Patients' Chat Highlights
Chat Highlights
November 17, 2004

Norma Devine, Editor

Note:  A medical emergency prevented Dr. Wilson from attending chat. We used the hour for a moderated patients' chat. If you would like another such chat, please send your comments to webmaster@willsglaucoma.org.

Angel Eyes (female, age 40, Nova Scotia, Canada)
I developed uveitis when I was 18-years-old, used steroids for many years and have open-angle glaucoma. I tried many kinds of eyedrops before having ALT (argon laser trabeculoplasty), which lowered the intraocular pressure (IOP) slightly. In 2002, the pressure increased to 46 and 48 mm Hg, and I had an emergency trabeculectomy in my right eye. Two weeks later, I had hypotony (low pressure) and cystoid macular edema in my right eye, and lost some vision in it. My left eye was fine after a trabeculectomy. My IOPs have been around 8 and 10 mm Hg for a year.

BPS (female, age 62, Vermont, U.S.)
I thought I had normal-tension glaucoma. Now I am not sure. Almost three years ago, I had dental surgery to remove an impacted wisdom tooth. At the same time, the oral surgeon did a bone graft.  I had general anesthesia. Afterward, I took strong medication and felt dopey for two weeks or so.  However, I noticed I was having trouble seeing, and thought I might need new glasses. 

After a month, I went to get new glasses and found I had a big blind spot in my right eye.  I think it was larger then than now.  At the time, it seemed to be an arcuate scotoma -- a gray cloud in the shape of a fat comma (one of the common shapes for glaucomatous scotomas).  Since then, I have been told I have either normal-tension glaucoma or primary open-angle glaucoma.  The damage is only in one eye.  Medications have had little or no effect on lowering my IOPs of between 18 and 22 mm Hg.  I have declined to use Xalatan because of my eye color (very pale green), which might change.  The manufacturer does not know the long-term effects. 

[Editor's note: "In clinical trials, after six months of treatment, 6.  8 percent of patients were reported to show a gradual change in eye color, due to an increased amount of brown pigment in the iris of the treated eye.  " The long-term significance of the change is currently unknown.] http://www.pslgroup.com/dg/954a.htm

Last week I consulted a glaucoma specialist at Wills Eye.  He concluded that I probably lost oxygen supply to the right optic nerve during my dental surgery, and that killed off part of the nerve.  He wants me to have an MRI (magnetic resonance imaging) and MRA (magnetic resonance angiography) next week to rule out tumors (unlikely), blood flow problems, or tiny strokes. 

If the MRI/MRAs find nothing significant, the doctor recommends SLT (selective laser trabeculoplasty). Although he doesn't think I will have further damage, he seems to regard the laser surgery as precautionary.

I've learned that my bad cholesterol is sky high, and my hemoglobin count is also high, indicating thick blood.  Thinking these might be factors, I'm trying to change some of my eating and exercising habits.

Fifi (female, Virginia, U.S.)
Because I have encountered "ageism," I hesitate to my give my age, which is why I'm so slow in the typing department.  I just learned to use the computer a few years ago.  I have advanced open-angle glaucoma.  I've had no surgery for glaucoma. 

Janet (female, age 37, Minnesota, U.S.)
For about two years I have had neovascular glaucoma in my left eye due to chronic posterior uveitis. Cosopt seems to be keeping the neovascular glaucoma under control for now, but I am concerned about the abnormal blood vessels returning. I have neovascularization of the iris in the right eye.  I had about seven PRP (panretinatal) lasers in the eye with glaucoma and endophotocoagulation laser during a vitrectomy last August.  I also have a big cataract in the eye with neovascular glaucoma that needs to be removed.  I am concerned that the cataract surgery will cause problems with the neovascular glaucoma. 

JoeG (male, age 43, Virginia, U.S.)
I was diagnosed with open-angle glaucoma at age 15 after a skating accident.  I have had optic nerve damage in my right eye since birth.  I started on epinephrine eyedrops 27 years ago.  I tried many different eyedrops over the years, trying to keep the IOP under control.  Under the care of a glaucoma specialist, I couldn't quite reach the target pressures, so I had trabeculectomies on both eyes.  I did not need to use glaucoma eyedrops until recently. 

