Faq about glaucoma
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Thursday, October 29, 2009
Thursday, October 8, 2009
Will high IOPs cause glaucoma
Question:
I am a 45 yr-old woman who has been given the label of glaucoma suspect due to IOPs that range from 26 to 31 mmHg over the last 3 years. My Dr. has not suggested treatment to lower them yet, but I still question whether it is going to be safe to continue with regular vision having these IOPs over the next 20 plus years. What are the chances of developing glaucoma in the future. I am ok with not treating now, since there is no cupping of the optic nerve and no change in visual field tests, but I feel like my Dr. is afraid to say what may come in the future.
Answer
No doctor can predict your exact chance of developing glaucoma although your risk will be based upon whether you have a family history and may be influenced by the thickness of your cornea. I would recommend that you find out the results of your testing, visual field, optic nerve imaging, corneal thickness and continue to ask this question.
I am a 45 yr-old woman who has been given the label of glaucoma suspect due to IOPs that range from 26 to 31 mmHg over the last 3 years. My Dr. has not suggested treatment to lower them yet, but I still question whether it is going to be safe to continue with regular vision having these IOPs over the next 20 plus years. What are the chances of developing glaucoma in the future. I am ok with not treating now, since there is no cupping of the optic nerve and no change in visual field tests, but I feel like my Dr. is afraid to say what may come in the future.
Answer
No doctor can predict your exact chance of developing glaucoma although your risk will be based upon whether you have a family history and may be influenced by the thickness of your cornea. I would recommend that you find out the results of your testing, visual field, optic nerve imaging, corneal thickness and continue to ask this question.
24 hr BP Fluctuation and Glaucoma
Question:
by Jesse1188, Jan 28, 2009 12:42PM
I am healthy but was put on Aceon 4mg/day for essential hypertension in 03/08. Optometrists have told me since my first eye check-up at age 37 that my optic nerves looked "suspicious", but my vision is great. An opthalmologist told me in Nov '08 that my RNFL's seem to be thinning and I am at risk for glaucoma. I see him again in 6 months. (IOP on Aceon : 16mmHg both eyes; off meds:18 both eyes - both daytime readings.) I have recently changed my lifestyle significantly (diet, weight loss, exercise) and discontinued Aceon under medical supervision a couple of weeks ago. 24 hr ABPM done two days ago shows a wide fluctuation in readings. Highest at 3.30PM: 139/90; lowest at 3.25AM: 96/55. I am allowed to stay off BP meds under supervision. Question: Does the huge drop in BP at night "starve" my optic nerves of adequate blood supply and cause RNFL thinning? Would the Aceon have caused even more marked nighttime hypotension and worsened the condition? I have a strong family history of HT, early MI and death and will probably need BP meds in future. (Female, age 47 now) This looks like a catch 22 - how can HT and glaucoma be treated if lowering the BP and IOP at night will cause even more harm? Is there a way to "even out " BP and IOP over a 24 hr period by raising BP at night and lowering it during daytime? Without meds, my highest nighttime reading was only 116/68 (just an hour after the 96/55 reading.) I am confused.
Answer
I would recommend that you seek the care of a glaucoma specialist and/or neuro-ophthalmologist to evaluate your eye
by Jesse1188, Jan 28, 2009 12:42PM
I am healthy but was put on Aceon 4mg/day for essential hypertension in 03/08. Optometrists have told me since my first eye check-up at age 37 that my optic nerves looked "suspicious", but my vision is great. An opthalmologist told me in Nov '08 that my RNFL's seem to be thinning and I am at risk for glaucoma. I see him again in 6 months. (IOP on Aceon : 16mmHg both eyes; off meds:18 both eyes - both daytime readings.) I have recently changed my lifestyle significantly (diet, weight loss, exercise) and discontinued Aceon under medical supervision a couple of weeks ago. 24 hr ABPM done two days ago shows a wide fluctuation in readings. Highest at 3.30PM: 139/90; lowest at 3.25AM: 96/55. I am allowed to stay off BP meds under supervision. Question: Does the huge drop in BP at night "starve" my optic nerves of adequate blood supply and cause RNFL thinning? Would the Aceon have caused even more marked nighttime hypotension and worsened the condition? I have a strong family history of HT, early MI and death and will probably need BP meds in future. (Female, age 47 now) This looks like a catch 22 - how can HT and glaucoma be treated if lowering the BP and IOP at night will cause even more harm? Is there a way to "even out " BP and IOP over a 24 hr period by raising BP at night and lowering it during daytime? Without meds, my highest nighttime reading was only 116/68 (just an hour after the 96/55 reading.) I am confused.
