Monday Night Chat Highlights

Monday Night Chat Highlights
June 4, 2001
Norma Devine, Editor

Dr. Jeff Henderer, a glaucoma specialist at Wills, paid a surprise visit to the Monday night chat support group on June 4, 2001.

Host: Welcome, Dr. Henderer. What a pleasant surprise.

Dr. Henderer: Sorry I missed chat last Wednesday night. I was in the operating room.

Host: We all understood. The topic, “Non-Penetrating Glaucoma Surgery,” has been rescheduled for later this summer.

Dr. Henderer: I thought I could be here for a bit tonight.

P: That is very kind of you, Doctor Jeff.

P: Was it a successful surgery?

Dr. Henderer: Yes, thank you.

P: The surgery was a success but the patient went blind. At least I feel that way.

Dr. Henderer: Please don’t jinx me!

P: I’m talking about my surgery, Dr. Jeff.

Dr. Henderer: So am I. I’m so sorry you’re having problems.

P: Is this chat open for any questions?

Host: Yes, so long as they are related to glaucoma. 🙂

P: I had a trabeculectomy six months ago. This weekend my vision became very blurry. It doesn’t matter if my glasses are on or off. Before, I could always see somewhat, even with the blind spot. Now it is not good. Should I call my doctor right away or should I wait for my appointment and visual field test on June 12th?

Dr. Henderer: Call your doctor right away.

P: What could it be?

Dr. Henderer: That’s hard to say without examining you. So far out from surgery it might not be related to it, or it might.

P: Doctor, I had cataract surgery on January 29 and March 29 in Florida. Before I left, the doctor said something about a membrane behind each of the lenses. Is that something that occurs frequently after cataract surgery?

Dr. Henderer: Yes, that is pretty common. It can even cause your vision to decrease again. Usually, a laser can clear it up in a few shots.

P: Do some patients have to keep massaging for years?

Dr. Henderer: Some do massage for years.

P: Is there a risk to using Pred Forte indefinitely?

Dr. Henderer: Pred Forte is risky mainly due to the chance of elevated eye pressure and cataract formation. There’s not much risk if you have had those taken care of.

P: I am very confused. I massage to keep my pressure down, and the Pred Forte could elevate it. I had needling in the eye. I’ve been using Pred Forte since February. How long will I probably have to keep using it?

Dr. Henderer: Sorry that it appears confusing. On the one hand, if you have not had glaucoma surgery, Pred Forte can raise the IOP. But after surgery, we use it to prevent scarring. That’s why we can use it for so long.

P: I understand now. Thanks, Dr. Jeff.

P: Do the Pred Forte drops affect blood pressure or diabetes?

Dr. Henderer: I suppose they can, but I have never heard of it. I guess the dose is low. It is an issue that we think about, but it doesn’t usually alter what we do. Or at least what I do.

P: I have an appointment on June 27 with a specialist at Wills. He has never seen me before. What records should I get from my ophthalmologist?

Dr. Henderer: If the visit is for glaucoma, get copies of your visual fields, photos of your optic nerves, if you can, and find out what your initial IOP (intraocular pressure) was and how treatment has gone.

P: Yes, the visit is for glaucoma. I was diagnosed five years ago and had laser in both eyes and a trab in the right eye in June of 1999.

Dr. Henderer: Okay. See if you can assemble those items. The idea is to figure out how much damage you have, what treatment is needed, and then to give it. The records will help to assess the damage (and rate of damage) and what treatments have been tried to see what can be offered now.

P: Can damage progress with pressures of 8 to 10?

Dr. Henderer: I guess it can, but it would be both unusual (thankfully) and might not be due to pressure itself, but rather to blood flow or other issues.

P: How much do migraines affect the optic nerve? Would a person have to have a lot of migraines or do occasional migraines cause a problem?

Dr. Henderer: Migraines are associated with glaucoma, but I have never seen any data that relates their frequency with glaucoma. I just don’t know that one.

P: I have had migraines since I was a teen-ager, which was long ago, but I never associated them with my glaucoma, which is primary open angle.

Dr. Henderer: Migraines are associated with glaucoma, but they may not cause glaucoma. Migraines are a marker for blood vessel spasm and that spasm may also be a mechanism for glaucoma damage.

P: Is there any relationship between glaucoma and optic nerve drusen?

Dr. Henderer: That is a great question. The short answer is “probably.” The long answer is that drusen can cause field defects identical to glaucoma, and the nerves can be hard to interpret. So we follow IOP, and that is not always helpful. Generally, we lower pressure because if the patient is getting worse we don’t know what else to do.

P: You mean higher IOP can lead to more drusen?

Dr. Henderer: No. Drusen are probably genetic. Their presence can lead to glaucoma-like field defects.

P: It’s a weird case, Doctor. I have normal-tension glaucoma with no genetic history of it. My daughter has drusen, with no genetic history of that.. Maybe that’s because drusen could not been seen back then.

Dr. Henderer: Good point!

P: What a treat to have the doctor here tonight.

Dr. Henderer: I think this is a super chat room. It is the only one I’ve ever been to, but I think it really makes this a wonderful experience.

P: You doctors have been fabulous to us.

Host: Dr. Jeff, this appears to be the only glaucoma chat room in all of cyberspace in which a specialist answers patients’ questions in real time. Do you think there’s a chance other great eye institutes will follow the Glaucoma Service’s example?

Dr. Henderer: I doubt it, but maybe. Sorry, but I have to leave in a few minutes to put the baby to bed, relieve my wife. Talk about a long day! She has the longest!

P: How old is the baby?

Dr. Henderer: He’s two and half.

P: The terrible two’s.

Dr. Henderer: It’s fun until you try to put him to bed! I am learning humility. It’s great to be here, but I hear him running around and I better go help.

P: Sorry to be late. I had computer problems. This is my first time here. I was just diagnosed as pre-glaucoma.

Dr. Henderer: I’ll hang out for a second if you have a question.

P: My doctor says my optic nerve is starting to look suspicious. They took a computer photo last November and in May they said it looked suspicious. I’m really kind of scared and trying to learn as much as I can.

Dr. Henderer: Well, there is a huge variety of “normal” optic nerves, some of which look like glaucoma.

P: Doctor Jeff, please go take care of the baby, and thank you so much for being here.

Dr. Henderer: Okay. Goodnight everyone.

P: Thank you, Dr. Jeff. You have been very helpful.

Host: Goodnight, doctor. Thank you. We look forward to your next visit.

Note: After Dr. Jeff left, patients urged the woman who arrived late to see a glaucoma specialist for a second opinion and encouraged her to return for the Wednesday night chat.

End of chat highlights for June 4, 2001.

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About the Author:

The Glaucoma Service Foundation’s mission is to preserve or enhance the health of all people with glaucoma and to provide a model of medical care by supporting the educational and research efforts of the physicians on the Wills Eye Institute Glaucoma Service, the largest glaucoma diagnosis and treatment center in the country.
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