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Glaucoma

Does Flying in an Airplane Could Cause Problem to a Glaucoma Patient?

ANSWER:

Open angle glaucoma should not result in symptoms during commercial flights.

Narrow angle glaucoma could result in headaches, brow-aches, and other symptoms during flight for a number of reasons. One would be that fear of flying can actually dilate the pupil resulting in angle closure. Another would be use of anti-nausea medications that can result in closure of the angle. Angle closure, however, is a medical emergency and does not usually resolve on its own.

Warm regards,
David Richardson, MD

 

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How Common Is Glaucoma?

ANSWER:

Of all the causes of irreversible blindness, glaucoma tops the list. No other condition causes as much permanent loss of vision as does glaucoma. If we include all types of blinding conditions (even reversible ones) glaucoma is still ranked #2.

Only cataracts cause more worldwide blindness – and this is only so because there are not enough surgeons to treat everyone with cataracts. In industrialized countries everyone knows someone who has had cataract surgery. You may not be aware of it, but you also know someone with glaucoma. Yes, it’s that common. In fact, just over 1 in 30 people aged 40-80 have glaucoma.[1]

“60-70 million people worldwide have glaucoma”

Read the Full Text Here: How Common Is Glaucoma?

 

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Does Everyone with Glaucoma Go Blind?

ANSWER:

“Will I go blind?” is one of the most commonly asked questions by patients newly diagnosed with glaucoma. There was a time not so long ago when the answer to this question was an unqualified “yes”. Being diagnosed with glaucoma in the early 20th century meant that you were going to face eventual blindness. Effective treatments were not developed until the mid-20th century. Even those worked poorly or were associated with near intolerable side effects until about 40 years ago. Modern medicine has made great strides in both medical and surgical treatment of this condition but we are still far from a cure. Indeed, the best we can currently hope for is to slow down the loss of vision.

If we cannot completely halt the loss of vision from glaucoma, how effective are modern treatments at limiting vision loss? One very well-respected study called the Early Manifest Glaucoma Trial (EMGT) took a look at this issue. At first blush the results do not appear to be encouraging. About 60% of patients diagnosed with glaucoma eventually lost some vision. It’s important to emphasize, however, that this does not mean that 60% of patients went blind.

A century ago someone who went blind from glaucoma had likely lost all functional vision. Today, however, we define blindness a bit differently. A commonly used definition is that of the World Health Organization (WHO) which defines blindness as either vision worse than 20/400 or with less than 10 degrees of central vision remaining. Many people who fit this definition of blindness are still able to function though often with visual aids as well as other assistance.

So most people who develop glaucoma and receive treatment in the 21st century do not go blind from glaucoma. But some do. Are we getting better at preventing blindness from glaucoma? It seems we are. In 2014 a study was published looking at residents of Olmsted County, Minnesota diagnosed with glaucoma from 1965 through 2000. Those patients diagnosed more recently (from 1981-2000) were approximately 50% less likely to go blind than those diagnosed between 1965-1980.1 Is this improvement over time a result of better treatments? Perhaps. It may also be the result of greater awareness of the dangers of glaucoma in the population, better screening, and earlier detection.

Multiple studies have estimated the risk of blindness over time but only a few studies have addressed the question patients are most interested in: “Will I go blind before I die?2” One of the more recent studies published in 2013 estimated that 4 in

in 10 patients diagnosed with open angle glaucoma go blind in one eye, and 1 out of 6 (~16%) go blind in both eyes.3 As expected, the longer someone has glaucoma the more likely it is that she will go blind. Ten years after diagnosis approximately 1 in 4 patients in this study lost vision in at least one eye and 1 in 20 were blind in both eyes. Twenty years after diagnosis almost 4 in 10 patients were blind in one eye and nearly 1 in 7 patients were blind in both eyes.

These results are sobering. In a time when many people assume that modern medicine can effectively treat or cure most diseases, glaucoma is still blinding a significant number of those with this condition. Yes, we’ve made quite a bit of progress as someone with glaucoma is less than half as likely to go blind today as they would have been 50-100 years ago. Is there something other than new treatments that might further decrease the risk of blindness in patients with glaucoma? Indeed, there is something that’s been known for over 30 years to reduce the chances of going blind from this disease: early diagnosis.

Earlier detection seems to be one of the key factors in whether someone is likely to go blind from glaucoma. Simply put, a person who has already lost some vision by the time of diagnosis is more likely to go blind4 than someone who is diagnosed with glaucoma prior to losing any vision. It’s been estimated that 50% of people with glaucoma don’t even know they have it.5 Without symptoms many people do not bother to have their eyes checked for glaucoma. By the time they do go to the doctor they may already have lost vision. This is why getting evaluated for glaucoma is so important among those at risk for this disease.

If you or a loved one is at risk of developing glaucoma get screened. It is the single most important thing you can do to protect yourself from going blind if you do develop glaucoma.

References

[1] Malihi M, Moura Filho ER, Hodge DO, Sit AJ. Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota. Ophthalmol. 2014;121(1):134-141.

[2] Forsman E, Kivela T, Vesti E. Lifetime visual disability in open-angle glaucoma and ocular hypertension. J Glaucoma. 2007;16(3):313–319.

