| Glaucoma Treatments |
Question: I am concerned because my visual field for one eye is bad, and I am relatively young (mid-50's). My IOP is always in the mid-teen's.
Answer:
You should have a doctor that you trust, and let him or her know your concerns. Does the doctor feel that your visual field is stable, and that your glaucoma is stable? You should ask these types of questions.
Dr. Michael James Pro
June 20, 2007
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Question: My glaucoma specialist recommends a trab but my second-opinion glaucoma specialist doesn't feel it's warranted at this time. What should I do?
Answer:
You should ask each why they make their recommendations. Where do they think your glaucoma will be years from now if you maintain the current treatment regimen? Some doctors are more aggressive than others when it comes to surgery. Ultimately you need to feel comfortable with the doctor who is treating you, and choose a treatment option. If you are really stuck, then get a third opinion. Although a second- or third-opinion doctor may see you only once, if he or she has access to your records including visual fields, then his or her recommendation is valid.
Dr. Michael James Pro
June 20, 2007
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Question: After laser eye surgery, can the eye be as good as before the operation?
Answer:
I am not sure about your question. Glaucoma has no cure and currently there is no way to reverse the process. So the eye that has suffered glaucomatous damage will never be as good as new. Surgery for glaucoma is meant to preserve existing vision.
Dr. Richard Lee
June 6, 2007
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Question: Should I consider surgery for my good eye if surgeries and medications in my bad eye have failed to lower its IOP?
Answer:
Given that one is worried about the "good" eye, I would treat it as soon as possible to preserve as much visual field as possible. I put "good" and "bad" in quotes because no eye should ever be ignored. I have patients who call their 20/400 eye their "bad" eye, but I explain that any vision is life-saving vision, and it is therefore a good eye. For instance, that is enough vision to find the door in a burning house and save one's life.
Dr. Richard Lee
June 6, 2007
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Question: Wasn't there a 2004 clinical study indicating that cholesterol-lowering drugs such as statins may delay progression in glaucoma suspects?
Answer:
That study was poorly controlled; a prospective study might not find nearly as much benefit. I tell all my patients to follow a healthy diet, and I am waiting for more definitive data.
Dr. Michael James Pro
March 21, 2007
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Question: Why aren't calcium channel blockers used in normal tension glaucoma?
Answer:
We looked at calcium channel blockers years ago. Researcher found that they improved optic nerve blood flow, but we were hesitant to put all of our patients on a systemic medicine with potential side effects. Theoretically, improved optic nerve blood flow would benefit NTG patients.
Dr. Michael James Pro
March 7, 2007
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Question: Should I try a non-prescription remedy for glaucoma that contains several herbs?
Answer:
I would not recommend it as a substitute for a drop. You should show the list of its herbs to your ophthalmologist and primary medical doctor before starting to use it.
Dr. Michael James Pro
February 21, 2007
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Question: What is endocyclophotocoagulation?
Answer:
Glaucoma specialists use endocyclophotocoagulation as end-of-the-line treatment. It involves burning the part of the eye that makes the aqueous fluid. The problem with the procedure is that it is destructive. Most glaucoma specialists would rather increase the flow of fluid out of the eye than decrease the fluid production in the eye. Oxygen and nutrients for the inside of the eye are carried by the fluid produced by the part of the eye that is destroyed, so there are lower levels of these for at least the first six weeks after a endocyclophotocoagulation. If other options have been tried, then it is a safer option than lasering through the wall of the eye. At Wills, we rarely have to extend treatment beyond two shunts.
Dr. Rick Wilson
January 3, 2007
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Question: When is Avastin used in glaucoma treatment?
Answer:
Avastin is an anti-neovascular agent (anti-VEGF). It is used for patients with abnormal new blood vessel growth in the retina (due to diabetes or macular degeneration). It is not typically used in glaucoma, except with patients that have a specific severe type of glaucoma associated with new blood vessels.
Dr. Michael James Pro
September 20, 2006
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Question: Is surgery better than eye drops? How many times can surgery be done?
Answer:
Surgery often lowers IOP more evenly and to a lower level than drops; therefore, it may be better for those with advanced disease. I usually only do three trabeculectomies on one eye, and three aqueous shunt plates, but cyclodestructive procedures can be done as often as needed to lower IOP to target IOP.
Dr. Rick Wilson
August 23, 2006
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Question: Is there anything I can do, besides taking my medication, that will help lower my IOP's?