I just returned from consulting a glaucoma specialist in another town.  The bleb (surgically created drain) may not be working as well as it should be. 

Mari (female, age 52, Georgetown, Kentucky, U.S.)
Diagnosed with normal-tension glaucoma (NTG) four years ago.  Tried all the medications.  Now using Lumigan, Cosopt, and methazolamide (a little worried about that one).  My IOP is 12 mm Hg.  However, my vision still is not stable.  I have suffered 70 to 80 percent damage to my optic nerve, but am still able to see well.  Recently, I had ALT (argon laser trabeculectomy) in both eyes.  The IOP in the left eye has not changed; I'm waiting to find out the results for the right eye. 

Marie (wife of John, New South Wales, Australia)
John, age 51, has end-stage glaucoma.  He can still tell the difference between day and night in the left eye, and a bit more in the right.  He has only about two percent vision remaining in the right eye.  The IOP is down to 2 mm Hg again, and the eye is very sore.  He is trying Maxidex again.  The pressure in the left eye ranges between 8 and 15 mm Hg. 

John has been using glaucoma medications since 1989.  He had laser surgery and trabeculectomies in both eyes.  He is still using Alphagan, Cosopt, and Lumigan.  His IOPs vary between 2 and 40 mm Hg, and have been in the 50's in both eyes.  His peripheral vision is almost non-existent.  Within 18 months he went from reasonably good vision and driving to almost nothing. 

John is not doing well at the moment.  When his IOPs seem to be within a reasonable range, he is happier because he isn't stuck with the pain.  When he was taking Diamox (an oral carbonic anhydrase inhibitor), he ended up in the hospital with inflamed kidneys and a kidney stone.  For that reason, doctors are reluctant to prescribe Diamox again for him. 

John's IOPs in the left eye range between 2 and 40 mm Hg.  The IOPS in the right eye have finally stabilized after about 18 months.  John is still using Alphagan, Cosopt and Lumigan in the right eye.  His eye is always painful these days, but the pain doesn't seem unbearable until the pressures are in the high 40's and 50's. 

We have had a rough time of it, but John's biggest frustration is having to rely on other people so much.  That will get better.  He has applied for a guide dog, is good at using the long cane and mini guide, and is learning to type in the hope of being able to use Jaws. 

There is no support group here locally, except a group of 70- and 80-year old people, who just want to sit around and have tea and scones.  John still goes to the meetings, and tries to get them motivated.  He has persuaded a couple of them to try the equipment at the library, use the white cane, etc., so it's a start.  We tried contacting the glaucoma Australia group when John first started having the problems, but they never even bothered to reply, so I didn't try again.  Maybe I should. 

John is getting involved in the local council access committee trying to improve road conditions around here.  There are no tactile markings anywhere, no audio traffic lights, no markings into shopping centres, on curbs and so on, so things will change!

Michelle (female, Israel)
I suffered from mild uveitis for three years and have secondary glaucoma.  Until recently, the glaucoma was controlled by medicine, but for the past three months the pressures in my right eye have increased to 33 and 35 mm Hg. 

I don't want to undergo filtering surgery (trabeculectomy), because that would prevent me from using contact lenses, so I am considering selective laser trabeculoplasty. 

Nan (female, Santa Cruz, California, U.S.)
I'm here for my Mom.  She has so many problems. 

Nursenan (female, age 59, Michigan, U.S.)
I have primary open-angle glaucoma, which is part of nail patella syndrome.  Four generations of my family have had glaucoma caused by nail patella syndrome.  I was diagnosed 12 years ago.  I had ALTs and tried different eyedrops.  Two years ago I was told that my optic nerve was badly damaged.  A glaucoma specialist performed trabeculectomies on both eyes.  One of the trabeculectomies had to be revised.  I had cataracts on both eyes removed and a secondary cataract zapped with a laser.  I'm now legally blind.  The right eye is pretty bad.  Two hours, sometimes less, of using the computer at one sitting is tops.  Everything fades. 

My type of glaucoma seems aggressive in my immediate family.  My Mom was legally blind in one eye and blind in the other at death.  I had to leave my nursing career after 36 years and can no longer drive. 

