Monday Night Chat Highlights
November 5, 2001

Norma Devine, Editor

On Monday, November 5, 2001, Dr. Jeff Henderer, a glaucoma specialist at Wills, paid another visit to the Monday night chat room.

Dr. Jeff Henderer:  Hi all!

Monitor:  Welcome, Dr. Jeff.  Nice surprise.  One of your patients was just singing your praises.

Dr. Jeff Henderer:  Great!  I just finished a surgery.  

P:  Before you arrived we were discussing hypotony.  My IOPs (intraocular pressures) have been 3 mm Hg since 1995.  Should there be any restrictions on my activities, such as bending over, lifting, etc.?  

Dr. Jeff Henderer:  Hypotony can be bad (as in the low IOP causes blurred vision) or it can be just one of those things. If you have had it a while and you're doing okay, then it is probably fine to do most everything.  I wouldn't do weight lifting, though. 

P:  I have had an infection on my eyelid for a long time.  I use Cilolax ointment, which is not helping.  Do you have any suggestions?  

Dr. Jeff Henderer:  Do you mean blepharitis?  If so, I would suggest warm compresses.  I'm not a big fan of lid scrubs when there are blebs.  Doxycycline is often helpful.  I have never had much luck with ointments.

P:  Is increased tearing and itching normal or is it reason for concern?  

Dr. Jeff Henderer:  That can be typical for blepharitis, but if it is a change

from baseline and you have a bleb, then get examined to make sure there's no infection.

P:  Is it normal for the eyelids over blebs to be very sensitive?  

Dr. Jeff Henderer:  Well, I have not heard that much, but they can be a bit sore, especially just after surgery.  Later on, it should not be tender.

P:  So if the eyelids over blebs are touchy after two years, there may be something wrong?

Dr. Jeff Henderer:  Not necessarily, but it should be looked at.  It might be a sty.  If nothing is there, then I don't know what could be the cause. 

P:  Dr. Jeff, I haven't been diagnosed yet.  During a routine exam on Thursday, a puff tonometer test showed I had some increases in the IOP that appeared to be in the upper 20's and low 30's.  I returned today for a Goldmann applanation and the pressures were much better -- 23 mm Hg in the right and 21 mm Hg in the left.  

Dr. Jeff Henderer:  Well, I'm glad you had an applanation pressure taken.  It sounds like you found the right chat room.

P:  Yes.  I'm trying to learn a few things I hope I don't need to know.  I am going to Vanderbilt Eye Clinic.  Their policy is for a general practitioner to do the initial screenings and then refer to a specialist in their clinic, if needed.  I'm trying to put together a good plan. 

Dr. Jeff Henderer:  See an ophthalmologist.

P:  Yes, I will be seeing an ophthalmologist at the Vanderbilt Eye Clinic in about ten days for a full screening.  

Dr. Jeff Henderer:  That is a very fine department, and I believe there is an ex-resident or fellow from Bascom Palmer, James Tsai, I think, who is the glaucoma specialist.  See him.  

P:  I have a blind spot that does not show up on the visual field test.  A fellow GlaucoMate refuses to believe that it does not show up on the test.   

Dr. Jeff Henderer:  Yes, it happens once in a while.  The problem is that standard visual fields only test every five degrees.  Some blind spots are smaller than that and so aren't picked up.  A central ten-degree field tests every two degrees, and will help in such a situation. 

P:  I've been having episodes of nystagmus (rapid, involuntary, oscillatory motion of the eyeball).  Could that be from poor correction with my glasses?  I'm corrected as best as they can get it.  I just started noticing it, especially when trying to read find print.  

Dr. Jeff Henderer:  No, nystagmus isn't from glasses.  I'm not sure what to make of your symptoms.

P:  I've got maculopathy from hypotony after a trabeculectomy.  My IOP is now 8 mm Hg. Would that cause nystagmus? 

Dr. Jeff Henderer:  An IOP of 8 mm Hg is usually a bit high for that, but I've seen it happen.

Monitor:  Does anyone understand why some patients apparently can tolerate IOPs as low as 2 mm Hg for years without any problems? 

Dr. Jeff Henderer:  No, but typically the younger you are and the more nearsighted, the less you can tolerate a low IOP.

P:  I was down to 1 mm Hg after surgery in April!  I had a couple of bleb leaks that healed up in a couple of weeks.  The pressure has been pretty much around 8 mm Hg since then.  

Dr. Jeff Henderer:  You may slowly improve.

