Ask an Expert about Glaucoma

You absolutely should set up a follow-up appointment. While every patient diagnosed with glaucoma is completely different, once you have been diagnosed a plan for follow-up should be established. This can be either a plan to watch your eyes closely or to begin treatment. All of this depends on how advanced the glaucoma is and how much damage has been done to the eyes. As an example, immediately after surgery, I may see my patients 1-2 times per week until they are stable. For those patients with advanced glaucoma and uncontrolled intraocular pressure I may see them several times per month if we are making changes to their eye drops or we are considering surgery. Other patients that are glaucoma ‘suspects’ or patients with mild glaucoma that has been stable for several years with no changes in intraocular pressure may be seen one or two times per year. Our goal as eye doctors is to identify glaucoma before you, as a patient, ever notice any changes. Your eye doctor will likely follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves at different intervals to see if there is any evidence of glaucoma that presents in the future. The frequency of examinations will depend on how advanced the glaucoma is and how well you are responding to treatment. If you have questions or concerns, do not hesitate to start an open dialog with your eye doctor and ask them to explain why they have chosen the particular monitoring plan that they have prescribed for you. If you are still concerned, it is always acceptable to ask for a second opinion from a glaucoma specialist.

First, to be clear, the package insert that includes the side effects of Lumigan does indicate that between 1 and 5 percent of patients do experience headaches after using Lumigan. Often it is difficult to determine whether or not the headache or side effect was caused by the medication itself or if they simply had a headache for another reason at the time they were in the clinical trial. As an example, another side effect that is listed at the same or slightly higher percentage is colds or upper respiratory tract infections. I can tell you that I do not believe Lumigan will cause 5 – 10 percent of people to get a cold. If a patient is enrolled in the study during the winter months and happens to get a cold during the time that they are enrolled in the clinical study, it must be listed as a side effect regardless of the cause.

Directly to your question, high eye pressure can cause headaches. However, it would be unusual to get headaches with eye pressures in the 20s. Usually, but not always, headache or eye pain is not noticed until the pressure is in the mid to upper 30s range. I have some patients that present to my office with pressures in the 40s and they are still not noticing symptoms. If you have had a CT scan and evaluation by an ENT specialist, I think you may want to consider seeing a neurologist who specializes in headaches just to be sure.

Finally, if you have been diagnosed with glaucoma and your eye pressure is still in the upper 20s, you should talk to your eye doctor to figure out what your goal or target intraocular pressure is. I would be surprised if your eye doctor has set your pressure goal in the upper 20s, so you may need to consider other options to decrease the pressure more. In addition, if you feel the headaches are related to Lumigan, you can try another prostaglandin analog like Xalatan or Travatan to see if the headaches disappear.

Thank you for your question. In general, your activities at the beach will not need to be changed just because you have been diagnosed with glaucoma. Swimming should cause no problems as long as you have not had a recent surgery on the eye. We also ask you to be cautious about open water exposure if you have ever had a trabeculectomy. Finally, if you are thinking of doing any scuba diving or snorkeling, you should discuss the type of dives you will be doing with your eye doctor. There are no good data showing exactly how intraocular pressures change during the dives, but changes in pressure because of the mask or goggles may alter eye pressure transiently depending on the type of mask, the depth of the dive, and the duration of the dive. There are dive techniques (equalizing mask pressure) that can alleviate this, but should be taught by a dive master. This being said, currently there is no contraindication to diving in individuals with open-angle glaucoma. In fact, several of my patients do dive and have not had any problems.

Finally, let’s discuss lying out in the sun. As a doctor, I cannot recommend lying out in the sun as a good practice for anyone because it is correlated to an increased risk of skin cancer. If you are going to be in the sun for an extended period of time, please use sunscreen with a high SPF rating and reapply the sunscreen throughout the day. In terms of eye health, I suggest that you wear a good pair of sunglasses to minimize the exposure of your eyes to UV radiation. While exposure to UV radiation does not necessarily worsen glaucoma, there is some evidence that it may play a role in the development of macular degeneration.

I hope you and your family enjoy your vacation.

