I am a 74-year-old female, and at times I have forgotten the exact time that I put the first drop of Combigan in my eyes, which my doctor recommended that I use only twice each day. If I accidentally used the drops less than 12 hours apart, was that harmful to my eyes? [ 09/07/12 ]
No, it is not harmful if you have spaced it less than 12 hours apart. But, like any medication, the dosing is designed to maximize its effectiveness, based on how long it lasts in your system. Of course, each patient is unique and different, so I would not worry too much about the scenario that you described. It is more important that you are using the medication consistently. If you can remember to space it 12 hours apart, that is ideal, but again, it is more critical that you take both doses in a given day.
An optometrist suggested that I should go to an ophthalmologist since he was concerned about the possibility of glaucoma. Now, a year later, I've finally made an appointment with an ophthalmologist. Apart from the eye pressure that I'm starting to feel, there is a light yellow excretion. Is this a symptom of glaucoma? Every morning when I wake up, my eyelashes are "glued" together. If so, what can I do? My eyes are also tearing, as if I'm crying all the time. [ 09/07/12 ]
Thank you for your question. I am glad that you are seeing an ophthalmologist soon to help answer your questions. I am unclear about the light yellow excretion. If you are referring to discharge, that sometimes does build up overnight. First, it is important that you determine the cause of the excretion when you meet with the ophthalmologist and ask him/her if the following would be helpful to manage the discharge:
There are steps that I have provided to my patients to improve the condition of their eyelids and manage the discharge. The process is called “lid hygiene”—I think of it like flossing your teeth—and it is a step that one should take in the morning and at night, if possible. Sometimes my patients just start once a day, while they are in the shower, for example. They can take a warm towel and place it on their eyelids, to liquefy the secretions that the glands of their eyelids are excreting. Then, they take a cotton swab, dip it in warm water, and gently clean along the eyelid margin (both the bottom and the top eyelids). Some of my patients use a 1:1 mixture of warm water and baby shampoo. There are also over the counter products (look for “lid scrubs) but I think these simple steps explained above may help you.
I am 55 years old and my dad had glaucoma. During my last visit to the ophthalmologist, my pressure was 22. My field test showed 'some' changes compared to the previous test. The doctor put me on timolol (one drop before bed). My main problem is glare and I can't get used to it. I never had this problem prior to the eye medications. Should I stop the eye drops? I'm being referred to a glaucoma specialist for follow up. I've never been formally diagnosed with glaucoma yet and would like to know what to do in the meantime. The glare is so annoying and I feel like I can't focus. [ 09/07/12 ]
Thank you for your question. I would first call and speak with the prescribing ophthalmologist and discuss with him/her whether it is appropriate to stop timolol; however, it is unusual to have glare symptoms from this medication. You could ask your doctor about using the medication only in one eye, and test out if it really is causing you to have the problems with glare. Sometimes patients notice problems coincidentally when they change their routine, and the glare may be caused by a different issue altogether. Certainly this is an important issue to discuss with your ophthalmologist and glaucoma specialist, and please do not make changes to your medication regimen until you talk with your eye doctor(s).
I had a trabeculectomy approximately four years ago and I am now having trouble seeing. I have good vision in both eyes (20/50 left and 20/20 right), yet I strain to see. I have an aversion to bright light, trouble keeping my eyes open, and pressure and pain in both eyes occasionally. My pressure is 11 in left and 12 in right, but I am having trouble reading and watching television. I use non-preservative eye drops in both eyes every hour to prevent dryness. Is this a common problem after having this type of surgery? My eyes seem to be failing. [ 08/30/12 ]
Thank you for your question. It is certainly possible that after having a trabeculectomy, or even after having been treated with glaucoma drops for a long time, it is possible that you have ocular surface disease. There are also other underlying problems that could be exacerbating your It is great that your eye pressure is now well-controlled, but how frustrating it must be to feel that you cannot see as well. It is known that trabeculectomy (and most types of intraocular surgery) will slowly accelerate cataract formation. Have you had your eyes checked for glasses recently? You may also benefit from seeing a cornea specialist in conjunction with your glaucoma doctor with regards to your ocular surface disease symptoms. Once an underlying cause is identified, steps can be taken to overcome your problems.
I was diagnosed with Posner-Schlossman syndrome in January 2012. In a routine test, the eye pressure in both eyes was measured as 40 and 45. Two days later, the pressure was measured at 17 and 21 without any medication. Since that time, I have been applying Combigan eye drops two times daily. My field vision tests were normal but the CD ratios are high (0.8) in both eyes. What are the chances of successfully controlling my glaucoma and protecting my vision? [ 07/09/12 ]
Thank you for your question and I am sorry that you are going through all of this. The eye doctor's goal is to identify glaucoma before you, as a patient, ever notice any changes. While it sounds as though your visual fields are full, the optic nerves may have early damage from the glaucoma (hence the increased cup to disc ratio). Therefore it is important to get the pressure lower so that further optic nerve damage and vision loss does not occur in the future. Eye doctors use three different methods to decrease the pressure:
- medicated use medicated eye drops (such as Combigan)
- laser treatments
- surgical methods to lower the intraocular pressure.
