Science & Research

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.

Thank you for your question. Without having examined your eyes, it is difficult to tell what your risk of developing glaucoma will be. Almost every person naturally has a small amount of "cupping" to the optic nerve. We usually become concerned when the cupping is uneven between the right and left eye (asymmetry), or if the cupping is large or getting larger. Glaucoma is classically defined as a stereotypical pattern of damage to the optic nerve and certain layers of the retina. When this damage occurs, we begin to see increased "cupping" of the optic nerve head. There are some "glaucoma risk calculators" available that your eye doctor can use after your examination to get a better idea of your risk of developing glaucoma. They will need to do a complete eye exam and after collecting some data, they can put that information into the calculator, which can provide you with a better idea of your risk of developing glaucoma. However, you should know that this is not a true prediction of whether or not you will develop this eye disease. No one can make that prediction accurately. That is why you should continue to see your eye doctor regularly so that they can evaluate you for any worrisome changes. 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. Hopefully, you will be one of the fortunate ones that never develop glaucoma, but by continuing to have eye examinations on a regular basis, if you do develop this eye disease, you will have the best chance of preserving as much vision as possible. I wish you the best of luck.

Thank you for your question. There is no evidence in the literature or from the clinic that blood pressure medications or cholesterol lowering medications cause glaucoma. In fact, the medications that we use to lower eye pressure are similar to those that are used to lower the blood pressure in some instances. Beta blockers are a common blood pressure lowering medication that is often used as a topical eye drop to lower intraocular pressure as well. The eye drops timolol, Timoptic, Betamol, Istalol, levobunolol, Betagan, carteolol, Ocupress, metipranolol, Optipranolol, betaxolol, and Betoptic are some of the beta blocker eye drops that we use to treat glaucoma. In addition, some doctors will place their normal-tension glaucoma patients on oral calcium channel blockers (another blood pressure lowering medication) because there is a possibility that this class of drugs is beneficial for this form of glaucoma. Finally, there is some evidence that long-term use of some cholesterol lowering medications may in fact reduce the risk of getting open-angle glaucoma. Further studies under underway concerning these medications, so continue to have an open dialog with your eye doctor and they can inform you of the study results as they develop.

Thank you for submitting your question. First, you should know that this happens to many of our patients at one time or another, so you are not alone. There is a pretty good chance that nothing bad has happened. We try to avoid this because there is a very small chance that the pressure in the eye could drop too low and you could get some side effects from this. Your eye constantly makes fluid (aqueous humor) that keeps the eye blown up like a water balloon. However, in glaucoma, the pressure in the eye is often too high and it needs to be lower. I tell my patients that the eye is a bit like a sink that has a dripping faucet. The water continues to drip into the sink and then it runs out the drain at the bottom. When you have glaucoma, it is similar to having a clog in the drain and the sink backs up (i.e., the pressure builds up). The medications that we give patients essentially do two different things: Either they turn the dripping faucet down (we call this aqueous suppression) or they allow more water to flow out of the eye by a couple of different methods. After surgery that puts in a new drain, a lot of the fluid bypasses the eye's natural drainage system. When the surgery has worked really well, like in your case, there is often no need to use drops any more. Because your pressure is excellent now, using drops to decrease the flow of fluid or increase the drainage even more could cause a small risk that the pressure in the eye can get too low. If this happens fluid can accumulate in the layer of the eye between the white part (sclera) and the retina. You would likely notice a change in your vision or pain. While this is relatively rare, if you are concerned that the pressure may have dropped too low, it is never a bad idea to stop by your doctor's office to let them check the pressure and make sure there are no problems.

Thank you for your question. If you have had successful iridotomies, I have to assume that you have anatomically narrow drainage angles and/or you have had episodes of angle closure in the past. If you simply have anatomically narrow drainage angles without glaucoma, examinations every 6-12 months is very reasonable. If you have glaucoma, then the answer becomes more complicated. Every glaucoma patient is completely different. It 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 1 or 2 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.

Thank you for submitting a question. I will first address the last part of your question. The previous surgery should not put you at an increased risk of glaucoma even though you had a black eye post-operatively. The fall that resulted in trauma to the eye could definitely put you at risk for developing angle-recession glaucoma in the future. However, this should not put you at an increased risk of glaucoma in the non-traumatized eye. I suggest you have an eye doctor that is good at gonioscopic examinations look at the drainage angle of the eye to determine whether or not you have any signs of damage to the drainage system.

To answer the first part of your question, the follow-up for every patient diagnosed with glaucoma or diagnosed as a glaucoma suspect 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. Even as a glaucoma ‘suspect,’ if your pressure is 25 mmHg, I would not suggest waiting 1-2 years for a re-examination. 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, but that is only after a pattern of stability has been established. I would not consider a change in eye pressure from 19 to 25 necessarily stable. While the information above may not be enough to diagnose you has having glaucoma, it would give me reason to follow you closely. 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. 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, and in this case, I might suggest that.

Thank you for the question. Unfortunately, the symptoms that you have provided are not stereotypical for someone experiencing problems related to glaucoma. While it is not impossible, your wife is rather young to be developing open-angle glaucoma. She may be having occasional episodes of angle closure, but this is not as likely as other causes for similar headaches. If her eyes are occasionally red and you are noticing a change in the size of her pupils, it is always advisable to have a routine eye exam with an eye doctor to ensure there are no problems. In cases like this, the source of pain is probably related to the eye in less than 5 percent of patients. However, to be safe, she could have an exam completed by an eye doctor and they will be able to measure the pressure, check her vision, check her refraction, complete a gonioscopy to ensure that she does not have narrow angles, and they can then dilate her eyes to ensure there is no evidence of glaucoma. Again, I think the chance of these symptoms being caused by glaucoma is very small, but if you are noticing changes in your wife’s eyes, it is always advisable to have a routine exam to look for any problems.

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.