Ang GS, Eke T. Life time visual prognosis for patients with primary open-angle glaucoma. Eye (Lond). 2007;21(5):604–608.

Goh YW, Ang GS, Azuara-Blanco A. Lifetime visual prognosis of patients with glaucoma. Clin Experiment Ophthalmol. 2011;39(8):766–770.

[3]Peters D, Bengtsson B, Heijl A. Lifetime Risk of Blindness in Open-Angle Glaucoma. Am J Ophthalmol. 2013;156(4):724-730

[4] Grant WM, Burke JF. Why Do Some People Go Blind from Glaucoma? Ophthalmol. 1982;89(9):991-998.

[5] Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90(3):262–267. Leske MC. Open-angle glaucoma – an epidemiologic overview. Ophthalmic Epidemiol. 2007;14(4):166–172.

Topouzis F, Coleman AL, Harris A, et al. Factors associated with undiagnosed open-angle glaucoma: the Thessaloniki Eye Study. Am J Ophthalmol. 2008;145(2):327–335.

Date: Aug 7, 2014

 

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Microchip Treatment for Glaucoma?

QUESTION:

My mother, ****** (68yrs) is suffering from glaucoma for 25years. Can you arrange a microchip treatment for her?

Thank you,

******


ANSWER:

Dear ******,

I’m afraid there are currently no FDA approved microchips available for the treatment of glaucoma. Perhaps in a few years. Sorry I could not be of more assistance.

Warm regards,
David Richardson, MD

Date: Wed, Dec 3, 2014 at 2:46 PM

 

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Are Sudden Vision Changes from Taking Melatonin Reversible in Glaucoma Patients?

QUESTION:

Are sudden vision changes from taking melatonin reversible in Glaucoma patients?

K. Hallmark‎ via Facebook


ANSWER:

I’m not aware of Melatonin causing sudden vision changes. Indeed, Melatonin is occasionally recommended for those with glaucoma in order to protect from vision loss.

 

Warm regards,
David Richardson, MD

Date: February 12, 2016

 

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My Daughter Has Glaucoma. Can I Make an Appointment for Her to See You?

QUESTION:

My daughter has glaucoma. Can I make an appointment for her to see you?

******


ANSWER:

Having a daughter myself, my heart goes out to anyone with a child with glaucoma. It is especially heartbreaking for the parents as they have a sense of the challenges which may be faced over a lifetime by their son or daughter – something that is often too abstract for a child to appreciate (which is likely a good thing).

I am not, however, the surgeon with whom your daughter should consult as my glaucoma practice is adult-only. Pediatric (childhood) glaucomas can behave very differently from adult glaucomas and do not always respond to the treatments used in adult glaucomas. For example, whereas trabeculectomy is the most commonly recommended glaucoma surgery in adults, glaucoma drainage devices are generally preferred in children. Less invasive options such as canaloplasty may be considered, but only after a detailed evaluation of the angle anatomy.

 

Warm regards,
David Richardson, MD
Adjunct Assistant Professor of Clinical Ophthalmology
Keck School of Medicine of USC

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

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Do You Take a Holistic Approach to Treating Glaucoma?

QUESTION:

Hi. I wanted to ask as I found an article about goji wolf berries in helping with glaucoma… article on your website. Im trying to find a holistic approach that take everything into consideration, nutrition etc. So, Dr. Richardson, do you look at the person and all factors in treating someone with glaucoma, or do you treat the issue by itself only? thanks,

D***** via Submit Form


ANSWER:

Hello D*****,

Unlike many of my colleagues, I do not focus only on the intraocular pressure. Thus, my writings and recommendations regarding oral OTC supplements as well as my preference for canaloplasty over trabeculectomy glaucoma surgery. Are you a member of the FitEyes online glaucoma support group? A number of the members of that group have become my patients and I’m sure some of them would be willing to tell you about their experience with me.

If you wish to schedule a consultation with me I think you will be pleased to discover that I am both thorough and take into account your needs as an individual as well as the needs of your eyes.

I’ve copied my nurse, Ana, on this email. She would be the person to contact if you wish to schedule a time to see me in my San Marino office.

 

Warm regards,
David Richardson, MD
Adjunct Assistant Professor of Clinical Ophthalmology
USC Roski Eye Institute
Keck School of Medicine of USC

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

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Is Rutin Good For Glaucoma?

QUESTION:

I have been hearing about the fact that RUTIN is good for glaucoma. Is it worth my taking it or is there a potential danger?

J**** via Submit Form


ANSWER:

Hello J****,

I do recommend a combination of Rutin and Forskolin to some of my patients with glaucoma. You can read more about this here:

Rutin May Have a Role in the Treatment of Glaucoma

 

Warm regards,
David Richardson, MD
Adjunct Assistant Professor of Clinical Ophthalmology
USC Roski Eye Institute
Keck School of Medicine of USC

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

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Is There a Laser Treatment for Someone with Glaucoma and Diabetes?

QUESTION:

I am diabetic and I believe I have gluacoma or floater, is there a form of surgery of laser treatment that would correct my condition? I have loss vision in my right eye

C**** via Submit Form


ANSWER:

Dear C****,

Both diabetes and glaucoma can result in permanent loss of vision. Whether loss of vision can be improved by laser or surgery depends upon the underlying cause. I’ve copied my nurse, Ana, on this email. She will be able to assist you if you wish to schedule a consultation with me in my San Marino office.