Answer
I would recommend that you seek the care of a glaucoma specialist and/or neuro-ophthalmologist to evaluate your eye
Eye pressure
Quesion:
Hi
What are normal limits of eye pressure for a male of 45 years?What is better,being on low or high side of normal eye pressure?Thank you.George
-----------------------------------------------------
Answer:
George,
The normal eye pressure is usually between 8 and 21.
In the past it used to be said that anyone with an eye pressure greater than 21 had glaucoma and anyone with an eye pressure less than 21 did not have glaucoma.
Eye pressure is the greatest risk factor for developing glaucoma but is not the only risk factor. We now know that many people with eye pressure greater than 21 never develop glaucoma. They are considered to have ocular hypertension. We also know that about 15% of all people with glaucoma have "normal" pressure.
It turns out that different people have different pressure sensitivity. Some eyes can tolerate high pressures better than others, but in general, the lower one's eye pressure, the lower the risk for glaucoma.
People with high pressure should be followed for glaucoma even if they do not have it. Currently, a large multi-center study (which includes Henry Ford Hospital) is underway to best determine the treatment for ocular hypertension.
It is best for anyone with concern about eye pressure be seen by an ophthalmologist and have his or her eyes throughly examined.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Hi
What are normal limits of eye pressure for a male of 45 years?What is better,being on low or high side of normal eye pressure?Thank you.George
-----------------------------------------------------
Answer:
George,
The normal eye pressure is usually between 8 and 21.
In the past it used to be said that anyone with an eye pressure greater than 21 had glaucoma and anyone with an eye pressure less than 21 did not have glaucoma.
Eye pressure is the greatest risk factor for developing glaucoma but is not the only risk factor. We now know that many people with eye pressure greater than 21 never develop glaucoma. They are considered to have ocular hypertension. We also know that about 15% of all people with glaucoma have "normal" pressure.
It turns out that different people have different pressure sensitivity. Some eyes can tolerate high pressures better than others, but in general, the lower one's eye pressure, the lower the risk for glaucoma.
People with high pressure should be followed for glaucoma even if they do not have it. Currently, a large multi-center study (which includes Henry Ford Hospital) is underway to best determine the treatment for ocular hypertension.
It is best for anyone with concern about eye pressure be seen by an ophthalmologist and have his or her eyes throughly examined.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Miosis
Question
I am a 69 year old Glaucoma patient. I have had
PI's in both eyes. When first diagnosed in 1994 I was put on Pilocarpine. Since 1996 I have been on Trusopt and Timoptic XE. My pupils are fixed and do not dilate and so do not dark adapt making my night vision minimal. I have been told that this miosis is a residual of the Pilocarpine and will go away eventually. lt's been two years that I have been off the Pilo and the condition has not improved. I suspect that my pupils are permanently fixed. Is there any treatment for such a condition?
Answer
I first wanted to mention that there is a new drug out which is a combination of Trusopt and Timoptic called Cosopt. You may want to speak with your ophthalmologist to see if you are a candidate.
I think that the chances of your pupils changing after being miotic for several years is unlikely. One option would be to try using phenylephrine drops at night if this is when you have most of your problems. This is a dilating drop and it may allow more light to enter your eye. This is a drop we use commonly to dilate eyes for routine examinations. Speak to your doctor.
Good luck. This information was provided for medical educational purposes only.
