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Loss Of Vision [Others]

I Can’t Afford to Pay out of Pocket. Are There Any Glaucoma Specialists in the San Gabriel Valley That Dr. Richardson Recommends

ANSWER:

I certainly understand that not everyone can afford to pay out of pocket for their health care. That is why I have worked hard to keep my overhead low and my fees reasonable. Indeed, if you have a high deductible you may end up paying out of pocket even if you see an in-network doctor. Worse, when you go to an in-network doctor you may have no idea what you will have to pay until after it has been processed through your insurance.

When you see me you will know ahead of time what to budget for. My initial consultation fee is $197 and any additional testing is $77 per test (not per eye as with some other practices). If you have copies of recent eye tests I may be able to use those reports saving you the cost of in-office testing. There are no unpleasant surprises here.

If you have a PPO insurance you may also have out of network benefits. We have found that many PPO insurances reimburse well enough that the final cost to see me is in the range of many in-network co-pays. My billing specialist, Helah, should be able to find out what your insurance may reimburse you after your visit with me.

 

Warm regards,
David Richardson, MD

 

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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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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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Loss of Vision Due to Low IOP (Hypotony)

QUESTION:

In the last year I have had 4 retinal detachments. The retina now seems to be in good shape and well attached. Unfortunately I now have low IOP with loss of vision. The eye pressure is 5. I live in mexico and seem to have run out of specialist to assist me. I have been told that a glaucoma specialist is a good place to start because of their familiarity with IOP issues. Do you have any thoughts about this. Do you treat low IOP or know someone who specializes in treating this condition.

******


ANSWER:

Dear ******,

I’m sorry to hear about your loss of vision. Low IOP (hypotony) can lead to a condition called hypotony maculopathy that can result in loss of vision. Hypotony is actually more challenging to treat than high IOP. We have many ways to bring down high IOP but few to deal with hypotony. Those that do work tend to be focused on revising prior glaucoma surgeries. Hypotony after retinal surgeries tend to be even less responsive to treatment.

Unfortunately, I cannot offer any advice without seeing in-person what might be causing this condition. Even with an exam it is unlikely that I would have much to offer you beyond what your doctors have already tried. If, however, you would like to set up a consultation with me I have copied my nurse, Ana, on this email. She can help you set up the appointment and arrange for obtaining copies of your prior records. I would need to see what attempts have already been made to treat your hypotony (such as topical steroid treatment).

 

Warm regards,
David Richardson, MD

Date: March 13, 2014

 

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Do You See Kids? If So, How Young Do You Start?

QUESTION:

Do you see kids? If so, how young do you start? I have a 6 year old who’s been complaining of eye pain, etc and I would really like to get them checked. Thanks


ANSWER:

Dear ******,

I’m afraid I do not see children, but Dr. Jeff Hong (who works out of my San Marino office) does. He is in my office two Friday mornings each month. If that does not work with your schedule he also works out of Pasadena. His Pasadena office number is (626) 844-7001.

 

Warm regards,
David Richardson, MD

Date: Aug 19, 2014

 

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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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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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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 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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