 

Warm regards,
David Richardson, MD
Adjunct Assistant Professor of Clinical Ophthalmology
USC Roski Eye Institute
Keck School of Medicine of USC

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

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Is Resveratrol Helpful For Glaucoma?

QUESTION:

I’m sorry to bug you, but I was wondering if you think Resveratrol would be helpful for glaucoma?

J****


ANSWER:

Hello J****,

I do think Resveratrol has the potential to benefit the optic nerve. I’ve written about it here:

Resveratrol May Protect the Eyes from Glaucomatous Damage

 

Warm regards,
David Richardson, MD
Adjunct Assistant Professor of Clinical Ophthalmology
USC Roski Eye Institute
Keck School of Medicine of USC

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

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Down Syndrome with Glaucoma

QUESTION:

My sister is down syndrome with glaucoma. She has insurance. I have money to do what ever i must do for her to see again

M**** via Submit Form


ANSWER:

Dear M****,

I am sorry to hear of your sister’s condition. How old is she and at what age did she develop glaucoma? I ask as childhood glaucomas can be very different from adult glaucomas. My practice focuses on adult-only glaucomas. If her glaucoma began in childhood then I would be happy to refer you to a colleague who would be better able to care for her eye condition.

With regard to insurance, I do not participate with any insurance panels. However, my colleague, Dr. Jeffrey Hong who practices both in my office and in Pasadena is contracted with a number of PPO insurances. If you prefer her exams, testing, and treatments to be covered by insurance then he might be a better choice for her care. I’m certain that either I, Dr. Hong, or one of my recommended glaucoma specialist colleagues would be available to care for your sister. Once an examination and testing have been performed appropriate treatment options can be discussed.

You mentioned that you are willing to do whatever you must in order “for her to see again”. I have no doubt your sister is fortunate to have a brother like you. If her vision loss is from glaucoma, however, then I do not wish for you to go out of your way (both in distance, time, and funds) with the hope for improvement in vision. Neither I, Dr. Hong, nor my other local colleagues have any unique treatment that can restore vision lost from glaucoma. If, on the other hand, her vision has been lost due to cataracts or other reversible disease then we may have something to offer beyond what you have found elsewhere. My hope, of course, is that there is something other than glaucoma that is contributing to her lost vision.

I’ve copied my nurse, Ana, on this email. She can assist you in scheduling a consultation with me, Dr. Hong, or another colleague of mine.

 

Warm regards,
David Richardson, MD
Adjunct Assistant Professor of Clinical Ophthalmology
USC Roski Eye Institute
Keck School of Medicine of USC

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

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I Am a Glaucoma Suspect, Can I Ask Questions?

QUESTION:

Hello Dr. David,

Greetings of the day.

My name is A**** and I am from India. I came to know about you from Youtube. I am a glaucoma suspect is what my doctor told me. I have few questions regarding that, please let me know if I can ask or not.

Thanks & Regards,

A****


ANSWER:

Dear A****,

I would be happy to answer any general questions you may have about glaucoma. Unfortunately, without performing an in-person examination I will not, however, be able to answer any specific questions you may have about your individual eye condition.

You may find the following website New-Glaucoma-Treatments helpful as I have addressed most of the questions about glaucoma that have been asked of me over the last dozen years.

 

Warm regards,
David Richardson, MD
Adjunct Assistant Professor of Clinical Ophthalmology
USC Roski Eye Institute
Keck School of Medicine of USC

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

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What Is Normal Glaucoma?

ANSWER:

Normal Tension Glaucoma (or “NTG”) is a subset of open angle glaucoma.  People who have this condition are at risk for losing vision even though their intraocular pressures (IOP) are not elvevated beyond what we generally consider the “normal” range. The treatment is essentially the same as with other open angle glaucomas: to further lower the IOP with drops, laser, or surgery.

 

Warm regards,
David Richardson, MD

Date: Aug 29, 2013

 

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After My Glaucoma Surgery How Long Should I Stay in the US for Recovery?

QUESTION:

How long should I stay in US for recovery?


ANSWER:

All glaucoma surgeries require about 90-120 days for stabilization after surgery. That being said, we generally have a good idea where the IOP will settle about a month after surgery. If you are planning to have surgery done on both eyes we can schedule the second eye within two weeks of the first. So, unless you have a local surgeon who is comfortable and willing to take over your post-operative care, I would recommend a minimum of six weeks. I’ve had patients stay for as little as one week after surgery, but they all had experienced local surgeons who had agreed beforehand to take over the post-operative care.

Warm regards,
David Richardson, MD

Date: Thu, Jan 15, 2015 at 1:53 AM

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Will Canaloplasty Cure My Glaucoma?

ANSWER:

Today there are no cures for glaucoma. Both drops and surgeries work to protect your vision from further loss of vision by lowering the pressure in the eye. Now, one of the advantages of surgeries such as canaloplasty is that there’s mountain of evidence that the pressure stays low throughout the day. Whereas with drops there can be quite a bit of fluctuations during the day. Additionally, canaloplasty has the added advantage of restoring your natural drainage system and opening it up so that it can work the way it used to before you developed glaucoma.