Sincerely,
I am a 69 year old Glaucoma patient. I have had
PI's in both eyes. When first diagnosed in 1994 I was put on Pilocarpine. Since 1996 I have been on Trusopt and Timoptic XE. My pupils are fixed and do not dilate and so do not dark adapt making my night vision minimal. I have been told that this miosis is a residual of the Pilocarpine and will go away eventually. lt's been two years that I have been off the Pilo and the condition has not improved. I suspect that my pupils are permanently fixed. Is there any treatment for such a condition?
Answer
I first wanted to mention that there is a new drug out which is a combination of Trusopt and Timoptic called Cosopt. You may want to speak with your ophthalmologist to see if you are a candidate.
I think that the chances of your pupils changing after being miotic for several years is unlikely. One option would be to try using phenylephrine drops at night if this is when you have most of your problems. This is a dilating drop and it may allow more light to enter your eye. This is a drop we use commonly to dilate eyes for routine examinations. Speak to your doctor.
Good luck. This information was provided for medical educational purposes only.
Sincerely,
Pigmentary Glaucoma laser surgery
Questin
My husband had laser surgery to relieve high pressure due to Pigmentary Glaucoma in mid-July. After the surgery, he developed severe pain in the eye, but the pressure was in the normal range. The doctor said that he was suffering from severe inflamation (inflammation). He was treated for the inflamation (inflammation) with drops, but it did not go away, and the pressure rose back up into the mid 30's, and he could not see out of the eye and was in severe pain. The doctor advised him to seek treatment at the U of M eye clinic in Ann Arbor immediately. The doctor at the U of M believed that the inflamation (inflammation) was due to the surgery, light, and an eye drop. I believe the name was Xylatan. She changed his medications and gave him some pills for two days to relieve the pressure. Since that visit, three weeks ago, the inflamation (inflammation) has not subsided, and now he is feeling pain in that eye again. The pressure is also rising again. It was 26 on the 9th, and today, the 16th, it was up to 32. I am writing because we dont know what to do. The doctor seems puzzled by his response to the laser treatment, and is notadvising any changes in medications. Do you have any advice? Thank-you for your time in this matter.
Answer:
Inflammation after laser surgery is unusual but can sometimes happen. It is important to know what type of laser surgery he had (laser trabeculoplasty or peripheral iridotomy). It is also possible that the medications can be making the inflammation worse. For example, Xalatan has very rarely been associated with inflammation in the eye. It is reasonable to stop those medications which may cause inflammation and put him on pills and possibly steroid medicines.
It is possible that he has an underlying predisposition for eye inflammation (UVEITIS) and should have a through evaluation for this.
If medicines cannot control his eye pressure and if there is risk of optic nerve damage, he may require glaucoma surgery.
The most important thing is to maintain follow-up with your ophthalmologist. I am sure your husband is getting very good care at Ann Arbor. I am also a glaucoma specialist and if you would like another opinion, you can call my secretary at 313-916-3260 (Paula) and ask to see Dr. Imami. If you want another opinion, please bring a copy of your old records and visual fields.
This information is for educational purposes only. It is not possible to advise on treatment without examining your husband.
My husband had laser surgery to relieve high pressure due to Pigmentary Glaucoma in mid-July. After the surgery, he developed severe pain in the eye, but the pressure was in the normal range. The doctor said that he was suffering from severe inflamation (inflammation). He was treated for the inflamation (inflammation) with drops, but it did not go away, and the pressure rose back up into the mid 30's, and he could not see out of the eye and was in severe pain. The doctor advised him to seek treatment at the U of M eye clinic in Ann Arbor immediately. The doctor at the U of M believed that the inflamation (inflammation) was due to the surgery, light, and an eye drop. I believe the name was Xylatan. She changed his medications and gave him some pills for two days to relieve the pressure. Since that visit, three weeks ago, the inflamation (inflammation) has not subsided, and now he is feeling pain in that eye again. The pressure is also rising again. It was 26 on the 9th, and today, the 16th, it was up to 32. I am writing because we dont know what to do. The doctor seems puzzled by his response to the laser treatment, and is notadvising any changes in medications. Do you have any advice? Thank-you for your time in this matter.
