Science & Research

I am unaware of any protein that can revive the optic nerve, but if you can send me the specific name of the protein, I will research it further. In general, patients with glaucoma should know that currently there are no prescription medications, natural therapies, vitamins, supplements, or alternative therapies that have been proven by controlled scientific studies in humans to be of benefit in protecting the optic nerve or reversing damage to the optic nerve caused by glaucoma. The only prescription medication currently on the market that is known to lower intraocular pressure and is also being studied as a potential “neuroprotective” agent (i.e. protects the optic nerve from damage caused by increased intraocular pressure) is brimonidine (trade name Alphagan). The original studies were promising in animal models of glaucoma; however, further studies are needed to prove this effect in humans.

Multiple medicines are being studied as possible "neuroprotective agents,", but to date there has been no conclusive evidence that any of these medications work in humans. There is a great deal of research in the field of "“neuroprotection" and I believe we will eventually find some promising new drugs in this area to help our patients, but we just are not there yet. I would caution you to research any supplements, vitamins, natural therapies, or alternative therapies carefully. These therapies are not regulated by the FDA and therefore the claims made regarding what they can dotheir efficacy does not have to be proven scientifically. Unfortunately, this can lead to false or misleading claims. That is not to say that supplements, vitamins, natural therapies, or alternative therapies cannot have beneficial effects;, the manufacturer should simply provide good controlled scientific evidence for the claims that they make. In addition, continue to have an ongoing conversation with your eye doctor regarding new developments in the field of "“neuroprotection"” research that may be of benefit to you.

The simple answer is yes. Even if you are using eye drops, you can go blind in the future if the intraocular pressure is not reduced enough to prevent further loss of vision. Without having examined your eyes previously, it is difficult to predict what will occur to your eyes in the future. There are a lot of different types of glaucoma and they can progress at different rates. Once a thorough eye exam has been completed, your eye doctor will likely set a target or goal intraocular pressure. To achieve this goal, there are essentially three different tools that he or she can use to treat your glaucoma. As glaucoma specialists, we use eye drops, laser treatments, and surgical methods to lower the intraocular pressure. We then follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves after the new treatment is started. If there is evidence of glaucoma progression, then more drops, more laser treatments, or more surgery will be necessary to lower the eye pressure even more. In the majority of patients, it is 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, we cannot stop the progression of the glaucoma and our patients do eventually go blind, but this is the minority of patients. If you are concerned that your glaucoma is progressing, it is also ok fine to ask for a second opinion from an ophthalmologist that has completed a glaucoma fellowship.

In addition, this may simply be a case of miscommunication. It is important to understand what definition of “blindness” your eye doctor is using. Often when patients hear an eye doctor use the words “blindness” they think about the eye not being able to see even very bright lights. However, your doctor may simply be saying that you are “legally blind.” This may have an impact on disability or insurance claims. The definition of legal blindness includes both acuity (how small are the letters that you can see) and your visual field (how much peripheral vision do you have). Some patients with advanced glaucoma have excellent visual acuity (20/20 vision) but have very small visual fields (10 degrees or less) and are considered legally blind. I encourage you to have a discussion about this with your eye doctor to clarify what he meant. If it is necessary do not hesitate to ask for a second opinion from another glaucoma specialist.

This medicine is prescribed for you to treat your keratitis. The successful treatment of this condition is important for keeping it from becoming a more widespread inflammation or infection that could, in fact, develop into a secondary glaucoma. Therefore, use of this medication is unlikely to make your glaucoma worse, and in fact may actually prevent it from getting worse. I have checked with the National Registry of Drug-induced Ocular Side Effects on Zovirax and there are no reported events of blindness associated with this medicine.

Pseudoexfoliation glaucoma is a variety of open-angle glaucoma. It often will be more advanced in one eye than the other. Although in general this type of glaucoma does not respond as well to typical glaucoma medications (drops) as the more common primary open-angle glaucoma, these are still a very reasonable starting point. However, if glaucoma drops do not lower your eye pressure enough to protect the optic nerve (a determination that your ophthalmologist will be able to make, depending on your eye pressure and the extent of your optic nerve damage) a laser treatment called laser trabeculoplasty can be more effective in many patients. This procedure is also more specifically called argon laser trabeculoplasty (ALT) or selective laser trabeculoplasty (SLT), depending on the type of laser that is used. If laser also does not control the pressure adequately, then conventional surgery (called trabeculectomy, or a filtering procedure) has a good chance of success. All board certified general ophthalmologists receive training and experience with these procedures, and if your ophthalmologist is comfortable with them, it is not necessary for you to seek care from a glaucoma specialist or go to a university setting. On the other hand, if you were to request such a referral, I’m sure that your doctor would know who to refer you to in your area.