 

Warm regards,
David Richardson, MD

Date: Aug 29, 2013

 

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I Was Wondering What a Few Point Difference Could Make When the Glaucoma Has Not Progressed Since Diagnosis?

QUESTION:

So my base OCT and the next one a year later (just recently) show NO progression of glaucoma – it is all relative though as my optic nerve had a lot of damage when I was diagnosed. The ophthalmologist wants me to be on latanoprost / timOlol combo. For two and a half years since diagnosis I was just on latanoprost which was working. That combo has side effects for me and I was reasonably happy with just the latanaprost and had no side effects that I could detect anyway. He wanted my IOP down. I was wondering what a few point difference could make when the glaucoma has not progressed since diagnosis.


ANSWER:

OCTs are a wonderful method of detecting subtle changes in the nerve fiber layer in the early and moderate stages of glaucoma. Unfortunately, in the later stages this technology is nearly useless. Once the nerve fiber layer thickness reaches 70 micrometers or less (commonly seen in advanced glaucoma) the OCT will not reliably detect further progressive loss even if vision is being rapidly compromised. At later stages in glaucoma there is no substitute for the much maligned threshold visual field testing which, unfortunately, must be repeated multiple times per year (not just annually) in order to detect real visual field loss.

With regard to your question about the importance of further IOP reduction the medical literature is clear that more advanced glaucoma requires lower target pressures. What that target is for each individual, however, is only discovered after the fact. In essence glaucoma is treated by choosing a target IOP based on many factors (age, severity of visual field and NFL loss, family history, medical conditions, etc.) then the NFL and visual fields are monitored. If no progression is detected the then target is considered adequate. If, however, progression is detected then the target IOP is reduced another 15-20% until the rate of progression is adequately reduced.

As you can imagine, the success of such an iterative process is severely limited by the variability inherent in all glaucoma testing (especially IOP and visual fields). It takes at least three measurements to separate out a trend from the noise of inter-test variability. For this reason I recommend that my own patients with glaucoma obtain visual field and/or OCTs a minimum of twice yearly and as frequently as every three months. I also encourage home IOP monitoring for those who can afford it. Hopefully such devices will be both affordable and covered by insurance over the next few years.

Warm regards,
David Richardson, MD

Date: Sun, Mar 15, 2015 at 11:37 PM

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I’m from India and My Father Is 66 Years Suffering from Glaucoma. Can We Visit Your Hospital for Glaucoma Treatment?

QUESTION:

Respected Sir, I’am From India Hyderabad. I saw your website. My father age is 66 years he suffering from glaucoma. Right eye was already lost due to effected of glaucoma, some days ago my father is able to see, read and write recently left eye was effected with glaucoma we consulted with the doctors they adviced to undergo operation and they conducted operation on left eye after replacing cornea first operation was failure and after 1 week the 2nd operation was done cornea was replaced, after operation was done for some times light was seen after 2 months my father not able to see on left eye,doctors are saying that left eye nerve is damage and weak due to high pressure.

Please sir I requested to you kindly inform immediately this is medical emergency, I’am waiting for your response, we are trying to come to your hospital for glaucoma treatment.

******


ANSWER:

Dear ******,

I’m sorry to hear about your father’s eye condition. Fortunately, I don’t think he needs to travel to the USA to receive excellent surgical treatment. Dr. Ganesh Venkataraman may be able to help him. I’ll contact Dr. Venkataraman and let him know about your father’s condition.

 

Warm regards,
David Richardson, MD

Date: October 2014

 

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What Is the Best Book on Glaucoma and Cataracts?

QUESTION:

Doctor Richardson:

I purchased your book on cataracts. I wonder if I can trouble you to refer me to two sources on glaucoma and cataracts. What is the best text on glaucoma and cataracts. One level is for the pro and the other for lay. I am having a real hard time finding this kind of information. I have some medical background and have been a diabetic almost 35 years. I have glaucoma and may need cataract surgery in the near future.My doc is Robert Avery and Mark Silverberg both practice in Santa Barbara. Thanks for any info on the requested sources.

******


ANSWER:

Dear ******,

I’m afraid there is no lay book on glaucoma that I can currently recommend. Indeed, for that reason I’m now working on the rough draft of So, You’ve Got Glaucoma? Unfortunately, it won’t be ready for print until late 2014 at the earliest.

As for textbooks, I can only recommend the ones I have been motivated to purchase in the last five years. As such, they are not basic texts and are really geared toward specialists or advanced surgical techniques which you may find a bit esoteric in your search for basic knowledge. Nevertheless, both of the following are excellent references:

 

Warm regards,
David Richardson, MD

Date: Nov 5, 2013

 

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Does Mirtogenol Really Work for Congenital Glaucoma?

QUESTION:

I have a 16 year old son who has congenital glaucoma and despite numerous surgeries, is blinded in both eyes.

His right eye has 2 shunts placed and perhaps due to the trauma of the surgeries, the retina is now detached. On top of that this eye has cataract and calcium deposit.

His left eye has 1 shunt inserted but despite being on maximum eyedrop and 2 diamox pills a day, his pressure still not ideal, IOP 25-36. The doctor has suggested to perform a trabeculectomy on this eye. My fear is that the retina will detach like what happen to his right eye.