Thank you for your question. Sometimes I think the hardest thing that I have to do as a doctor is to tell my patients that I do not know "why" they have glaucoma. I understand why my patients often feel better if they can point to an exact reason or an exact incident that lead to their problems. Unfortunately, in a lot of our patients we never find an answer. You are correct that glaucoma does run in families and having a family history of this eye disease does put you at a higher risk. However, in many cases there is no family history and we never find a reason for the development of glaucoma.

In your case, if your eye doctor has not found any reason for the development of glaucoma (trauma, pigment dispersion, the lens getting bigger, etc) then you likely have idiopathic primary open-angle glaucoma. Idiopathic is the term that we use for "unknown cause." There are several things that you should understand. First, there is absolutely no evidence in the literature to suggest that Fetal Alcohol Syndrome predisposes you to glaucoma as an adult.

Second, just because you have glaucoma, this does not mean that your children or grandchildren will definitely get glaucoma. Again, having a family history of glaucoma increases your risk of getting glaucoma, but does not ensure that you will get it. Finally, even though we cannot give you a definitive answer as to "why" you have developed this eye disease, you should know there are a lot of people working to understand how genetics plays a role. Hopefully, as the years pass, this research will help answer the question of how and why glaucoma develops.

Thank you for submitting this interesting question. Let's divide this question into two parts.

First, the most recent large study looking at the risk of alcohol consumption and the diagnosis of glaucoma were published in 2007 out of Harvard Medical School. The study examined 80,486 female nurses followed from 1980 to 1986 as part of the prospective, longitudinal Nurse's Health Study, and 42,251 male healthcare professionals who were followed from 1986 to 2002. The final conclusion of this study was that the amount of alcohol consumed by an individual did not influence the risk of being diagnosed with glaucoma.

This brings up a second different question however, and that is whether or not alcohol consumption has an impact on intraocular pressure. The answer to that question is yes. Alcohol consumption can lower intraocular pressure for a short time; however, it should never be used as a method of treating glaucoma or increased intraocular pressure. This is important for patients with glaucoma, or for patients that are currently being followed because the eye doctor is concerned that they may develop glaucoma in the future (i.e., a ‘glaucoma suspect’). It is important that you do not consume alcohol prior to your doctor's visit as this may falsely lower your intraocular pressure and make monitoring or diagnosing glaucoma more difficult.

Thank you for your question. Mobic (meloxicam) is a non-steroidal anti- inflammatory medication that is quite beneficial for many patients that suffer with arthritis. There are multiple studies looking at the effect of non-steroidal anti-inflammatory medications on the effectiveness of certain glaucoma medications. Primarily, researchers have been focusing on looking at the effect of non-steriodal anti-inflammatory medications on the effectiveness of prostaglandin analogs such as Xalatan, Travatan, and Lumigan. Depending on the type of anti-inflammatory medication used, some studies have shown that the mediation may benefit the glaucoma patient and allow the prostaglandin analog to be more effective at lowering intraocular pressure. However, other studies have shown that these anti-inflammatory medications may prevent some prostaglandin analogs from helping get the pressure lower. None of the studies that I found are using meloxicam specifically. I do not think any specific conclusions about the overall effect of non-steroidal anti-inflammatory medications on the effectiveness of prostaglandin analogs can be drawn yet. I will continue to watch for more data. I do feel comfortable telling you that there is no current contraindication to using Mobic (meloxicam) if you have been diagnosed with glaucoma, even if you are using a prostaglandin analog.

Thank you for your question. There are a lot of different types of glaucoma, and they can progress at different rates. Some types of glaucoma, like angle-closure glaucoma, can progress quickly if the pressure is incredibly high and it can take vision within days or weeks. Other types of glaucoma are quite slow and it may take months or years before there is any evidence of vision loss. Also, it depends on how advanced the glaucoma was before it was diagnosed. Someone that had glaucoma diagnosed very early, before much damage had occurred to the optic nerve, will most likely have a longer duration of time before noticing changes in vision compared to someone that was diagnosed in later stages of the disease after extensive damage had occurred to the nerve.