One final point is that this type of glaucoma tends to be associated with more rapid development of nuclear sclerotic cataract (cloudiness of the lens) in the affected eye. If this develops, successful conventional cataract surgery is possible. However, the pupil in these eyes tends to dilate poorly. In addition, the zonules (the ligaments that support the lens) may be weaker than normal. Both of these factors increase the risk of complications in removing the lens. Because of this, some specialists recommend that cataract extraction be performed earlier than in an eye without pseudoexfoliation, so that the cataract will be less dense and easier to remove. Again, your general ophthalmologist will be familiar with these issues and how to handle them.

Without having examined your eyes previously, it is difficult to predict what will occur to your eyes in the future. There are many different types of glaucoma and they can progress at different rates. Once a thorough eye exam has been completed, 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 drops, laser treatments, and surgical methods to lower the intraocular pressure. We then follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves after the new treatment is started. If there is evidence of glaucoma progression, then more drops, more laser treatments, or more surgery will be necessary to lower the eye pressure even more. In the majority of patients, it is 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, we cannot stop the progression of the glaucoma and our patients do eventually go blind, but this is the minority of patients. If you are concerned that your glaucoma is progressing, you should be evaluated by an ophthalmologist that has completed a glaucoma fellowship so that they can offer you every possible treatment option. There are countless specialists throughout the world that are exceptional. An exhaustive list of the best specialists or best hospitals is impossible to provide; however, an excellent starting point that includes an international list of some of the leading experts on glaucoma is the World Glaucoma Association website under the General Assembly and Boards subheading. The names listed on each board or committee is not an exhaustive list of all the exceptional glaucoma specialists throughout the world, but this list includes individuals that are highly regarded in the field and they often work at the institutions that attract the top glaucoma specialists.

I am sorry that you have lost your peripheral vision and that it has caused you problems in the workplace. This question is difficult to answer because of several factors. Let me first say that, I am not a lawyer, and I do not pretend to be an expert in the field of law involved in the employment of individuals with disabilities. I encourage you to become acquainted with the American’s with Disabilities Act, the portion of the US Equal Employment Opportunity Commission website that deals with disabilities, and your particular state’s labor bureau policies. It would be prudent to contact a lawyer in your state who specializes in disability issues for professional legal advice concerning your specific situation; they can provide you with information regarding what you are obligated to provide to your employer, and how to most effectively communicate with them.

I am an ardent supporter of low vision specialists, and I believe that as glaucoma specialists we underutilize our low vision colleagues. I strongly encourage you to be evaluated by a low vision specialist. They can help you by recommending work modifications, recommending devices that may help you at work to continue in your current job, and they can discuss your disability with your employer to help them understand your needs.

Given the above information, I also think it is important to note that I do not know what your job entails. If you work on heavy machinery or in close approximation to multiple moving parts and only have 25 degrees of central vision, this could put you or others that work with you at risk for serious injury or death because of your lack of peripheral vision. In that case, I could not advocate you continuing in a job that would put you or others at risk of injury. You should note that if your visual field is reduced to less than 20 degrees, you meet the criteria for legal blindness, and you may need to consider filing for disability at some point in the future. Do not hesitate to ask your eye doctor for assistance in this regard.

Thank you for your question. Congenital glaucoma is often very difficult to treat. While primary open-angle glaucoma often presents later in life, congenital glaucoma must be treated throughout an entire lifetime. At this time, the best “treatment” for your eyes is to maintain your intraocular pressure at the target pressure set by your eye doctor. In addition, it is important to minimize fluctuations in the intraocular pressure as these fluctuations may actually cause damage to the optic nerve. Reduction and stabilization of intraocular pressure is achieved by using a combination of prescription medications (both eye drops and possibly oral medications), laser surgery, and/or eye surgery. The damage done to the optic nerve by glaucoma is rarely reversible; therefore, our current treatment regiments are geared toward preventing further damage.

Currently there are no natural therapies, vitamins, supplements, or alternative therapies that have been proven by controlled studies to be of benefit in protecting the optic nerve or reversing damage to the optic nerve caused by glaucoma. However, a great deal of research is being done in this area. The only prescription medication currently on the market that is known to lower intraocular pressure and is being studied as a potential “neuroprotective” agent (i.e. protects the optic nerve from damage caused by increased intraocular pressure) is brimonidine (trade name Alphagan). The original studies were promising in animal models of glaucoma; however, further studies are needed to prove this effect in humans. There is a great deal of research in the field of “neuroprotection”, so I encourage you to continue to maintain optimal control of your intraocular pressure by using the combination of medications, laser treatments or surgeries recommended by your eye doctor. In addition, continue have an ongoing conversation with your eye doctor regarding new developments in the field of “neuroprotection” research that may be of benefit to you.

Loss of peripheral vision and central visual acuity, as well as decreased contrast sensitivity definitely affects depth perception and balance. There is much evidence on the impact of vision loss on activities of daily living, from how vision loss can increase the incidence of falls in the elderly to how an athlete may have decreased performance with loss of depth perception. Glaucoma may cause a small blind spot in your visual field that may affect your golf game. Typically, patients with cataract development note difficulty in sports such as golf and tennis. Your eye care provider should be able to pinpoint any eye pathology that might cause difficulty with aspects of your game and may be able to recommend solutions.