Answer:
Inflammation after laser surgery is unusual but can sometimes happen. It is important to know what type of laser surgery he had (laser trabeculoplasty or peripheral iridotomy). It is also possible that the medications can be making the inflammation worse. For example, Xalatan has very rarely been associated with inflammation in the eye. It is reasonable to stop those medications which may cause inflammation and put him on pills and possibly steroid medicines.
It is possible that he has an underlying predisposition for eye inflammation (UVEITIS) and should have a through evaluation for this.
If medicines cannot control his eye pressure and if there is risk of optic nerve damage, he may require glaucoma surgery.
The most important thing is to maintain follow-up with your ophthalmologist. I am sure your husband is getting very good care at Ann Arbor. I am also a glaucoma specialist and if you would like another opinion, you can call my secretary at 313-916-3260 (Paula) and ask to see Dr. Imami. If you want another opinion, please bring a copy of your old records and visual fields.
This information is for educational purposes only. It is not possible to advise on treatment without examining your husband.
P.I.
Question:
About 10 years ago I had a pressure spike from narrow angle glacoma. I had a PI done and since then I have experienced no problems at all. The pressure has always been normal.
Three months ago I had an attack in the other eye. A P.I. was done.. but two weeks later I experienced another attack with pressure rising to 60. After the P.I. was checked it was determined that it was not completely opened. So it was redone.
Since then they have put me on 2 drops a day of pilocarpine 2%.
After a recheck they said all was fine and took me off the drugs.
Two days later I began to feel the pressure rise. (all the attacks come in the evening). I gave myself a drop every fifteen minutes and after the fourth drop the pressure stopped.
The next day I went back to the doctors and they told me the PI was fine and the only thing it could be was that the cornea is plateauing covering up the PI. I think they called it plateauitis. I can't find anything written about this problem.
They state they want to keep me off the drops and when an attack occurs they now have to see the eye during the high pressure. I think it is very dangerous waiting in an emergency room with a pressure of 60 waiting for a specialist to see me.
I'm looking for other alternatives. Please help. Thank goodness with all the problems I have had they say that the nerves are still very healthy.
Thank you.... and any more info on the problem I would appreciate.
---------------------------------------------------------------------------
Answer:
Danielle,
It seems like you have described attacks of acute angle closure glaucoma. A successfull patent PI reduces the risk of this event recurring almost completely.
If someone does have an attack of sudden pressure rise with a patent PI, then one must consider other possible problems.
Plateau iris is a very uncommon iris shape which can cause the iris to cover the drain even if there is a patent PI. If this is the case, there are a few possible treatments. One could stay on chronic pilocarpine to keep the iris away from the drain. Another possibility is Iridoplasty. This is laser treatment to move the iris away from the drain. This is different from a PI.
It is important to confirm the diagnosis of plateau iris. This is a very rare condition and should be confirmed by a glaucoma specialist.
If there is no plateau iris, then other options must be considered. There could be damage to the drain form the attack of angle closure or there could be an inflammatory cause of the pressure rise.
In any case, it is important for you to keep close follow-up with your ophthalmologist. It is good news that your nerve is still healthy.
disclaimer:
This information is provided for educational purposes only. Please see your physician for diagnostic and treatment options.
If you need further information and are in the Michigan area, you can see the glaucoma specialists at the Henry Ford Hospital by calling 313 916-3260.
Sincerely,
About 10 years ago I had a pressure spike from narrow angle glacoma. I had a PI done and since then I have experienced no problems at all. The pressure has always been normal.
Three months ago I had an attack in the other eye. A P.I. was done.. but two weeks later I experienced another attack with pressure rising to 60. After the P.I. was checked it was determined that it was not completely opened. So it was redone.
Since then they have put me on 2 drops a day of pilocarpine 2%.
After a recheck they said all was fine and took me off the drugs.
Two days later I began to feel the pressure rise. (all the attacks come in the evening). I gave myself a drop every fifteen minutes and after the fourth drop the pressure stopped.
The next day I went back to the doctors and they told me the PI was fine and the only thing it could be was that the cornea is plateauing covering up the PI. I think they called it plateauitis. I can't find anything written about this problem.