Recently, another boy with glaucoma (his glaucoma was caused by eczema though) and has since been blinded too, started on taking Mirtogenol twice daily and his pressure went from 36-16. His father told me he is unsure if it was the Mirtogenol working or it was just some kind of divine intervention or that the IOP actually fluctuated.

I am very troubled and not sure what kind of treatment should my son undergo. From your experience, does Mirtogenol really work, for congenital glaucoma?

I would deeply appreciate if you could spend some of your precious time advising me.

Thank you very much.

******


ANSWER:

Dear ******,

I’m very sorry to hear about your son’s glaucoma. I can only imagine how much suffering you have both experienced from his condition and the multiple failed treatments. I wish that Mirtogenol could provide some much needed relief from this suffering. I do think it is a generally well-tolerated supplement with decent evidence of benefit in adults. However, as you most likely already know, congenital glaucoma is a more challenging disease than the glaucoma commonly seen in adults. There simply is no study of which I am aware that has looked at the use of supplements such as Mirtogenol with congenital glaucoma. Additionally, I have personally never seen a decrease in IOP by 50% in any of my patients taking any oral supplement. That being said, as there are few risks associated with taking Mirtogenol it may be worth considering.

 

Warm regards,
David Richardson, MD

Date: Mar 5, 2014

 

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My 13 Years Old Son Has Glaucoma. Any Advice You Can Give Me?

QUESTION:

Dear Doctor,I need a help and advise from you regarding my 13 years old suffering from congenital glaucoma since birth. He has gone through series of surgery and eyes drops. Now my son surviving with his left eyes only. Both eyes has implant lens and tube. Doctor I got worried with the latest info from my doctor where by my son need to undergo another tube implant in his left eyes.

Doctor, I really need to talk to you further on this issues. I really need a help as I don’t want my only son go blind and I am financially suffering.

My son name is ******, Age 13, Nationality Malaysian Indian. Mother Vietnamese.

I look forward to hear from you soon Doctor.

Sadly, ******


ANSWER:

Dear ******,

I’m very sorry to hear about your son’s condition. Congenital glaucoma is both heartbreaking and challenging to treat. Unfortunately, my practice is focused strictly on adult eye disease so I am unable to provide any valuable assistance. I wish you and your son the best.

 

Warm regards,
David Richardson, MD

Date: Feb 10, 2014

 

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Is Laser Peripheral Iridotomy for Me?

QUESTION:

Hello Dr. Richardson,

I viewed one of your patients on Youtube who had a Laser iridotomy done by you. I know you are a very busy man so I’ll keep this brief.

I have seen 4 specialist regarding narrow angle and 3 out of 4 say I should have laser Iridotomy. I’m terrified after reading so many horror stories online and so few success stories. I wonder if you could give me some positive feedback about the potential side effects. I am so anxious about the side effects (double vision, white lines, and glare) that so may complain is permanent. Are these typical because it sure looks that way from all the blogs.

I have someone who I think is a good Ophthalmologist from Miramar Eye Specialists Medical Group in Ventura County where I live. However, I would appreciate a little feedback from another professionals experience.

If you are not able to write back I understand and if you are thank you in advance.

Best regards,
******


ANSWER:

Dear ******,

Although I cannot comment on whether laser iridotomy is appropriate for you, it is generally well-tolerated. Yes, there are risks as with every surgery. Do most people notice glare or ghosting afterward? No. But some do and it can be permanent.

However, for those who have very narrow (what we call “occludable”) angles the real risk is a sudden, permanent, severe loss of vision. Compared to that all the risks of laser peripheral iridotomy are but annoyances. Are there people who have commented online about how unhappy they are with glare or ghosting after the laser treatment? Yes. Would each and every one of those people prefer their current symptoms to severe loss of vision? Your guess is as good as mine, but I’d bet dollars to donuts that not one of them would prefer blindness over glare or ghosting.

Laser peripheral iridotomy is a bit like wearing a seatbelt. If you never get into an accident then you may feel it was an annoying, wasted effort to wear it. But if you knew you were going to get into an accident I bet you’d make certain you had buckled up. Your doctors don’t know your angle will close (get into an accident) but it sounds like most agree that you’re at high risk.

Hope this gives you some perspective.

BTW, is the doctor you’re seeing at Miramar Dr. John Davidson? If so, he’s excellent. I’d trust my eyes to his care.

 

Warm regards,
David Richardson, MD

Date: Aug 21, 2014 at 6:36 AM

 

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I Am 73 Years Old. I Was Recently Diagnosed With Glaucoma. What’s The Best Treatment For Me

QUESTION:

My Eye Dr- whom I do not trust, recently diagnosed me with glaucoma. But she never explained my type of glaucoma and despite several exam. She just recommended eye drop. She does not gives me details description of my eye problem. She recommend laser surgery. She told me before, “you did not need the drop”. In my last visit, she prescribed eye drop. Please help me. I am 73 years old and I can read without glasses and do not have any Blur vision. What is the best choice of treatment?

Thank You.

