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Thank you for your question. If glaucoma remains untreated, the natural progression is a progressive loss of vision. Usually this starts in the periphery and continues to progress until central vision is diminished or lost. During this process, patients often notice a loss of contrast visions (difficulty in telling similar shades of color or grays). Once the vision is lost, it is nearly always permanent. Because the pressure is likely still elevated, patients often still feel pain in or around the eyes, have headaches, or other symptoms. Just because the vision has been lost, this does not stop the other symptoms. It may be beneficial to have the cataract removed if the cataract is causing closure of the natural drainage system in the eye (i.e. narrowing of the angle). However, if the angle remains open, cataract surgery is not likely necessary unless the physician cannot see to the back of the eye to manage other eye problems. If you are concerned, I suggest that you obtain a second opinion from a glaucoma specialist.

You are correct that the eye drops, lasers, and surgeries are often expensive. However, your sister-in-law is 75 and may well live for quite some time. I think maintaining the remaining 30% of the vision that she does have would be beneficial. Complete bilateral blindness often can be expensive as well because the blind patient often needs full-time assistance to help with their activities of daily living. Often, maintaining even a small amount of vision can help these patients maintain some independence and quality of life.

Thank you for the question. You are correct; Stugeron is a calcium channel blocker that is used primarily for the treatment of vertigo. Interestingly, there are quite a few studies that show calcium channel blockers may aid in the treatment of normal-tension glaucoma. Several of my colleagues actually prescribe calcium channel blockers in their patients with normal-tension glaucoma that have progressive vision loss despite excellent intraocular pressure control. Some of them have had success with the calcium channel blockers in their patients. So to answer your question specifically, taking Stugeron may help treat your normal-tension glaucoma. There do not appear to be any adverse side effects from taking this medication from a glaucoma standpoint.

Yes, there is no evidence to indicate that this type of x-ray would have any interaction with your glaucoma.

Thank you for your question. Unfortunately, without having actually examined your cousin's eyes, it is very difficult to give an accurate interpretation of what has happened. The things that you describe are not consistent with the usual process of having open-angle glaucoma, which takes away vision over a very long time (on a timeframe of months or years) and not days. It is possible that your cousin had angle-closure glaucoma, as this can cause more rapid vision loss. The pain that you describe in the back of the head is not what we usually associate with increased intraocular pressure. Usually the pain that is felt due to increased intraocular pressure is near the eye. While this could still be glaucoma, it is not the typical presentation. Without examining the eyes and doing specific tests it is impossible to give you a reliable answer as to whether or not this was caused by glaucoma. Only after that exam could I predict whether or not the vision in your cousin's eye could be helped. There are countless exceptional glaucoma specialists in the United States and other countries. I suggest finding someone that has completed a glaucoma fellowship to examine your cousin.

I am sorry that your husband is having this difficulty, and I appreciate your concern. First, let me be clear. Having debilitating pain that keeps you in bed for half a day or a full day is not normal, and this is not typical for glaucoma patients. I strongly suggest that he be seen by a glaucoma specialist on one of the days that he is having the eye pain so that the glaucoma specialist can determine what is causing the pain. There are a variety of different problems that can cause pain around the eye that may or may not be related to increased intraocular pressure (such as migraines, sinus problems, etc). If the eye pressure is well controlled, then the doctor needs to look for other causes of the pain. When you describe a "flap" on the eye, I assume you mean that he has undergone a trabeculectomy surgery and has a trabeculectomy flap. It is important that the eye doctor examines the trabeculectomy bleb or filter to make sure it is working properly. Sometimes they are not working well enough and the pressure remains too high and additional therapy is needed. Other times, the trabeculectomy is overfiltering and the intraocular pressure is too low. This can also cause pain.

To answer the other part of your question, "can anything be done?" The answer is yes. First, do not hesitate to ask for a second opinion from a glaucoma specialist (an ophthalmologist that has completed a glaucoma fellowship). In regard to the cataract, it is possible that the cataract can be safely removed. In regard to the intraocular pressure, it is possible that additional mediations, laser surgery, or incisional surgery is needed to help reduce the pressure. I do agree that caution is needed in your husband's case though. When patients have already lost vision in one eye and have had a trabeculectomy in the other eye that sees well, I am often cautious regarding any further surgery in that eye (i.e. cataract surgery). The cataract can be removed when it becomes visually significant, but with the understanding that it can have deleterious effects on the trabeculectomy and it may cause the need for further glaucoma surgery in the future. Only a glaucoma specialist can determine whether or not cataract surgery or any other surgery is in the best interest of your husband. Best of luck to both of you.

Thank you for your question. The answer to this question is not as straight forward as you might originally think. First, vision loss from glaucoma can have a couple of different components. There is the degree of field loss (how far away from your central vision does the field loss start) and depth of field loss (how bad is the field loss....i.e. can you see objects even though they are fuzzy, or is it black). Your ability to function depends on both the amount of peripheral vision loss and the depth or density of the vision loss. You can have very mild peripheral vision loss and still be able to see objects in the periphery or you can have very dense vision loss where you can see no objects in the periphery. A visual field test (either an automated Humphrey visual field or Goldmann visual field) performed by your eye doctor can help determine the extent of the loss.

