Science & Research

This is an excellent question. What you have experienced is not unusual. There is a great deal of evidence that suggests cataract surgery can lower intraocular pressure, and that some glaucoma patients may be able to reduce or stop their glaucoma medications for some time. The reason for the decrease in eye pressure after cataract surgery is not yet known, but there are several studies trying to find the answer. Some people have proposed that the cataract, which is the natural lens in the eye that has gotten cloudy may be at fault.

Over our lifetime, the natural lens in the eye continues to grow similar to an onion adding layers. As the lens gets bigger, it may crowd the drainage system in the eye causing the pressure to increase (like a sink backing up when the drain gets clogged). Removing the lens may allow the drainage system to expand again and begin to flow better. Other people have proposed that the inflammation caused after the surgery may in fact be of benefit and cause the drainage system to start working better.

Finally, some people feel that some of the techniques that we currently use to remove the cataract (i.e. phacoemulsification) may have steps that cause the drainage system to be cleaned and begin flowing better. The true answer is that we don't know; however, we do know it is a real phenomenon. There are some lucky patients (like my grandmother) who used glaucoma drops for years prior to cataract surgery and have never had to restart them again. However, on average, we tend to see the eye pressure staying lower for about 1-2 years, and then it often increases again over time. It is important that you continue to see your eye doctor for routine exams to check the intraocular pressure, vision, visual fields and optic nerves because we cannot predict who will need to restart their medications or when this need will occur. Best of luck, and I hope you are one of the lucky patients that get to stay off of your drops.

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 from 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 patients that are currently being followed because the eye doctor is concerned that the patient may develop glaucoma in the future (i.e. a ‘glaucoma suspect’). Patients in these categories should not consume alcohol prior to their doctor's visit as this may falsely lower their intraocular pressure and make monitoring or diagnosing glaucoma more difficult.

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." 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 this disease 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, and the appearance of the optic nerves to see if there is any evidence of glaucoma that presents in the future; however, these visits do not need to be on a monthly basis. Glaucoma progresses very slowly over time. I typically see my ocular hypertensive patients and my glaucoma suspect patients initially every 3-6 months, and if they are stable for quite some time, I may extend their visits to every 6-12 months, but every patient is different. 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.

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.

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 questions. Unfortunately, there is currently no "cure" for glaucoma. When I use the word "cure," I mean that the damage done to the optic nerve and the vision lost due to the damage at the optic nerve cannot be reversed. However, 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. 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 drop medications, 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 conventional surgery to help lower the intraocular pressure further.

To answer the second part of your question, there are essentially five different types of drops that are primarily used to treat glaucoma. I will give you the type or class of medications that are used. There are many different companies that make each class of medication and there are too many brands to list (plus I do not specifically endorse any single brand over another). Feel free to ask your doctor which class of medicine(s) they have prescribed. The five different classes of medications include:

1. Prostaglandin Analogs: These medications work primarily by helping fluid exit the eye from a secondary, less common drainage pathway (i.e. the uveoscleral pathway).
   
2. Beta-Adrenergic Antagonists or Beta-Blockers: These medications work primarily by decreasing the amount of fluid made inside the eye.
   
3. Alpha Agonists: These medications work primarily by decreasing the amount of fluid made inside the eye, but they also help fluid exit the eye from the uveoscleral pathway.
   
4. Carbonic Anhydrase Inhibitors: These medications work primarily by decreasing the amount of fluid made inside the eye.
   
5. Parasympathomimetic or Miotics: These medications work primarily by helping the fluid exit through the main drainage system of the eye (i.e. the trabecular outflow pathway).

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. This is likely what your eye doctor has seen on your examination. Elevated intraocular pressure is a risk factor for glaucoma, but just because the pressure is elevated this does not mean you have glaucoma (similarly, people with "normal" pressures can have glaucoma). In someone with glaucoma, the damage to the optic nerve and the retina usually causes a loss of peripheral vision first and only as the glaucoma advances does central vision become affected. Because of this, very few isglaucoma patients ever notice any changes in vision until they have more advanced disease. Our goal as eye doctors is to identify glaucoma before you, as a patient, ever notice any changes. The vision changes that you describe as "looking through dirty glasses" are not typical of glaucoma. While patients with glaucoma do have some reduction in contrast sensitivity (i.e. the ability to distinguish similar shades of grey), the changes you describe sound more consistent with changes at the cornea, the development of cataracts in the natural lens of the eye, or other changes in the retina. I encourage you to discuss these symptoms with your eye doctor.

There are a lot of different types of glaucoma, and they can progress at different rates. It is difficult to predict what course your glaucoma will take. 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 your glaucoma. We use eye medicated eye drops, laser treatments, and surgical methods to lower the intraocular pressure. Your doctor has started you on a prostaglandin analog 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 will add more medications or use laser surgery or conventional surgery to help lower the intraocular pressure further. 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 treatment plan that they have prescribed for you.

Thank you for your question. I will look at each medication individually. First, taking diltiazem is not contraindicated in patients with glaucoma. In fact, quite the opposite may be true. Currently there are studies being completed looking at a topical drop form of diltiazem to see if it may actually assist in lowering intraocular pressure for the treatment of glaucoma. Studies at this timeCurrently, studies are not conclusive, but we are continuing to do research in this area. At. I have multiple glaucoma patients that take diltiazem, and at this time, there is no evidence to suggest stopping this medication. Triamterene/Hydrochlorothiazide (HCTZ) is a combination of two different medications. The first, triamterene, is a diuretic that works in the kidneys primarily. It is what we call a potassium sparing diuretic. Again, there are no contraindications to using this medication if you have been diagnosed with glaucoma. This medication is also being studied to determine if it actually lowers intraocular pressure. The studies were not conclusive, but it is being examined further.

Finally, we should discuss hydrochlorothiazide. Of the medications that you have asked about, this medication can have adverse side effects in patients with glaucoma. HCTZ is a sulfonamide (in the same family as sulfa drugs). While it is relatively rare, sulfonamides have been known to cause attacks of angle closure in some patients. Your eye doctor has likely already done a procedure called gonioscopy to determine if you have open- angle glaucoma, narrow- angle glaucoma, or angle- closure glaucoma. This will help your eye doctor determine how much of a risk using HCTZ is for you. The risk of angle closure is very small and the majority of glaucoma patients can still use HCTZ. I have multiple patients on HCTZ and Mmost glaucoma patients that use this medication never have problems; however, a small number of patients can have further narrowing of their angle or closure of the drainage system when using this medication, so I encourage you to discuss this with your doctor further.