P:  I hope so!  I'd rather improve quickly, though.

P:  Do shunts work better than trabs, or does it depend on the person?

Dr. Jeff Henderer:  That depends on the eye. Shunts are usually for those whose eyes will scar easily.

P:  Why would a trab close up?  Can that also happen with a shunt? 

Dr. Jeff Henderer:  Trabs can scar down.  It is, after all, a hole in your eye.  Tubes have the silicone stent there to prevent scarring.

P:  What are the names of the different shunts?  

Dr. Jeff Henderer:  Ahmed, Baerveldt, and Molteno. 

P:  You can't see a shunt when it's in place, right?  

Dr. Jeff Henderer:  Right.

P:  And you don't feel a shunt once it is in right?

Dr. Jeff Henderer:  Yes, that is almost always true.

P:  Do trabs usually work better than shunts?

Dr. Jeff Henderer:  No, both work well.  Trabs often have a more immediate result and are thought to be better at achieving lower pressures.  They are often used first.  Plus, no hardware is involved. 

P:  Can a patient have more than one shunt?  Can a shunt be removed?  

Dr. Jeff Henderer:  One tube is almost always all you get.  Sometimes two, but there is no room for more.  And it can be removed, but it isn't fun.

P:  Why would a shunt be so much less effective at lowering IOP than a trab? 

Dr. Jeff Henderer:  It isn't necessarily.  Often the tubes don't do quite as well, but often they do very well.

P:  I have a very severe discrepancy in the vision in my right eye and my left eye.  My right eye is a +5.00 with a 2.75 astigmatism compared to a +1.00 and a .75 in the left.  Since I do not use my right eye very much, I am wondering how well I can meet the demands of the extended use of my right eye.

Dr. Jeff Henderer:  Probably better than you think.

P:  I hope so because it really doesn't like to work by itself very much, except for peripheral vision.

Dr. Jeff Henderer:  There are ways of getting around that with different target sizes, etc.  You may be pleasantly surprised.

P:  Plus, my vision isn't corrected in that bad eye.  It's a congenital problem.  

Dr. Jeff Henderer:  Well, that's okay.  

P:  It is time for me to have my eyes checked for new glasses.  Is there any reason I should have to have the visual field test done there?  I am pretty sure my glaucoma doctor could send them a recent one.  I take a visual field test every three months.  I can't see paying for unnecessary tests.  

Dr. Jeff Henderer:  Either place is fine so long as it's the same machine.

P:  I have a question about a change in my vision.  I seem to have developed an astigmatism, which I suspect may be from using Lumigan eye drops. 

Dr. Jeff Henderer:  I haven't heard that one. Interesting.

P:  Or do people usually get astigmatism as they age?

Dr. Jeff Henderer:  Yes, they do.  Did you stop using the eye drop to see if it went away?

P:  I wouldn't stop the drop unless my glaucoma specialist told me to.  I will see him in about a month.  Because I always had perfect vision, I don't know what is from age and what is from glaucoma and what is from meds.  Should I wait to fill the eyeglass prescription until after we experiment with stopping the Lumigan?

Dr. Jeff Henderer:  Yes, wait until you complete the experiment.

P:  Cosopt can cause cornea erosion in some people.  Could Lumigan cause that, too?  

Dr. Jeff Henderer:  Yes, I suppose so, but dryness-like irritation is more typical.  

P:  I was wondering if cornea erosion could cause astigmatism?

Dr. Jeff Henderer:  I doubt it.  That shouldn't affect your refraction, in my experience.

P:  Do you know how long it usually takes to have the screening papers processed for the memantine study?  I know the doctor's office sent mine the day I was there 20 days ago.  I am still waiting to hear. 

Dr. Jeff Henderer:  I don't know.  We are no longer enrolling subjects at Wills.  I would call them and ask.

P:  Have there been any advances in gene therapy for glaucoma patients?

Dr. Jeff Henderer:  Not that I'm aware of.

Monitor:  Thanks for helping us tonight, Dr. Jeff.

Dr. Jeff Henderer:  Okay, all.  Take care.  Hope to see you in a couple of weeks.  Academy meeting next week in New Orleans.  So long!

End of highlights for November 5, 2001.

On November 7, Dr. Wilson joined the glaucoma chat support group for a general glaucoma discussion in the Chat room. Click here for highlights of that meeting.

Click here for the most recent glaucoma chat highlights and links to the chat archives.

Click here for upcoming glaucoma chat events.