******


ANSWER:

Dear ******,

I am sorry to hear that your current eye doctor has not earned your trust. It takes time (something few modern doctors have enough of) to both educate about eye conditions and earn trust. I have created a website to address the glaucoma education challenge: New-Glaucoma-Treatments.com

With regard to your glaucoma treatment, I’m afraid it is not possible to make a recommendation without first completing an in-person examination. Glaucoma treatments depend upon elements of the eye’s anatomy that can only be seen with a slit lamp (clinical microscope). I’ve copied my nurse, Ana, on this email so you may schedule an appointment to see me if that is possible for you. I am located in San Marino, CA (San Gabriel Valley).

Warm regards,
David Richardson, MD

Date: Sat, Dec 27, 2014 at 10:15 PM

 

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Sick and Tired These BAK-Containing Eye Drops for Glaucoma. What Are the Pharmaceutical Companies Thinking

QUESTION:

Hi, Doc!

Many thanks from South Africa, as well as a happy and prosperous 2015!

I will definitely mention this (new?) procedure to my ophthalmologist, as I’m sick and tired these BAK-containing eye drops for glaucoma, which seem to harm and severely irritate my eyes rather improving their condition. I filled out your questionnaire out of desperation! I know glaucoma can not be healed, but it can be slowed down significantly, which, in my case, doesn’t seem to be happening.

At the moment I am doing my own (layman’s) Internet research on glaucoma eyedrops containing less harmful preservatives, or none at all. I know many drugs have different brand names in different countries.

Even the only anti-allergy eye drops gluacoma patients are allowed to use, Relestat, contain the above-mentioned preservative! What are the pharmaceutical companies thinking? Do they care enough?

Yours sincerely,
******


ANSWER:

Dear ******,

You are fortunate to live in South Africa where the “father of Canaloplasty”, Dr. Robert Stegmann practices. He has taught many surgeons in South Africa and around how to perform this surgery. If you can get in to see him or one of his associated surgeons I’m confident you’ll be in good hands.

Warm regards,
David Richardson, MD

Date: Fri, Jan 2, 2015 at 10:14 PM

 

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Is It Possible for Someone to See Again after Being Blind for Two Years If They Undergo a Surgery?

ANSWER:

If glaucoma was the cause of vision loss then we do not currently have any way of getting vision back. Perhaps stem cell or genetic treatments will provide the possibility of returning vision in the future, but at present this is not available.

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Can a Lens Replacement Surgery Give Better Eyesight and More Room in the Eye of a 55 Year Old Patient with Narrow Angle Glaucoma?

QUESTION:

Hi, I am 55 & have narrow angle glaucoma. I had urgent iridotomies 5 months ago, which were successful, but my IOP is still high & angles still narrow, even with drops. I have recently read an article about Cataract surgery helping glaucoma patients (with or without cataracts). I do not have cataracts, but would lens replacement surgery give me more room in the eye, & better ‘prescription’ eyesight (I am longsighted), or have I misunderstood the whole concept. thankyou.

******


ANSWER:

Dear ******,

Your understanding of the concept is correct. Here in the USA, however, removal of an otherwise clear lens is not embraced as a treatment for narrow angle glaucoma. There are a few reasons for this. One is that removal of a clear lens has significant risks (including loss of vision – though rare). Another is that most insurances do not recognize glaucoma as a reason to remove the natural lens so they often refuse to pay for the surgery.

 

Warm regards,
David Richardson, MD

Date: Sep 13, 2012

 

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My Son Was Diagnosed with Glaucoma at the Age of 12, Is It a Fluke or Is There Some Underlying Issue or Genetic Disorder That Caused This?

QUESTION:

Is it just a fluke that my son was born with bilateral cataracts and was recently diagnosed with glaucoma at the age of 12 or is there some underlying issue or genetic disorder that caused this?

******


ANSWER:

Dear ******,

Not necessarily a fluke. Glaucoma is more common in children with cataracts. Not necessarily genetic either as prior surgery can predispose to glaucoma.

 

Warm regards,
David Richardson, MD

Date: Sep 22, 2012

 

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Is There Any Similar Less Invasive Surgery, Other Than a Trabeculectomy?

QUESTION:

Hi, I understand that unfortunately Canaloplasty is not a treatment for narrow angle glaucoma, are there any similar less invasive surgeries, other than a trab for my condition. I have had laser.

******


ANSWER:

Dear ******,

If the narrow angle is secondary to cataract formation then either cataract surgery alone or combined with canaloplasty is an option. Unfortunately, it is difficult to get insurances in the US to approve cataract surgery when the only indication is narrow angle glaucoma.

 

Warm regards,
David Richardson, MD

Date: Oct 3, 2012

 

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Can Glaucoma Lead to Floaters in the Eye?

ANSWER:

In general, no. Although floaters are common among the elderly, the new presence of floaters could indicate the presence of a retinal tear which would need to be treated in order save vision. The only way to tell whether a new floater is associated with a retinal tear is by having a “dilated exam” by an ophthalmologist.

 

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Does Glaucoma Surgery Last a Life Time?

ANSWER:

There is no currently available glaucoma surgery that can be expected to last for life (at least when one’s lifespan is measured in decades). That being said, there are many exciting new surgical treatments being developed that could be of benefit if canaloplasty failed down the line.

