no conclusive evidence in the literature showing a beneficial effect for using vitamins or antioxidants for treating glaucoma. However, given that much research is being done in the area of neuroprotection, much of this research is focused on the role of antioxidants on keeping retinal neurons alive after initial damage. Hopefully, in the near future, this research will start identifying some potential antioxidants that can be used to help slow the progression of this eye disease. Until then, continue seeing your eye doctor regularly and do not hesitate to use all of the treatment options currently available. I wish you the best of luck.
I had a trabeculectomy on my left eye 5 weeks ago. My doctor's target pressure following surgery was 8. The pressure went down to this number for a couple of weeks; it then rose to 13, and now it is hovering around 10. Would the removal of some stitches be necessary if the pressure doesn't decrease to the target goal? I am not using mitomycin C, which I understand can slow down the healing process. [ 04/13/11 ]
Thank you for your question. The simple answer to your question is yes, stitches in the trabeculectomy flap can be cut to help lower the pressurepost-operativelyin order to get closer to your target pressure. Often I leave 2 - 3 sutures in the flap and begin cutting them a couple of weeks after the surgery as needed. The stitches are not actually removed unless releasable sutures were used during the case. A laser is often used to cut the suture in the office, which releases tension on the trabeculectomy flap allowing more fluid to flow out of the flap; thislowers the pressure.
There are only a few eye doctors who use mitomycin C post-operatively to help slow the healing process; most use it during the actual surgery. This can also be accomplished using steroid eye drops such as prednisolone. I wish you the best of luck; it sounds as though you and your doctor are on the right track.
I am 22 years old and have glaucoma, but I don't know which type it is. Sometimes, I feel severe eye pain, have blurry vision and see halos around lights. My glaucoma was identified after I had cataract surgery. I continue treatment and use Latocom eye drops regularly at 9 p.m. once each day. I am a student, and find it difficult to focus or concentrate for more than 10 - 15 minutes before I start experiencing the symptoms mentioned above. What can I do? [ 04/12/11 ]
Thank you for your question. Because I have not examined your eyes or have seen the results of previous exams by your eye doctor, it is difficult for me to make a guess as to what type of glaucoma you have. Given that you are 22 years old and have had cataracts at this young age, this leads me to believe that you do not have the typical primary open-angle glaucoma. The symptoms of severe pain, blurred vision and halos can be caused by a few different things, but could possibly be due to increased pressure in the eye. This is especially true if you have "rainbow colored" halos around the lights, as this can be suggestive of angle-closure glaucoma. Given that you are taking Latocom (a combination of a beta-blocker and a prostaglandin analog), it appears that you still have some tendency to have increased pressures. I would suggest that if your symptoms can be reliably reproduced every time that you begin studying, simply make an appointment with your eye doctor to check the eye pressure. Prior to having the pressure taken, study or read for 20-30 minutes in the office (in a similar manner as to what you would do at home or in the library )so that the symptoms are reproduced for the eye doctor. He/she can then examine the eyes and determine if the pressure is elevated or if it is something more benign like dry eye syndrome. I wish you the best of luck.
My mom is 80 yrs. old. She has been treated for glaucoma since 2006 with Dorzox and Libatim. She complained about eye irritation and pain, so the Dr. advised her to use another drop, called Libroxim, as-needed. Recently, she has complained of blurry vision at times, which lasts for 5 min. and then improves. The Dr. examined her eyes and informed my mom that she needed surgery because the eye pressure is not under control. What is the risk involved in doing the surgery? If the surgery is not successful will she lose her vision entirely or will it remain stable? Is it advisable to take a calculated risk and have the surgery, or would it be prudent to go for a second opinion? Lately, my mom is complaining that she has dry mouth, a sense of uneasiness, acidity in the stomach, irritation around her eyes, and palpitations. I read that these symptoms are potential side effects of the glaucoma eye drops. Can you suggest a remedy to overcome these side effects? [ 04/11/11 ]
Thank you for your question. Unfortunately, without having examined your mother's eyes myself or seeing the results of her test, it is impossible for me to give you accurate advice in this situation. In addition, I am a bit confused by the drops. Dorzox is a combination medication thatis commonly used,but I cannot find any information on Libatim. I do not know what that is and cannot find it in my resources. The drug Libroxim is an antibiotic, and I do not know why they would prescribe that for eye problems unless they suspected an infection in the eye. It is not typically used for treatment of glaucoma. I suggest specifically discussing these medications with your eye doctor to determine why each was prescribed.
What is the risk involved in doing the surgery?
There are multiple surgeries that can be done to help lower eye pressure. The most common are trabeculectomy and a glaucoma implant/shunt. There are newer surgeries as well, and they have some additional risks. In general, the risks of the first two surgeries include, but are not limited to:
- loss of vision
- loss of the eye
- eye pressure not being low enough or being too low (both of which might require further surgery)
- death from anesthesia.
