Science & Research

There are very few precautions that will cause you to change your activities of daily living after glaucoma laser surgery. Your eye doctor should discuss the risks, benefits, and alternatives of any procedure before you agree to have any procedure performed in the office or in the operating room. For any glaucoma laser surgery, you will have a few drops of medication put into your eye prior to the procedure to help with your comfort level during the procedure. In addition, a few drops may be put in after the procedure to decrease the amount of inflammation that is created during the laser procedure. After the procedure has been completed, you will likely be asked to wait approximately 20-30 minutes to have the intraocular pressure checked again.

There is a small risk that the laser procedure can cause an increase in the eye pressure. This can often be reversed in the office with a couple of additional pressure lowering drops and in most people it does not last long. It is very common to have a slight headache after the laser procedure, so you may not feel like doing much that evening. Other than that, there are no real restrictions to your activities. There is often a small amount of inflammation that occurs in the eye after the procedure, so you will likely be given an anti-inflammatory eye drop for approximately 1 week. I often see my patients back one week after the procedure to make sure that the eye is no longer inflamed and the patient is comfortable. We would not expect the pressure to be reduced at one week because the full effect of the laser is often not complete until at least 4-6 weeks after the laser procedure. You will likely be seen again 1-2 months after the laser procedure to see if your eye pressure is reduced to the target that was set by your eye doctor.

Thank you for this excellent question. The simplest answer I can give you is ABSOLUTELY. The intraocular pressure fluctuates throughout the day even in patients without glaucoma. This is called a diurnal rhythm or circadian rhythm. We do not yet know the exact mechanism that controls this diurnal fluctuation, but some people are studying it to determine why this occurs. In most people, but not all, intraocular pressure is highest in the morning. The peak is often shortly after someone wakes up.

We also know that even in patients without glaucoma the intraocular pressure can vary approximately 4 to 6 millimeters of mercury (mmHg) throughout the day. In patients with glaucoma or glaucoma suspects, this amount of variation can increase (similar to what you are describing). In these cases, it is not uncommon to see variations over 6 mmHg throughout the day and the highest pressure may occur at a time other than the morning. If we believe someone may have glaucoma, but has always had normal pressure readings in the office, we will look to see what time they have had appointments. Often we will schedule them for a day long appointment and get a "diurnal pressure reading." This means that the patient will come in as early in the morning as possible to have the intraocular pressure checked. They will then stay in the office or return to the office every hour or two throughout the day to have the pressure checked to determine how much the intraocular pressure is fluctuating and how high it gets. It sounds as though your eye doctor may have suspected this, and that is why you have had appointments scheduled in both the morning and afternoon.

That is an excellent question, thank you for submitting it. Glaucoma itself is not usually a cause of dry eyes; however some of the drops that doctors use can be irritating to the eyes. In particular, one of the medications in Cosopt, the carbonic anhydrase inhibitor, often causes a stinging sensation when it is put in. In addition, some patients will notice some redness after using prostaglandin analogs like Xalatan. While these may cause some minor irritation, they do not necessarily cause dryness. Alternatively, if the bleb from the trabeculectomy is large and hangs over the cornea, it may cause an uneven tear film distribution over the cornea when you blink. I suggest that you have your eye doctor check to make sure that the shape of the bleb is not causing any problems with the tear film distribution. Finally, your doctor should be able to do a Schirmer's test to determine if you have a baseline deficiency of tears being produced or if there are other problems. If the artificial tears and the Restasis are not helping, your doctor may suggest that you use an ointment at bedtime to help hydrate the eye throughout the night, and this may improve your symptoms during the day.

The second part of your question is a bit difficult to answer in light of your dry eyes. The dryness of the eyes can cause extreme blurring of your vision by itself. Secondly, the trabeculectomy can cause some changes in your vision and even the refraction depending on how the surgery was performed. Over time, the sutures will often relax and you will return to a stable refraction and can get new glasses if needed. Finally, your doctor should be following your visual fields to make sure that your glaucoma is not progressing and causing a change in your vision (although this is less likely if your pressures are stable between 6-8 millimeters of mercury).

Thank you for the question. According to all of the sources currently available, your eye doctor is correct. It is not likely that this medication is going to make your glaucoma worse, and it is not contraindicated in patients with documented open-angle glaucoma. Imipramine is a tricyclic antidepressant. The insert states that the medication should not be used in patients with glaucoma; however, studies have not shown a contraindiaction to using this medication in patients with open-angle glaucoma. All of the literature and studies show that imipramine is associated with angle-closure glaucoma and therefore should not be used by individuals that have narrow angles or episodes of angle closure. It is important that you make sure that your eye doctor has completed a gonioscopy to ensure that the drainage angle is open, and then I would feel comfortable recommending that you can continue using imipramine.