Your doctor will follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how your eyes respond to the treatment and ensure that you stay at your goal intraocular pressure. If the pressure is not reduced enough or your doctor ever notices advancement in your glaucoma, he or she will add more medications or use laser or surgery to help lower the intraocular pressure further.
If someone is diagnosed with glaucoma very early, the goal is to begin treatment and hopefully prevent the person from ever noticing any changes in vision. Unfortunately, doctors cannot predict if or at what rate a patient will lose vision because of the glaucoma. In some cases, despite the best efforts, doctors cannot stop the progression of the glaucoma and patients do eventually go blind, but this is the minority of patients. It will be important that you continue to visit your glaucoma specialist regularly, follow their advice, and maintain your eye pressure at the appropriate goal for the best chance of maintaining vision throughout the rest of your life. I wish you the best of luck.
My mother-in-law has glaucoma. She said that my husband needs to get tested because sons inherit glaucoma from their mothers and daughters inherit it from their fathers. Is this true and should he get tested? Thank You. [ 07/08/12 ]
Thank you for your question. Your mother-in-law is partly correct; however, a few of the details are incorrect. First, your husband should be checked for glaucoma. In addition, all of his siblings, both male and female (if he has any) should be checked as well because glaucoma is known to run in families. Further, according to some of the major glaucoma studies that have been completed, having a first-degree relative (parent or sibling) with glaucoma means that their immediate family members have between a 2- to 9-fold increased risk of having glaucoma compared to a person who does not have a first-degree relative with glaucoma. Given this, any sibling (regardless of gender) should be checked. The genetics of glaucoma is quite complex and it is the focus of many studies. Due to its complexity, it is not passed only from mothers to sons and fathers to daughters; all direct relatives are at risk. I hope this helps answer some of your questions.
I was born with cataracts, which were removed (along with my lenses), leaving me with decent vision. I was then diagnosed with glaucoma at age 7. When I was 15, I had a trabeculectomy in my right eye, and then a tube implant in the same eye at age 19. I’m 33 years old now. I also recently had a cornea transplant in the right eye because it decompensated. Somewhere amidst those glaucoma surgeries (10+ years ago) I lost functional vision/acuity in my right eye although the tube has kept the pressure low. My left eye has been fairly stable with eye drops until recently, but the pressure is creeping up and I may require surgery in that eye. I’m obviously nervous to lose functional vision in that eye following surgery, and would like to know the impact that modern tube surgery has on vision. What should I should I expect? Also, when medications are changed, how long should it take for the new medication to start lowering pressure? [ 07/07/12 ]
Thank you for your question. I am sorry that you are having so many problems with your eyes. It sounds as though you have quite a complex history. Unfortunately, given the complex nature of your problem, the fact that I have not examined your eyes, or the fact that I have not seen any of the test results from previous exams, it will be nearly impossible for me to give a completely accurate assessment; however, I can give you some general thoughts. These are questions that you should directly ask your surgeon prior to your glaucoma surgery.
First, ask about the impact of modern tube surgery on vision. Any time eye doctors discuss surgery, they should talk about the risks, benefits, and alternatives to each surgery that is recommended. In the case of glaucoma tube surgery, they discuss things like the risks of bleeding, infection, pain, the pressure not being low enough (requiring further surgery or medications), the pressure being too low (requiring further surgery or medications), decrease in vision, or loss of the eye. While these are some of the risks, this is not meant to be inclusive because each case is different. While these side effects can occur, the more serious complications, such as vision loss, happen in a minority of patients. Most patients notice only minimal changes (if any) in vision. If vision does change, the vision loss can occur immediately after surgery because of the stress the surgery places on the eye. In addition, simply inserting a tube into the eye can cause the cornea to change its refraction slightly; therefore, a glasses prescription may be needed (or it may need to be changed) to obtain the best visual acuity. Finally, some patients can notice some double vision because the glaucoma tube implant is near the muscles of the eye.
In your particular case I do not think this will be a problem given the poor vision in your left eye. Some vision loss may also happen later in life. Often a glaucoma tube, if placed into the anterior chamber, can cause cornea decompensation and the need for a cornea transplant. These would be the primary reasons for a change in vision after the glaucoma tube is implanted. Again, overall, most people do not notice much change in vision, but it is something that you should discuss with your doctor.
Finally, you asked about the length of time it takes for glaucoma medications to take effect. In most cases you can tell if a medication is working within a few days; however, there are a few medications, such as prostaglandin analogs, that may take a few weeks to have their full effect. I hope this helps and I wish you the best of luck.
Does taking a daily extra-strength aspirin have any negative consequences for someone with glaucoma? [ 07/06/12 ]
Thank you for your question. Taking a daily aspirin has not been shown to have any negative consequences for someone with glaucoma. The only caveat is that if your glaucoma should progress and your eye doctor recommends surgery. If this happens, you should inform your doctor that you are taking an aspirin and they will work with you to decide if the aspirin should be stopped prior to surgery; sometimes this is required. In addition, you will be happy to know that there is some research exploring whether or not aspirin may actually be beneficial in slowing the progression of glaucoma. While there are no conclusive results at this time, it is an area of research that is ongoing.