 

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Can a Patient Undergo Canaloplasty After Having SLT (Selective Laser Trabeculoplasty)?

ANSWER:

Briefly, canaloplasty can generally be performed after SLT. It is ALT that can sometimes be problematic. As for how long it lasts, the longest studies of canaloplasty have shown well-sustained results as far as three years out from surgery. Beyond that no one knows, but we have good reason to believe that for most people with glaucoma it would continue to last beyond that.

 

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Can Glaucoma Patient Do Weight Lifting Exercise? Is High Dose Vitamin C Such as Ascorbic Acid and Laroscorbine Able to Lower IOP?

ANSWER:

I generally recommend to my patients with glaucoma that they limit weightlifting to multiple repetitions of lesser weights rather than fewer repetitions of higher weights as the effort required to lift heavy weights does transiently increase the intraocular pressure. Also, recent studies have confirmed that working out with lesser weights can be just as effective in building up muscle as heavier weights (safer too).

As for the use of vitamin C, there is no strong evidence that this supplement has any benefit in the treatment of glaucoma. If you are looking for supplements that may benefit glaucoma then Mirtogenol and Curcumin have some evidence of a beneficial effect.

 

Warm regards,
David Richardson, MD

Date:

 

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Can a Patient Take Glaucoma Eye Drops to Reduce IOP After Having Surgery?

ANSWER:

I’m afraid it would be unwise and potentially harmful for me to give an opinion about treatment when I have not performed an examination myself. What I can say is that the IOP can fluctuate immediately after any glaucoma surgery. Whether 25 mm Hg is too high depends upon the underlying health of the optic nerve and visual fields (something I cannot comment on). The best source of an answer to a question of this type would be the surgeon who performed the surgery.

 

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Is There Any Reason Not to Use Glaucoma Drops After Canaloplasty/Cataract Surgery?

ANSWER:

  • Residual blood in the canal can elevate IOP after canaloplasty.
  • Residual viscoelastic can elevate IOP after cataract surgery.

There are more reasons, but those are the most common. As to why doctors don’t always lower the IOP when it is elevated? That depends upon the unique clinical situation. Some people are able to tolerate an IOP in the high twenties for a period of time without significant risk of nerve damage.

 

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Is It Okay for a Glaucoma Patient to Take Amoxicillin (500 Mg) for a Chest Infection?

ANSWER:

I’m sorry, but my California medical license limits my ability to give specific medical advice over the internet. You will have to ask your personal ophthalmologist this question.

In general, however, Amoxicillin does not pose a problem with open angle glaucoma.

 

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Is There Any Special Diet to Observe or Effective Way to Be Taken for Dry Eyes?

ANSWER:

With regard to dry eyes, I will often recommend a diet rich in omega-3 fatty acids – or that supplements be taken by mouth (fish oil or flax seed oil).

 

Warm regards,
David Richardson, MD

Date: Jun 17, 2013

 

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Will Eye Drops Be Necessary After Surgery?

ANSWER:

This depends upon how severe the glaucoma is and what the “target IOP” might be.  Canaloplasty alone can generally get the IOP into the teens.  For many people this is acceptable.  For others who need IOPs in the single digits (<10mmHg) canaloplasty alone is unlikely to achieve that goal without additional drops.  Although trabeculectomy may be more likely to achieve IOPs below 10mmHg without drops, “trab” surgery also has a higher risk of resulting in an IOP that is too low (<5mmHg) especially in myopes.  Keep in mind that no surgery is guaranteed to achieve a given IOP. I follow plenty of patients who have had trabeculectomy surgery who still need drops to adequately control their eye pressures.

 

Warm regards,
David Richardson, MD

Date: Jul 5, 2013

 

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Prolene Suture, Normal-Tension Glaucoma and Canaloplasty

QUESTION:

As an advancing OAG patient, I have for some time now been interested in the canaloplasty procedure. In Australia, however, where I live, no glaucoma specialist is yet performing his surgery. Of course, the overriding reason for my interest is with this surgery’s safety profile over that of traditional filtering surgery.

One concern expressed by an ophthalmologist down here is with the tensioning suture being left indefinitely in place in the canal. I gather that there have not been any concerns to date in this regard? Another concern I have heard mentioned is with the efficacy of the canaloplasty with NTG patients, the ones who were not formerly NTG patients but had advanced to such a stage following successful, at the time, SLT interventions with various ongoing topical medications, all of which were no longer effective with the newly acquired NTG.

Lastly, I am wondering if trials were ever done with a canaloplasty type procedure where the tensioning suture were excluded. If a circumnavigation of Schlemm’s canal were done with the microcatheter (including viscodilation) to help unroof the canal, with a soon after postoperative ALT or SLT of the trabecular meshwork, then two questionable sites would be (virtually) concurrently addressed. Without a prompt laser trabeculoplasty being done subsequent to the above unroofing of the canal, would it not be possible, then, that the canal could eventually re-collapse with an inefficacious pinocytosis of aqueous percolating through the meshwork? Conversely, in the absence of an almost simultaneous canal dilation, would this not be the reason that ALT and SLT have not always had good long term outcomes? All in all, with both sites concurrently targeted, perhaps the tensioning suture may not be required.

******


ANSWER:

Dear ******,

You have a number of good questions, not all of which have answers that are known.