Answer:
Exercising aerobicly for 20 minutes 4 times a week lowers IOP and improves ocular circulation. Weight loss, if needed and possible, often also lowers IOP (as well as blood pressure and blood sugar).
Dr. Rick Wilson
August 2, 2006
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Question: How can I do a better job of asking my ophthalmologist questions?
Answer:
A recent highlight deals with this topic:
Communicating With Your Ophthalmologist
Chat Highlights for November 8, 2000
Come prepared with your questions written down. I think it is best to have two copies, and give one to the doctor. He can then move rapidly through them, answering the questions while you write the answers down. This way the doctor makes efficient use of the time you both have together.
Dr. Rick Wilson
July 12, 2006
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Question: If IOP's are ideally less then 15 mmHg, then why aren't medications usually started until the IOP's are in the mid 20's?
Answer:
We usually start treating when the constellation of IOP and other risk factors (such as central corneal thickness, family history, race, low systemic blood pressure, etc.) make us think the chances of developing glaucoma are significant. If the cornea is thick, an IOP of 25 mmHg may really be around 21. If the nerve is quite healthy, it may be resistant to glaucoma damage at mid 20's IOPs. One has to look at the whole picture when judging when to start therapy.
Dr. Rick Wilson
July 26, 2006
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Question: How common is the freezing technique for glaucoma?
Answer:
It used to be very common. At one time in my early career, I was doing 4 to 6 cyclocryo procedures a week. At that time, the retina doctors had not discovered that argon laser treatment especially works to stop neovascularization. We know now that it does.
Dr. Rick Wilson
April 26, 2006
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Question: Why would optic nerve damage continue to progress in POAG (primary open angle glaucoma) when pressures are controlled around 16? Would lowering the pressure to 13 or less make any difference?
Answer:
No one knows the answer to your question, but it is a common and very troubling problem. Many glaucoma patients with damage seem to progress despite what appears to be adequate pressure lowering. We believe that in such patients lowering pressure even more may help halt or slow the progression, but there is no good proof of that.
Dr. Elliot Werner
March 30, 2005
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Question: Does the amino acid lutein help those with glaucoma?
Answer:
Lutein has been shown to be protective in macular degeneration, but this has nothing to do with glaucoma.
Dr. Elliot Werner
March 30, 2005
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Question: What would be your ideal method of screening for glaucoma, if you had all the time and money you needed?
Answer:
#1 A magnified, stereo look at the optic nerve by a competent observer
#2 A good visual field, of the blue-on-yellow type for subtle cases
#3 Throw in an intraocular pressure (IOP) to round out the information in order of importance.
Dr. Rick Wilson
April 06, 2005
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Question: Can retina cells be revitalized with hyperbaric oxygen chamber treatment?
Answer:
No, the dead ones are dead and gone. The dying ones may be helped slightly but I have not seen a study on hyperbaric O2 for glaucoma.
Dr. Rick Wilson
March 29, 2006
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Question: When would a glaucoma suspect be treated aggressively?
Answer:
If there is any perceived damage to the optic nerve or visual field, then treatment is mandatory. Even when there is no definite damage, other risk factors can add to the need to treat: elevated IOP, a family history of glaucoma, poor blood circulation, low blood pressure, African American ethnicity, etc.
Dr. Rick Wilson
March 8, 2006
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Question: If medication cannot lower the intraocular pressure adequately, what are the alternatives?
Answer:
A laser trabeculoplasty is used if the patient is older (usually over
60) and has good pigment in the trabecular meshwork. If that plus meds
is not adequate, then a trabeculectomy is usually required.
Dr. Rick Wilson
January 18, 2006
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Question: I am a glaucoma suspect but have been prescribed no glaucoma drops. Could this be correct?
Answer:
It depends on what your optic nerve and visual field look like, and what your intraocular pressure (IOP) level is. In my experience, a lot of patients are treated for glaucoma who are really just suspects and don't need treatment.
Dr. Elliot Werner
September 7, 2005
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Question: When do you treat a patient for glaucoma, and what type of evidence do you want before you start treatment?
Answer:
I treat patients who have very early observable damage or risk factors (family history, thin corneas, race, low blood pressure, etc.) that make them almost certain to develop glaucoma. A glaucoma specialist is able to detect glaucoma earlier than a general ophthalmologist.
Dr. Rick Wilson
February 16, 2005 |
