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Yes, you are correct; Cosopt is a combination of timolol maleate 0.5% and dorzolamide HCL 2%. Using each drop individually may in fact be cheaper depending on where you get the medications and what insurance company you are currently using. In most cases, you can get timolol for 4 dollars at many of the national chain pharmacies. Recently, however, Cosopt has become available as a generic medication. This being the case, it may now be cheaper to buy the single bottle of generic Cosopt instead of a bottle each of timolol and dorzolamide. Check with your local pharmacist and they can assist you making that comparison.

Thank you for submitting your question. Normal-tension glaucoma is a difficult type of glaucoma to treat. There are some studies that do show an association between hypotension (low blood pressure) and normal-tension glaucoma. Maintaining the blood pressure at a normal level is very important. In some patients, we even recommend that raising the pressure to a normal level from a low level may be of some benefit; however, you should talk with your primary care doctor regarding ways to safely increase the blood pressure. Your primary care doctor will work with your eye doctor to monitor your blood pressure to ensure that you do not end up getting hypertension (high blood pressure) as this can be detrimental to your health. Eating more salt may be helpful, but your doctor may ask that you keep track of your salt intake and blood pressure to determine how your body responds.

I can tell you that as an eye doctor, the only thing that we can do to prevent the further progression of glaucoma is to reduce the intraocular pressure. Continuing to use your prostaglandin analog (Xalatan) and your beta blocker (Timolol) every day is very important. In addition, having regular intraocular pressure checks and complete exams to ensure the pressure and vision remains stable is crucial. Unfortunately, since I have not examined your eyes and have not examined the results of your tests (i.e. visual field, stereo photos, and OCT) it is impossible for me to tell how advanced your glaucoma is and how quickly it has progressed over the past few years. In addition, every person progresses at a slightly different rate, so that makes predicting stability over time more difficult. Wish I could provide a more definite answer, but I encourage you to continue seeing your eye doctor regularly and follow their instructions for the best chance of preserving the vision that you currently have for the longest time.

Thank you for your question. In order to most accurately answer this question it would be best to check your eye pressure with a Tonopen and then have you do the exercise that you are concerned about. During that exercise, if we could check the pressure again (with the same Tonopen), we would be able to determine whether or not the pressure goes up. Unfortunately that is not usually possible unless you have a very dedicated eye doctor! If you are concerned, the best advice I can give you is to avoid lifting extremely heavy weights or doing exercises that are rigorous enough to causes you to use a Valsalva manuver to complete them. A Valsalva manuver occurs when you take a deep breath, hold it, bear down, and strain to lift a weight or complete an exercise. In extreme cases, you will notice your face getting red and the vessels in your neck or forehead bulge. If you have questions about specific exercises or activities that cause a Valsalva manuver, I suggest you consult with your eye doctor and possibly demonstrate what type of exercises you are doing.

Concerning your other question, if your backpack is similar to mine (I carry a 15 year old Lowe Alpine Contour internal frame pack), the majority of the weight should be distributed off your shoulders to your hips. Even if this backpack is heavy, it should not cause you to be doing repetitive Valsalva maneuvers to walk or hike. You should be able to walk in a relatively relaxed fashion even though you are carrying a load. If you struggle with your backpack and feel you have to strain to carry your load, I highly recommend you seek out an experienced backpacker to help give you advice on how to pack so that the weight is distributed to the hip belt and adjust your backpack straps so that the load is transmitted to your hips and not your shoulders and lower back. Hope you enjoy your camping trip!

Thank you for your question. There are many different types of glaucoma, and they can progress at different rates, so it is impossible to determine how long you have had the disease. Some types of glaucoma, like angle-closure glaucoma, can progress quickly if the pressure is incredibly high and it can take vision and cause nerve damage within hours, days or weeks. Other types of glaucoma progress quite slowly and it may take months or years before there is any evidence of vision loss or optic nerve damage. In addition, it is difficult to predict what course your glaucoma will take, and that is why it is important to see the eye doctor regularly and not miss the appointments.

The reason for the optic nerve damage caused by glaucoma is being studied by a variety of different scientists. In general, it is believed that the intraocular pressure inside of the eye causes damage either directly or indirectly to the retinal ganglion cells (the cells that eventually group together to make the optic nerve). The damage likely occurs at the back of the eye where the retinal ganglion cells turn and exit the eye to make the optic nerve. The exact mechanism is still up for debate, but I believe we are getting closer to finding an answer.

