Questions and Answers | Q&As

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
Patient-Focused Ophthalmologist

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

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

QUESTION:

Hello, Do you have patients from out of state?

I am moving to Mesquite, NV. I have had Glaucoma for over 4 years. So far, I am just being watched – none of the eye drops have worked for me. The pressure is 23 in one eye and 24 in the other. I recently read your article that Canaloplasty doesn’t work as well if Cataract surgery is not involved. I am 69 and in good health. I was told that I only have a tiny cataract at this time. Should I schedule an appointment with you or wait until the Doctor says that I need Laser? I am in a real quandary by the drops not working.

Thank you,

D**** via Submit Form

ANSWER:

Dear D****,

I often care for those who live outside of California. Indeed, this is common enough that travel guidance can be found on my website here:

Patient Travel Guide

I’ve copied my nurse, Ana, who is also a great resource. Please feel free to email or call her for questions not already covered in our travel guide.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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

QUESTION:

Hi Dr. I hated to bother you, but I have tried everything and just can not find an answer. My own eye Dr did not know. I have GLAUCOMA and I am on many eye drops for treatment. I also have arthritis and NEED to take over the counter pain meds. I have heard that I should NOT take aspirin. Is it OK to take ibuprofen? I do not over use, just enough to take the edge off the pain of arthritis. (once or twice a day.)

Please help me I don’t want to do anything that would be harmful to my GLAUCOMA

J*** via Email

ANSWER:

Dear J***,

Please understand that I cannot provide specific recommendations for you without having a first-hand knowledge of your ocular condition. That being said, I can share with you what I tell my own patients. For those with significant arthritis I generally recommend oral supplementation with Curcumin (by Life Extension) and/or PEA (by Vitalitus). Recommended dosing and potential drug interactions are listed on the New-Glaucoma-Treatments.com website.

I also recommend discontinuing Glucosamine/Chondroitin (if being used to treat arthritis) as it can elevate intraocular pressure.

With regard to aspirin and ibuprofen, I neither recommend for or against use of those analgesics if needed for pain control.

Hope this was helpful.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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

QUESTION:

Don’t know if anyone has asked you already, but have you formed any opinion on the newly approved Symfony IOL yet?

Thanks.

via Email

ANSWER:

Hello Y*****,

I’ve personally not found a reason to use the Symfony IOL. If my patients desire an “extended range” of vision then I offer the Staar nanoFLEX which can provide that without the rings associated with multifocals or the Symfony IOL. For those who I believe will tolerate some rings at night I generally recommend the AMO multifocal IOLs. Time will tell whether the Symfony IOL is anything other than a multifocal IOL with less range and fewer rings around lights than prior IOLs. For now I’m essentially watching from the sidelines.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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

August 3, 2016

QUESTION:

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

via Email

ANSWER:

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
Patient-Focused Ophthalmologist

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

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

August 4, 2016

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?

via Email

ANSWER:

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
Patient-Focused Ophthalmologist

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

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

August 5, 2016

QUESTION:

Hi. I wanted to ask as I found an article about goji wolf berries in helping with glaucoma (article on your website). I’m 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 merely treat the issue itself only?

via Email

ANSWER:

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 they 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
Patient-Focused Ophthalmologist

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

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

January 18, 2017

QUESTION:

Dr. Richardson, Could you give me your opinion/evaluation of Alternating Current Stimulation being used to treat Glaucoma and other optic nerve disorders. This is being conducted at the SAVIR Center (Sabel Vision Restoration Center) in Magdeburg, Germany.
http:// savir-center.com/en

via Facebook

ANSWER:

I am intrigued by Alternating Current Stimulation. However, given the lack of peer-reviewed literature combined with the expense of the treatment (plus traveling expenses), I cannot recommend it at this time. I am hopeful that the doctors performing this treatment will publish comparative results at some point in the future.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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

February 16, 2017

QUESTION:

Hi Dr. Richardson, I am a glaucoma patient for over five years now. A year ago I saw a new doctor for my glaucoma . He labelled my cup-to-disc ratio (CDR) 0. 8 both eyes and he put me on Travantan Z and Timolol 0. 5. After seeing him every two months for check up, he has labelled my CDR now to 0. 6 both eyes. He told me I should now see him after three months if the damage does not continue then I will have to see him after six months. Was confused about the drop in my CDR from 0. 8 to 0. 6. Please help me out a bit

via Email

ANSWER:

Although reversal of optic nerve cupping can be seen in infants and children, it is rare to observe this in adults. Most likely one of the two estimates of cupping is incorrect. Unless the cup-to-disc ratio was objectively measured (by stereo disc photos or OCT) it is not possible to be certain of a change in cupping.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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

June 11, 2017

QUESTION:

How do you correct glaring vision when you have glaucoma?

via Email

ANSWER:

The most common form of glaucoma, open angle glaucoma, is not associated with glare. On the other hand, angle closure can result in glare but only in the setting of severe intraocular pressure (IOP) elevation. Symptoms of angle closure which would warrant immediate (emergent) evaluation and treatment include such things as sudden loss of vision, new onset glare or halos or rainbows around lights, red eye, eye ache, headache, brow ache, nausea, vomiting.

There are many eye conditions that can cause glare. Which one is the cause of glare for an individual can only be determined with an in-office consultation under the exam microscope. Based on the area code of the phone number you provided it appears that you are in New Jersey. Although I would be happy to provide a consultation if you happen to be in Southern California, there is an exceptionally skilled surgeon in New Jersey that you might wish to see: Dr. Steven Safran.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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

August 30, 2018

QUESTION:

Are you dilating then performing Gonioscopy Assisted Transluminal Trabeculotomy (GATT) or just straight viscodilation?

via Email

ANSWER:

With regard to leaving or removing the trabecular meshwork (TM), I leave it intact as the literature is supportive of the TM as having an active role in the regulation of aqueous outflow (more of a pump than a grate or flow restrictor). Additionally, once the TM is removed (or torn, as is the case in all GATTs other than Kahook Dual Blade or Trabectome) the benefit will wear off in a year or so once the leaflets scar down and occlude the canal (this is why trabeculotomy was abandoned decades ago as a treatment of adult glaucoma).

I firmly believe that the surgical treatment of glaucoma is heading into a multiple MIGS direction. Surgeons are already performing both ABiC and iStent or Endocyclophotocoagulation (and shortly, Hydrus) at the same time. From a physiologic point of view dilating both the canal and collector channel system prior to placing a permanent scaffold into the canal is the logical best approach. Even if we are not placing stents or scaffolds at the time of ABiC, leaving that option available for the future is prudent.

So, I leave Kahook Dual Blade (KDB) for last after ABiC and stenting of the canal.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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

April 30, 2018

QUESTION:

Hi Dr. Richardson, I found you article on the need (or lack of need) for a laser in cataract surgery refreshingly honest. I also wonder, do ophthalmologists give any fees to optometrists for patient referrals? I keep wondering why my optometrist used to recommend Dr. A and now recommends Dr. B for cataract surgery.

via Email

ANSWER:

Yes. Unfortunately this practice is all too common. Personally, I find the idea of paying optometrists (or anyone, really) to refer patients to me both distasteful and unethical which is why I do not do this. It may also be illegal (as is payola) but the government is not enforcing it. It can be such a good source of revenue that some optometry groups refuse to refer patients unless a kickback is provided by the surgeon. I even know of one group in my area that refers patients across Los Angeles (a 40-60 minute drive) because the surgeon on the “westside” gives the best “co-management” fee. Disgusting.

I’m sure I would be financially much better off if I played this game, but to do so would rot the very foundation of why I chose to go into medicine in the first place.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

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

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