In addition, it depends on whether or not there is any loss in the right eye as well. Visual field loss on the sides (temporal visual field) is often more problematic because this area of vision is only created by one eye. The opposite is true of visual field loss toward the inside of the nose (nasal visual field) because the nasal visual fields are duplicated by the opposite eye. This is most easily demonstrated by putting your finger about a foot in front of your nose. Both eyes can see your finger. If you put your finger a foot from either shoulder, only the eye on that side can see the finger (your nose is in the way of the other eye). If you are bumping into things on your left side (the side where your glaucoma is mostly noted), then yes this could all be from your glaucoma. You should be aware that this portion of your vision is gone, and you need to be particularly aware when you are driving as you may not see things around you on the left side as well. Secondly, if you are bumping into things on your right side (opposite of where your glaucoma is worse) then you should look for another cause or determine if your right eye has also lost some vision. I hope this helps.

Thank you for your question. The first part of your question is easier to answer. Lifting heavy objects can cause an increase in eye pressure in some people. Anytime you perform a “Valsalva maneuver” (hold your breath and bear down to lift heavy objects, play trumpet, hold a yoga pose, etc.) the pressure in the eye can become elevated. The second part of your question is more difficult to answer because I have not examined your eyes. The answer is based primarily on how much damage has been done to the optic nerve because of the glaucoma. If you were my patient, I would find out how much you lift and try to reproduce this in the office. I would take your eye pressure while you are resting and then take the pressure again while you are lifting something heavy. If your pressure increases, we would have to determine whether or not it is elevated enough to be worrisome. I hope this helps.

That is an excellent question, thank you for submitting it. 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, 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." There are a lot of different types of glaucoma, and they can progress at different rates. It is difficult to predict what course glaucoma will take. Regardless of the type of glaucoma that you have, the only variable that we can change to slow or stop the progression of glaucoma is the intraocular pressure.

Once a thorough eye exam has been completed, as eye doctors we often set a target or goal 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. The eye doctor will follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see if the glaucoma progression has stopped. If the pressure is not reduced enough or the doctor ever notices advancement in the glaucoma, they will add more medications or use laser or surgery to help lower the intraocular pressure further.

Thank you for the question. There have been several studies that have shown an association between sleep apnea and the presence of glaucoma. Many ophthalmologists are beginning to routinely ask their patients whether or not they have ever been diagnosed with sleep apnea when asking about the patient’s past medical history. While we recognize that there is likely a correlation between sleep apnea and glaucoma we currently do not know the underlying reason behind the association. Some believe that sleep apnea causes a decrease in the amount oxygen being carried in the blood to the optic nerve. Others feel that it may be related to the use of the continuous positive airway pressure (CPAP) machine for treatment, as CPAP use has been correlated with increasing intraocular pressure. Other theories also exist. Currently very little is known regarding the cause and effect relationship between these two diseases; however, most ophthalmologists do agree that there is a correlation between them. A lot of studies are currently being done in this field and hopefully we will know more in the future.

Thank you for the interesting question. This is a topic that is debated around the water cooler and in rounds by many ophthalmologists, glaucoma specialists, and residents in training. There are very few studies that have actually looked at the effect of wearing a necktie on intraocular pressure. In 2003, one study showed that wearing a "tight" necktie for approximately 3 minutes caused the intraocular pressure to increase in both "normal" patients and patients that had been diagnosed with glaucoma. These researchers believed that the increase in intraocular pressure was caused by pressure being placed on the jugular veins, which restricted the blood flow out of the head. This likely led to an increase in the blood pressure in the head and an increased intraocular pressure. A second study completed in 2005 again showed that wearing a necktie caused an increase in intraocular pressure 3 minutes after tightening the tie, but that without loosening the tie, over the next 12 minutes the intraocular pressure actually decreased back to near the original level. From this study, many concluded that the initial tightening of the tie increased intraocular pressure, but that prolonged wearing of a necktie does not cause an increased risk in patients with glaucoma because the pressure equalized over time.

I think the only conclusion that I feel comfortable making from these studies is that a "tight" necktie can increase the intraocular pressure, but I do not know the long-term consequences. There is no evidence to suggest that it causes an increase in the rate of progression of glaucoma; however, no studies have specifically looked at this, so it might be possible. I typically recommend that a neck tie and buttoned up collared shirt should not be overly tight around the neck. In addition, I ask all of my patients to unbutton their collar and loosen their tie before I take their intraocular pressure so that the tightness of the necktie does not interfere with my reading of the intraocular pressure. Personally, I buy a shirt 1/2 size larger so that mine stays a little loose, but I always wear a tie when I am seeing my patients.