I suggest that you discuss the exact surgery that you are having with your eye doctor and he/she can explain the risks, benefits, and alternatives of the procedure that they have chosen for you prior to the surgery.
If the surgery is not successful will she lose her vision entirely or will it remain stable?
Unfortunately, doctors often cannot predict the course that the vision will take. They will try to establish and obtain a goal intraocular pressure. Often, if the pressure does not go low enough, it is possible to slow or stop the progression of glaucoma and vision loss; however, there are some patients who still lose vision, regardless of the doctor's efforts.
Is it advisable to take a calculated risk and have the surgery, or would it be prudent to go for a second opinion?
I think this is a question that you have to answer yourself. If you have concerns, then I think a second opinion is always a good idea. If you are comfortable with what the doctor has discussed with you and you understand the risks, benefits, and alternatives, then you do not need a second opinion. This is something that your mother and your family will have to decide.
Lately, my mom is complaining that she has dry mouth, a sense of uneasiness, acidity in the stomach, irritation around her eyes, and palpitations. I read that these symptoms are potential side effects of the glaucoma eye drops. Can you suggest a remedy to overcome these side effects?
This is something that should be discussed with the eye doctor that has prescribed the medications. It is possible that it is related to the eye drops, but it is important to know all of the medications that she is taking (not just the eye drops)so that you can identify any cross reactions. Also, given the fact that I cannot find information on the Libatim, I cannot give recommendations on the cross reaction of this particularmedication. The eye doctor that prescribed the medications can answer that question.
I have normal-tension glaucoma, but it is more advanced in my right eye. At times, my eyes will feel like they are full of fluid (but it does not feel like watery eyes) and they may bother me like that for several hours. Is this another symptom of glaucoma? [ 04/10/11 ]
Thank you for your question. Unfortunately, a feeling of the eye being “full of fluid” is not necessarily a sign of increased pressure or glaucoma. Very few patients feel anything until the pressure reaches into the 30s. If it gets that high, it is usually painful, not a feeling of fullness. The best way to determine if you are having elevated pressure during one of these episodes is to go to the eye doctor when you feel like the eye is “full of fluid.” Since these episodes last for several hours, that should give you enough time to get to the eye doctor or his/her technician to have the pressure checked. If the pressure is normal when you are feeling this sensation, it is likely something else causing this feeling and not eye pressure. If the pressure is up while you have this feeling, then you may have open-angle glaucoma and not normal-tension glaucoma. Until you have an exam while having the feeling that your eye is "full of fluid," it is impossible to guess what the pressure might be. I wish you the best of luck.
I have been suffering from narrow-angle glaucoma since I was 67 years old. I underwent 3 YAG iridotomies in December of 2005. Thereafter, I was taking Xalatan and my IOP was stable at 14 - 16 millimeters of mercury. I would like to know whether Timolet can have any adverse effects on my glaucoma compared to Xalatan. I read the side effects for each of these eye drops, but would like your input on whether or not it makes sense to change eye drops. [ 04/09/11 ]
Thank you for your question. Without having examined your eyes or the results of your previous exams, it is difficult for me to provide an accurate recommendation. I will assume that your doctor was happy that your pressure was between 14 and 16 and that is your target or goal intraocular pressure.
Changing to a new medication can always put you at risk for additional adverse effects. I do wonder why you switching from Xalatan if it has controlled your eye pressures for the last 5 - 6 years. Typically, eye doctors do not change medications if they are working well. If you are having trouble with side effects from the Xalatan (the most common are change in iris color, change in skin color around the eye, redness, etc.) or the medication is too expensive, then you might want to consider changing medications. Timolet is a preparation of timolol. Timolol (a beta-bloker) is contraindicated in patients with:
- bronchial asthma
- a history of bronchial asthma
- severe chronic obstructive pulmonary disease
- sinus bradycardia
- second or third degree atrioventricular block
- overt cardiac failure
- cardiogenic shock
- hypersensitivity to any component of this product per the timolol insert.
As you have read, there are many potential side effects of this medication. These can include, but are not limited to shortness of breath, slowing of your heart-rate, lowering of blood pressure, dizziness, etc. Most people tolerate timolol relatively well and it is often less expensive than Xalatan or other prostaglandin analogs. I suggest that you discuss the change in medication with your eye doctor and determine why they have recommended that you change medications even though it appears that the Xalatan is working well for you. Overall, as long as you do not have side effects from the Timolet and it reduces the pressure to the appropriate goal, I think using it is fine. I have patients on both medications and most do relatively well. I wish you the best of luck.