Thank you for submitting your question. Unfortunately the symptoms that you are noticing are very non-specific and are not predictive of having or not having glaucoma. In fact, a lot of patients that do end up having glaucoma have never noticed any symptoms and it is simply recognized on a regular ophthalmic examination. In your case, a difference in the size of your two eyes can be an indication of glaucoma because when infants or young children have glaucoma it can cause the eyes to become enlarged.

You can think of this as being similar to a balloon. When we increase the pressure inside of a balloon it will become larger. Your doctor has done the right thing by doing a baseline examination and then plan on re-examining your eyes after a short interval. Your eye doctor will follow the intraocular pressure, vision, visual fields and the appearance of the optic nerves to see if there are any changes. If your eye doctor sees any progression, they will discuss your treatment options. Your case is not typical, so if you have any concerns, I would not hesitate to request a second opinion from an ophthalmologist that has completed a glaucoma fellowship.

Thank you for the question. Travatan Z is a type of medication called a prostaglandin analog. It lowers the intraocular pressure by increasing the outflow of aqueous humor (fluid) from inside the eye back to the body. There is no evidence that this medication has any effect on blood sugar levels. In addition, there have been no studies indicating that prostaglandin analogs are contraindicated in patients with diabetes or elevated blood sugars.

Thank you for your question; it raises an interesting point. Let’s divide this into two sections.

First, let’s look at the use of Ritalin and its association with glaucoma. Ritalin, also known as methylphenidate, is a psychostimulant medication that is primarily used for the treatment of attention deficit disorder (ADD) in children. While there are rare case reports of glaucoma and/or cataract formation in children that have used Ritalin, a direct association has never been proven. However, this medication is now increasingly being used to treat adults for various reasons. In addition, glaucoma is generally diagnosed during adulthood. There are several sources in the literature that do show a connection between Ritalin and the presence of glaucoma in some adults, but again, there is no definitive causal relationship. Interestingly, the same can be said for any stimulant whether it is prescribed by a physician or self administered (caffeine, cocaine, for example). Caffeine is a naturally occurring stimulant and has been proven to transiently increase the production of aqueous fluid within the eye. This theoretically could lead to an increase in intraocular pressure and worsening of glaucoma. While some studies find that caffeine intake can be correlated with intraocular pressure and glaucoma, other equally reliable studies have found no association between the two. Therefore eye doctors cannot definitively tell their patients to stop all caffeine; however, they often ask their patients to limit their intake as a precaution. If you are taking Ritalin or any other stimulant mediation and are concerned about also having glaucoma, you should be seen by a glaucoma specialist for a thorough eye examination to determine whether or not you do have glaucoma.

The second part of your question deals with the symptoms that you are noticing. While "pressure in the eyes" or "pressure in the head" may rarely be the presenting signs of glaucoma, most patients do not feel pressure or pain until the intraocular pressure is quite elevated (above 30). "Pressure" or "pain" is not usually the reason most glaucoma patients present for an evaluation, but some do. Many patients are diagnosed by chance during a routine eye exam, if they have noticed a change in vision, or if they have requested an evaluation because of a family history of glaucoma. I suggest that you be evaluated by a glaucoma specialist. They can evaluate you for glaucoma, but also look for any other causes of "eye pressure" or "head pressure" that may be related to your eyes. It would be best to have the evaluation during a time when you are experiencing the eye or head pressure, if possible. Secondly, you should let the physician that prescribed the Ritalin and your family physician (if they are different doctors) know that you are experiencing these symptoms so they can evaluate you for other non-ocular causes of these symptoms.

Thank you for your question. There are a many different types of glaucoma, and they can progress at different rates. If you were diagnosed at the age of 19, you likely have some form of congenital/juvenile glaucoma, angle-closure glaucoma, or secondary glaucoma and not primary open-angle glaucoma. Some types of glaucoma can progress quickly if the pressure is incredibly high and it can take vision within days or weeks. Other types of glaucoma are quite slow and it may take months or years before there is any evidence of vision loss. It is difficult to predict what course your glaucoma will take; however, if your pressure remains in the upper 30s to 40s range it should be treated aggressively to lower it as soon as possible. It is important to see your eye doctor regularly and not miss any appointments.

Once a thorough eye exam has been completed, eye doctors often set a target or goal intraocular pressure. The only variable that we can change to slow or stop the progression of your glaucoma is the 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 (like the Betoptic that you are using), laser treatments, and surgical methods to lower the intraocular pressure. Your doctor has prescribed Betoptic, and it is very important that you continue to use the eye drop daily as directed. He or she will likely follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how your eyes are responding. If the pressure is not reduced enough on Betoptic alone or your doctor ever notices advancement in your glaucoma, they will add more medications or use laser or surgery to help lower the intraocular pressure further. 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, doctors cannot stop the progression of the glaucoma and patients do eventually go blind, but this is the minority of patients.