Peg (female, age 59, New Jersey, U.S.)
Five years ago I noticed halos around lights with my left eye.  I was diagnosed as having ICE (iridocorneal endothelial) syndrome and secondary glaucoma.  For three years I was treated by a general ophthalmologist.  I used four different glaucoma medications, with all the nasty side effects, but the pressure was not controlled.  I was having sub-acute attacks, with pain and nausea.  Two years ago, I was referred to a glaucoma specialist.  Within weeks, I had a trabeculectomy.  My concerns are that the bleb (surgically created drain) is now thin and oozing and that eye has a cataract, which will have to be dealt with in the future.  I wish I had gone to a glaucoma specialist a lot sooner. 

PC (female, age 51, Northwest Georgia, U.S.)

Open-angle glaucoma.  Diagnosed February 2003.  Elevated pressure before that for two years.  On two glaucoma medications.  Tried three others before, which had too many side effects.  Cataract removed and implant in left eye.  Trying to keep pressure at tolerable level before moving on to selective laser trabeculoplasty.  Have appointment with doctor in the morning.  IOP was 21 mm Hg in both eyes during last visit. 

Phil (male, Kingston, Pennsylvania, U.S.)

Diagnosis: Steroid-induced glaucoma

Quest (male, Lower Gwynedd, Pennsylvania, U.S.)
Open-angle glaucoma.  Recently had SLT.  Lucky to live near Wills Eye. 

Tom (male, age 50, Mobile, Alabama, U.S.)
Had good IOP readings yesterday of 12 and 14 mm Hg by an optometrist, but a puff test was used.  I don't see the glaucoma specialist until December 12.  I'm waiting to find out if I need to repeat the SLTs. 

Sunshine (female, Toronto, Canada)
I have open-angle glaucoma. 

SteveBC (male, age 50, Vancouver, British Columbia, Canada)
I was diagnosed as a glaucoma suspect in November 1999 at age 45.  Intraocular pressures in my right eye were high.  The diagnosis was confirmed in December.  My glaucoma was caused by severe trauma to the head at age 18 (that's another story).  My visual field tests showed minimal damage, but there was damage nonetheless.  Fortunately, my visual fields have remained stable during the past five years. 

I began treatment with a .  05% solution of timolol twice a day.  I talked my doctor into trying .  25% solution some months later because I was not happy with the side effects.  Then, a year later, I only used the eyedrops once a day, and everything was fine. 

After cataract surgery in my right eye (cataract caused by the same trauma), the pressure in that eye dropped to an acceptable level.  I have been off drops for a year, and my visual fields are stable.  My next visual field test is in February.  My intraocular pressures were still within the normal range at my last visit, and I do not use any glaucoma medication. 

Viv (female, age 43, Pennslvania, U.S.)
At age 29 I was diagnosed as a glaucoma suspect.  At age 30 I had laser surgery to lower my IOP.  At age 34 I had a trabeculectomy in my left eye.  The surgery failed and I use homeoatropine and Betoptic.  At age 37, the pressure in my right eye increased.  I had laser surgery in that eye, followed by a trabeculectomy and lens implant.  Then I had a pars plana vitrectomy and more lasers.  I'm okay now.  I use the same eyedrops in both eyes. 

Wendala (female, age 27, Ohio, U.S.)
Diagnosed at age 16.  Glaucoma secondary to bilateral, familial congenital cataract removal.  All glaucoma surgery has been on the left eye, with presenting pressure of 45 mm Hg.  Have had ALT, two trabeculectomies, and SLT.  The left eye has been stable for the past 11 years, but my bleb is very thin.  Both MMC and 5-FU were used.  The right eye IOP ranges between 15 and 22 mm Hg. 

I am using Cosopt, Alphagan, andTravatan.  I also have congenital nystagmus and amblyopia.  I had strabismus, and oh, just a tad of astigmatism -- to add flavor.  With best correction, I see about 20/300 with the left eye, and about 20/602 with the right eye. 

I'm a third-year resident in pediatrics and want to sub-specialize in pediatric endocrinology -- if anyone will give me the chance!

End of highlights for November 17, 2004.

On December 1, Dr. Werner discussed "Recovering From a Trabeculectomy" in the Chat room. Click here for highlights of that meeting.

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