Science & Research
If the pressure in my right eye is holding around 24, and the optic nerve does not show any signs of glaucoma, are eye drops still recommended? I do have glaucoma in the left eye. [ 05/03/11 ]
Thank you for your question. Unfortunately, in this particular situation, it is impossible for me to tell if you have glaucoma or ocular hypertension in your right eye; however, given the fact that glaucoma often occurs in both eyes, you may simply be in the earliest stages and the doctors cannot detect any changes. Further, without having examined your eyes myself and having seen the results of previous tests, it would be difficult for me to give you an accurate answer. Glaucoma is classically defined as a stereotypical pattern of damage to the optic nerve and certain layers of the retina. Elevated intraocular pressure is a risk factor for glaucoma, but just because the pressure is elevated it does not mean you have glaucoma. Often people with elevated intraocular pressure alone, and no other signs of glaucoma, are given the diagnosis of ocular hypertension. Similarly, just because the intraocular pressure is normal, this does not mean that someone cannot have glaucoma. Doctors often see patients with glaucoma that have never had increased intraocular pressure, and they are given the diagnosis of "normal-tension glaucoma."
Your eye doctor will likely follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see if there is any evidence of glaucoma that presents in the future. Unfortunately, we cannot look into the future to find out if you will be one of the fortunate people with ocular hypertension that never develops glaucoma in the second eye, or if you will eventually develop this eye disease. I often give my patients two options. First, you can either start a medication now, or you can wait. Unfortunately, only you can make this decision.
When I tell patients that I am considering changing medications or recommending a new therapy, I always discuss the risks, benefits, and alternatives with them. First, your doctor needs to discuss what medication he would consider starting you on. If it is a prostaglandin, then he will likely discuss the fact that it can make your eyes red, change the color of the eyes or the color of the skin around the eyes, etc. If he were to choose a beta blocker, he would likely discuss the fact that you could have symptoms of feeling lightheaded or have a drop in your blood pressure. Also, he would need to know if you have asthma or any other pulmonary issues, etc.
The benefit of starting therapy is that the intraocular pressure will likely be lowered. Lowering eye pressure is the only way we have of possibly preventing or slowing the onset of glaucoma. The alternative is to do nothing and continue to examine the eye to see if it continues to progress to the point that you can be definitively diagnosed with glaucoma. The real question is whether you want to start taking medications now and risk possible side effects from the medicine, even though the doctors have not officially given you a diagnosis of glaucoma, or whether you would rather wait until they can definitively say that you have glaucoma before starting treatment. That is something that only you can decide. I have some patients that would rather know they are trying to do something to prevent any loss of vision even though they may not have glaucoma. Others say that they want to avoid using medications as long as possible and want more definitive proof that they have glaucoma before using drops. Either route is fine as long as you are comfortable with the choice. Best of luck with making this decision, and I encourage you to discuss the risks, benefits and alternatives with your eye doctor.
What was the primary treatment for glaucoma in the 1940s? My grandmother had glaucoma and became blind. I have the eye disease now and take TravatanZ. [ 05/02/11 ]
Treatment for glaucoma in the 1940s was quite different from treatment now. Essentially eye doctors only had a couple of eye drops options available to them. There were also a few topical medications in use at that time; however, both had some pretty bad side effects. Topical pilocarpine was used quite frequently, but often caused a slight change in vision, headaches, and constriction of the pupil. In addition it had to be instilled in the eye multiple times during the day. Worse yet, if patients were near sighted (myopic) there was a slight chance of retinal detachment. Even with these side effects, there are still some patients on this medication that do quite well. In addition to pilocarpine, some people also used topical epinephrine. There were fewer side effects, but it did not work quite as well. In the 1950s, oral carbonic anhydrase inhibitors (Diamox) were used in a few patients, but the major breakthrough in topical treatment of glaucoma came in the late 1970s when timolol was introduced. Timolol essentially became the drug of choice for almost everyone. From the 1980s forward, we have seen the addition of topical carbonic anhydrase inhibitors (Trusopt, Azopt), alpha agonists (brimonidine, Alphagan), prostaglandin analogs (Travatan, Xalatan, Lumigan), and combintions of these drugs. Obviously, laser therapy was not available in the 1940, but surgical correction of glaucoma was attempted. Surgeries similar to trabeculectomies were being performed to varying degrees of success. The trabeculectomy and glaucoma valve surgeries as we know it did not really start until the 1960s. Your treatment options are much better today than your grandmother in the 1940s; however, the goal to reduce eye pressure is still the same. I wish you the best of luck, and our older glaucoma specialists would like to thank you for the walk down memory lane.
My wife of 65 years had surgery for narrow-angle glaucoma in both eyes. Subsequently, she had cataract surgery. Her IOP was 16/17 mmHg with Travatan, but the doctor prescribed Travacom. She experiences some blurry vision, heaviness and a “stretchy” effect in the left eye. Would you advise her to switch over to Travatan if IOP remains in the 16 – 17 range? Are the side effects related to Timolet (which is in the Travacom)? I would appreciate your input. Also, she recently had a slight abbess in her gums, and the dentist gave her 500 milligrams of phexin. Would you mind letting me know if this medication has any adverse effects on her vision? She took two capsules each day for three days only. Thanks a lot and GOD bless you as your support is very useful. [ 05/01/11 ]
Thank you for your question. I am sorry that your wife is having troubles. Unfortunately without personally examining your wife and looking at the results of some of her previous tests, I am unable to give you an exact recommendation. It sounds as though the pressure was around the 16-17 range on Travatan alone, but the doctor appeared to want the pressure slightly lower. If that is the case, then I would not recommend returning to just the use of Travatan. Essentially, you will need to know what the target pressure is (and only her doctor would know that from his or examination and looking at the results of her tests). By changing the drops to Travacom, the eye doctor was using a combination of two medications (Travatan and Timolol). It is difficult to tell what the “heaviness or stretchiness” is, but I seriously doubt this is related to the timolol component. In addition, it is rare for timolol to cause a change in vision. You might watch this closely and see if it does not disappear over time. As for the phexin, that should not have any impact on your wife's eye pressure. I hope this is helpful.
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.
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Last Review: 04/28/13