They state they want to keep me off the drops and when an attack occurs they now have to see the eye during the high pressure. I think it is very dangerous waiting in an emergency room with a pressure of 60 waiting for a specialist to see me.
I'm looking for other alternatives. Please help. Thank goodness with all the problems I have had they say that the nerves are still very healthy.
Thank you.... and any more info on the problem I would appreciate.
---------------------------------------------------------------------------
Answer:
Danielle,
It seems like you have described attacks of acute angle closure glaucoma. A successfull patent PI reduces the risk of this event recurring almost completely.
If someone does have an attack of sudden pressure rise with a patent PI, then one must consider other possible problems.
Plateau iris is a very uncommon iris shape which can cause the iris to cover the drain even if there is a patent PI. If this is the case, there are a few possible treatments. One could stay on chronic pilocarpine to keep the iris away from the drain. Another possibility is Iridoplasty. This is laser treatment to move the iris away from the drain. This is different from a PI.
It is important to confirm the diagnosis of plateau iris. This is a very rare condition and should be confirmed by a glaucoma specialist.
If there is no plateau iris, then other options must be considered. There could be damage to the drain form the attack of angle closure or there could be an inflammatory cause of the pressure rise.
In any case, it is important for you to keep close follow-up with your ophthalmologist. It is good news that your nerve is still healthy.
disclaimer:
This information is provided for educational purposes only. Please see your physician for diagnostic and treatment options.
If you need further information and are in the Michigan area, you can see the glaucoma specialists at the Henry Ford Hospital by calling 313 916-3260.
Sincerely,
GLAUCOMA
Question
MY MOTHER IS 80YEARS OLD AND HAS GLAUCOMA. THE FIRST DRUG USED CAUSED HER TO HAVE ITCHING AROUND THE OUTSIDE LID AND BELOW. THE DOCOTER CHANGED IT AND IT WAS OKEY. BUT HER LAST VISIT HE PUT HER BACK ON 2 DRUGS ONE THAT CAUSED THE ITCHING AND ANOTHER ONE. THESE ARE EYE DROPS. HER DOCTOR SAID THE PRESSER WAS TO HIGH AND THATS WHY THE 2 DIFFERENT DROPS. MY QUESTION ::IS THERE ANY THING SHE CAN DO TO STOP THE ITCHING AS I KNOW THIS IS MISERABLE FOR HER . ANY HELP WILL BE APPRECIATED. SHE DID TELL ME THAT ONE OF THE DROPS HAS SULFUR IN IT. AND I KNOW THIS IS A VERY ALLERGIC DRUG FOR SOME . THANK YOU CAROL
Answer:
The best thing she can do for the itching is to stop the drop and change to a different drug or different formualtion. There are many good options out there so I would not be concerned that there are only two. Good luck.
This information was provided for educational purposes only.
HFHS MD-JL
MY MOTHER IS 80YEARS OLD AND HAS GLAUCOMA. THE FIRST DRUG USED CAUSED HER TO HAVE ITCHING AROUND THE OUTSIDE LID AND BELOW. THE DOCOTER CHANGED IT AND IT WAS OKEY. BUT HER LAST VISIT HE PUT HER BACK ON 2 DRUGS ONE THAT CAUSED THE ITCHING AND ANOTHER ONE. THESE ARE EYE DROPS. HER DOCTOR SAID THE PRESSER WAS TO HIGH AND THATS WHY THE 2 DIFFERENT DROPS. MY QUESTION ::IS THERE ANY THING SHE CAN DO TO STOP THE ITCHING AS I KNOW THIS IS MISERABLE FOR HER . ANY HELP WILL BE APPRECIATED. SHE DID TELL ME THAT ONE OF THE DROPS HAS SULFUR IN IT. AND I KNOW THIS IS A VERY ALLERGIC DRUG FOR SOME . THANK YOU CAROL
Answer:
The best thing she can do for the itching is to stop the drop and change to a different drug or different formualtion. There are many good options out there so I would not be concerned that there are only two. Good luck.
This information was provided for educational purposes only.
HFHS MD-JL
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