It is difficult to predict what course your glaucoma will take, and that is why it is important to see the eye doctor regularly. Once a thorough eye exam has been completed, eye doctors often set a target or goal intraocular pressure. The only variable that doctors can change to slow or stop the progression of your glaucoma is the intraocular pressure. To achieve this goal, there are essentially three different tools that we can use to treat glaucoma. We use eye medicated eye drops, laser treatments, and surgical methods to lower the intraocular pressure. Your doctor will follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how your eyes respond. If the pressure is not reduced enough or your doctor ever notices advancement in your glaucoma, they will add more medications or use laser or surgery to help lower the intraocular pressure further. If someone is diagnosed very early, the eye doctor’s main goal is to begin treatment and hopefully prevent the person from ever noticing any changes in vision. For those that have more severe glaucoma, it is often possible to lower the pressure enough to stop or dramatically slow the loss of vision; but this may take multiple surgeries, lasers, or medicines (and likely a combination of these three). In some cases, the progression of the glaucoma cannot be stopped and patients do eventually go blind, but this is the minority of patients.

Thank you for your question. This is a difficult case to make too many recommendations about because of how little information that you currently have. In addition, because I have not been able to examine your eyes personally, it is also difficult to give an accurate assessment. Glaucoma is classically defined as a stereotypical pattern of damage to the optic nerve and certain layers of the retina. Elevated intraocular pressure is a risk factor for glaucoma, but just because the pressure is elevated this does not mean you have glaucoma. Often people with elevated intraocular pressure alone, and no other signs of glaucoma, are given the diagnosis of ocular hypertension. Similarly, just because the intraocular pressure is normal, as in your case, this does not mean that someone cannot have glaucoma. We often see patients with glaucoma that have never had increased intraocular pressure, and we call this "normal tension glaucoma." With a family history of glaucoma, or any other risk factors for glaucoma, your eye doctor may give you the diagnosis of being a "glaucoma suspect." This means that they do not yet believe you have glaucoma, but that you should be watched closely for the development of glaucoma in the future. Our goal as eye doctors is to identify glaucoma before you, as a patient, ever notice any changes. Your eye doctor will likely follow the intraocular pressure, vision, visual fields, OCT, and the appearance of the optic nerves to see if there is any evidence of glaucoma that presents in the future.

In your case specifically there are things that I would like to know. First, you say that the intraocular pressure is normal and that the OCT reading is just above borderline. The area just above borderline on the OCT machine is the "normal" area. So this leads me to believe that you have normal intraocular pressure and normal or maybe borderline retinal nerve fiber layer thickness. I would definitely like to know what the visual field shows and what the gonioscopy shows. Secondly, I would want to know what your glasses prescription is and if you are very nearsighted (high myopia). This can cause a tilting of the optic nerves and cause them to look a bit different than normal. In addition, I would want to figure out why at a young age you have one eye, and not both, that show possible signs of glaucoma. Glaucoma typically does not affect young individuals, and when it does, the majority of the time it is both eyes. A couple of exceptions to this are if you have had trauma to the eye. Try to remember if you have had a black eye in the past. If so, your doctor should be looking for any evidence of damage to the angle structures of the eye and possible angle recession glaucoma. Secondly, I would want to know if you have been using any steroid drops, inhalers with steroids, or any medications that have steroids in them. This can lead to a secondary steroid induced glaucoma. In general, when a young person presents with glaucoma in a single eye (or asymmetry), you need to figure out why. I suggest that you be seen by an ophthalmologist that has completed a glaucoma fellowship for a second opinion. If you have glaucoma, this is not a routine case. Someone with specialized training is the most likely to be able to correctly diagnose whether or not you have glaucoma. If you do end up having glaucoma, they may also be able to give you an explanation as to why. If your eye doctor is not a glaucoma specialist, do not hesitate to ask for a second opinion. Finally, after you have seen the specialist and you have been able to determine whether or not you have glaucoma, I think it is reasonable to have your father see an eye doctor. Everyone should have routine eye exams, especially as we get older. This is when most eye problems begin to present, and a routine exam will establish a good baseline for your father so that the doctor can compare and look for changes in the future.