With regard to the Prolene suture, this material has a very good track record as it has been used as intraocular lens haptic material for decades with exceedingly rare complications associated with it.

NTG is a challenge with any treatment (medical or surgical). I have treated NTG patients with canaloplasty but generally warn them that canaloplasty alone will not eliminate their need for drops. Trabeculectomy is more likely than canaloplasty to reach the target IOP in someone with NTG or advanced glaucoma, but as you know, that comes with a price paid in risk and lifestyle limitations.

The suture is needed for full effect. All experienced canaloplasty surgeons will tell you that IOP lowering effect is diminished in patients in whom they could not fully catheterize and place the Prolene suture. In my experience placement of the stent (suture) adds an additional 2-3mmHg IOP lowering.

Finally, with regard to SLT and ALT, no one really knows how these procedures work so your guess is as good as anyone elses.

 

Warm regards,
David Richardson, MD

Date: Jul 22, 2014

 

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I Have Glaucoma. Do You Have Plans of Going to India?

QUESTION:

I am from Guwahati, Assam of India. I have been suffering from Glaucoma since 11 years. I have been taking treatment at ****** India. But i am not satisfied with my doctors. I want to see the beauty of the world, so i want to take best treatment under a best doctor just like you.

Sir it is quiet impossible for me to go USA from India. I cannot afford. Sir when you will come India please inform me, I will go to you immediately for my best checkup. I want to meet you. Sir please give me response.

******


ANSWER:

Dear ******,

I would very much like to travel to India. Although I have no plans to do so in 2014 or 2015, I will keep such a destination in mind for future years. If I do travel to India I will be certain to announce it on my website www.new-glaucoma-treatments.com

 

Warm regards,
David Richardson, MD

Date: October 2014

 

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Can a Glaucoma Patient Use Another Set of Eyes If He/She Can Get from a Donor?

ANSWER:

No, not with currently available medical technology. To date the only “transplantable” ocular tissues are in the front of the eye (conjunctiva, sclera, cornea). Whole eye transplants will likely remain in the realm of science fiction for at least a few more decades (if they ever leave that realm).

 

Warm regards,
David Richardson, MD

Date: August 28, 2014

 

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I Have Angle Closure Glaucoma, Is Canaloplasty Not Suitable For Me?

QUESTION:

Hi Doctor Richardson.

Thank you so much for your email.

Does it mean if I have angle closure glaucoma, canaloplasty is not suitable for me?

I have asked my previous ophthalmologist who did iridotomy, and she quite’s sure that I have angle closure glaucoma, but the other ophthalmologist who would do trabeculectomy to me is quite sure also that I have open angles glaucoma. I have plans to seek a third opinion from a Singaporean ophthalmologist regarding angle closure or open angle glaucoma.

Is there any test so I can send you the result to you to determine whether I have angle closure or open angles glaucoma?

Thank you


ANSWER:

Dear ******,

If your angle is closed then canaloplasty would not be an option for you. That being said, if it is possible to open the angle with cataract surgery then canaloplasty could be done either at the time of or after cataract surgery. Unfortunately, there is no test report that will give me the information I would need to determine whether your angle is appropriate for canaloplasty. Only an in-person gonioscopic examination at the slit lamp (clinical microscope) would allow me to make this determination.

Warm regards,
David Richardson, MD

Date: Sat, Dec 27, 2014 at 7:21 AM

 

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I Am Very Nearsighted. I’ve Been Told That I Could Be at Higher Risk for Complications after Glaucoma Surgery. Why Is This?

QUESTION:

I am very nearsighted. I’ve been told that I could be at higher risk for complications after glaucoma surgery. Why is this?


ANSWER:

High myopes (those who are extremely near-sighted) are at greater risk for developing vision-threatening hypotony maculopathy after trabeculectomy or glaucoma drainage device surgery. This is one of the reasons I prefer canaloplasty in my area which has a disproportionate number of myopes due to the racial mix of my community.

Extreme myopes may also suffer from a condition termed “scleral rigidity” which can result in widely fluctuating IOPs and frustration or failure with multiple glaucoma surgeries. Think of the highly myopic eye as a thin-walled ball. Pumping up a thin-walled plastic (not rubber) ball will result in a squishy ball until just before it is filled with air. Once filled it is suddenly firm. The next half pump of air makes it rock solid.

Such is the case with extremely high myopes. When there is less than a certain amount of aqueous fluid in the eye the IOP is too low (hypotony). A few micoliters more and the IOP shoots up past 30mmHg. There’s just very little “wiggle-room” in terms of how much fluid a myopic eye can hold and maintain an ideal pressure. Truly, myopic eyes are the high-maintenance Goldilocks of eyes.

Oh, did I mention that the sclera (eye wall) tends to be much thinner in myopic eyes? This makes creation of a partial thickness scleral flap (required in both trabeculectomy and canaloplasty) quite challenging. With canaloplasty the surgeon actually has to create two partial thickness flaps! No wonder so few surgeons are volunteering to take on this challenge.

Bottom line is that the highly nearsighted who also have glaucoma should expect to face challenges in both the diagnosis and treatment of their glaucoma.

 

Warm regards,
David Richardson, MD

Date: Nov 23, 2014

 

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