Thank you for your question. Unfortunately, I am not sure that I have enough information to provide a good answer. It depends on whether or not the drop in pressure is related to just having glaucoma surgery in an attempt to lower the pressure, or if the eye pressure is dropping because the eye is so "sick" that it has stopped making intraocular fluid and is beginning the process of becoming soft or "phthysical".

One of the potential side effects after glaucoma surgery is that the eye pressure may drop too low. If this occurs, we first look to see if a leak has occurred after the surgery. This is similar to a tire leaking air and going flat. Even if you keep putting air in the tire, if you don't stop the leak, it will never hold pressure. There are various techniques used to stop the leak, if this occurs after surgery.

If there is no leak and the pressure is simply too low, it is possible in certain cases that dilating the eye can be helpful. This often causes the ciliary body to rotate posterior into a more natural position and produce an increase in intraocular fluid, hence raising the eye pressure. In some cases, if we know the patient is a "steroid responder" we can give higher doses of steroid drops and this can cause the pressure to go up. Unfortunately, in many of these cases we cannot use the steroids due to the specific type of surgery employed, as this class of medication will slow the natural healing process and prolong the lowering of the pressure. As you can see from this response, the method of increasing the pressure in each patient is quite different and depends on many different variables. I highly suggest that you discuss this with your eye doctor/surgeon to determine what type of treatments are necessary or what other avenues are available until the patient is able to travel.

Thank you for submitting this question. Even with the information that you provided, because I did not complete the examination myself or see the results of the tests completed, there is no way I can determine whether or not you have glaucoma.

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 it 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 frequently see patients with glaucoma that have never had increased intraocular pressure, and we call this "normal-tension glaucoma." Often, if we are concerned that a patient may eventually develop glaucoma (because of something seen during the eye exam, family history, or other factors), we will call them a "glaucoma suspect." This means that they have not yet developed clinically definable glaucoma, but the doctor is concerned that glaucoma may develop in the future.

The only variable that we can change to slow or stop the progression of glaucoma is the intraocular pressure. Sometimes, physicians will start their ocular hypertension patients and glaucoma suspects on intraocular pressure lowering drops in hopes of preventing the patient from ever developing glaucoma. Once a thorough eye exam has been completed, eye doctors often set a target or goal intraocular pressure. Your doctor has started you on an eye drop and 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 may add medications or recommend other treatments. If you have questions or concerns, do not hesitate to start an open dialog with your eye doctor and ask them.

That is an excellent question, and thank you for submitting it. Determining whether to use a trabeculectomy or a glaucoma drainage device often comes down to the physician's preference, the type and severity of your glaucoma, and the goal eye pressure after the end of the procedure.

There is an ongoing research project, called the "Tube vs. Trab" study, which is looking at long-term outcomes that compare the two procedures head-to-head. In general, trabeculectomies can get the intraocular pressure a bit lower than glaucoma implants; however there are also drawbacks. The risk of trabeculectomy-related side effects (leaks, endophthalmitis, hypotony, etc.) is a bit higher, and glaucoma implants may not get the pressure as low with a single implant. In addition, you have a choice between valved and non-valved implants that can help regulate the intraocular pressure a bit. The type of glaucoma also may play a role. For example, I do not use Baerveldt implants on my uveitic patients who take steroids chronically. I tend to find that they have a higher rate of hypotony (intraocular pressure lower than we want) than Ahmed valves.

Trabeculectomies and glaucoma implants can be repeated. Usually, I prefer to not do more than 2 trabeculectomies in a single eye unless there is a very good reason to try a third. In addition, more than one glaucoma implant can be placed in a single eye. I have even taken care of one patient that is doing quite well after they had 3 glaucoma implants in each eye prior to seeing me.

Anytime that you are going to have a surgery, your physician should discuss the risks, benefits, and alternatives of any surgery that they are planning to do prior to you signing the informed consent form. Within this discussion, your physician should let you know why they are choosing a particular surgery. I encourage you to have an open dialog with your surgeon prior to having the procedure.

Thank you for your question. Dry eyes are something that many of our glaucoma patients suffer with. The eyes naturally create tears throughout the day and those tears will travel over the eye, moisten the eye appropriately, and then accumulate along the eyelids. As you blink, the tears are coated over the eye to keep everything nice and moist. The remaining tears then have to travel through a hole in the corner of your upper or lower eyelids near the nose. Each hole is called a "punctum." Once the tears pass through that hole, they have entered into the tear drainage system. When you blink, those tears are forced through the tear ducts and run into the back of your nose and down your throat. When your eyes are dry, the tears are usually evaporating before getting to the tear drainage system, which causes irritation. The eyes then send a signal to your body to make more tears. Unfortunately, your body responds to the dryness and irritation by not only making a few more tears, but making so many tears that the drainage system cannot handle that much fluid. That is why your eyes overflow and you get tearing. By putting plugs in the holes (punctum) you stop up the drainage system and allow the tears to stay on the eye longer before they evaporate or drain out. This keeps the eye from being irritated and asking for too many tears to be made. The punctal plugs are usually made of a soft plastic like silicone and they can be put in during an office visit. Once the plugs are place within the punctum, most patients do not have any problems and they cannot feel the plugs because they are very small. If any problems arise, the plugs can be taken out.

Thank you for your question. Because I have not evaluated your mother's eyes, giving advice in this situation is difficult. It sounds as though your mother has quite advanced glaucoma and very little nerve tissue remaining. Advanced glaucoma causes the "tunnel vision" that you describe. In addition, it sounds as though she has advanced cataracts that are also causing problems with her vision. It is possible that the cataract may now be "visually significant." This means that it has gotten bad enough that it is blurring her vision and is now also affecting her activities of daily living (i.e., the ability to get around the house, see things clearly, do hobbies she enjoys, read, or watch TV, for example). When any physician discusses the possibility of surgery with a patient, they will talk about the risks, benefits, as well as alternatives to the surgical procedure. In addition to the normal risks associated with cataract surgery, when performing this type of procedure in a patient with very advanced glaucoma and very little nerve tissue remaining, there is a very small risk of damaging the remaining nerve tissue. This occurs because of the changes in eye pressure that occur during cataract surgery. This is known as "snuffing out" the nerve, and after the surgery the vision can be decreased instead of improved. While this is a small risk, it is still very real.

I tell my patients that if the risk of a certain side effect during surgery is 1 out of 10,000, that often does not sound too bad. But, the one patient that does get the side effect is a real patient; they are not a number. And if you are the 1 patient that has the side effect, you no longer care about the 9,999 that got through the surgery without problems; you only care that the side effect happened to you. When you agree to have surgery, you sign an "informed consent" form. This means that you understand that there are risks to the surgery beyond the doctor's control but that you want to proceed with the surgery knowing that these side effects are possible. Most glaucoma specialists also perform cataract surgery, so I would suggest getting a second opinion from a glaucoma specialist that feels comfortable doing cataract surgery in patients with advanced glaucoma. They can discuss the risks and benefits of cataract surgery in patients with advanced glaucoma and you can make an informed decision on the route that you would like to take. These decisions are often not easy to make and often there is not one single "right" answer. You and your family will need to weigh all of the potential risks against the potential benefits and determine what you are comfortable doing. Best of luck making this decision; I know it can be difficult.

Thank you for your question. This is a problem for some patients, and I wish there were more options. Timolol does come in a preservative free form and it is available in the United States. I have personally prescribed this for some of my patients, and they have done well with this medication. You may need to call several different pharmacies to see which one can order it for you. Secondly, I believe that both Trusopt and Cosopt also come in preservative free forms and are available in Canada. I have not yet had luck in finding them in the United States. Finally, there is a preservative free prostaglandin analog that is available in the United Kingdom (Tafluprost) but not yet available in the United States. Studies are currently ongoing to get approval for this eye drop in the United States. You may ask your eye doctor if you can be enrolled in the study. He or she can find more information by calling 1-888-577-8839 or by visiting clinicaltrials.gov under the identifier number NCT01026831.

A second alternative is to try Travatan Z. This is a different formulation of Travatan that does not use benzalkonium chloride (BAK), which is the most common preservative used in the other eye drops. You could try a trial of that eye drop to see if it causes less irritation. Hopefully, in the near future we will have more preservative-free options for our glaucoma patients.