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Any advice?

Question:

I had been diagnosed with a slightly raised IOP about nine months ago, low 20s in both eyes. Time of day didn’t seem to matter. I have gone for a second opinion and tested every three months. IOP is now in the mid-20s. Field-of-vision tests show no peripheral vision loss.  Visual examination of dialated eyes shows no "obvious" damage of optic nerves, but one (the one with the slightly higher IOP) looks "different". My specialist calls definate diagnosis of glaucoma "an inexact science", and an "art form". He sighs and says that he wishes he could determine definately whether or not I have glaucoma, or am in the early stages or not. He goes on to say that because elevated IOP affects each individual so differently, he knows he is prescribing drops for people who probably do not have glaucoma and not prescribing drops for people who probably do have glaucoma. So, I have been lurking on the sidelines of this group and I wonder at what point we decide if I do have glaucoma and should start taking the drops? Any thoughts on this. Thanks, Chris

Response:

Eye there, I see that there are not many postings in this group. Still, I hope  someone out there reads this and can give me some  advice. I am 57, and was diagnosed with glaucoma at the end of last year. IOP readings were first 24/25, next time 27/28. Visual field test showed some loss in the right eye. I got Timoptol 0.5% eyedrops (same as Timolol), but after about three months my IOP was still 23, and my ophthalmologist wanted it to come down to below 20. She prescribed Cosopt, which after about  2 months gave a result of 21. Better, but not good enough, and I had  some side effects: stinging eyes, dry mouth and sometimes a bad taste in the mouth… So I got Xalatan, but after one month on these drops my IOP was again 24! So this one didn’t seem not to help very much. The eye specialist then suggested  laser treatment, but was willing to try one more combination of drops: Alphagan together with Timoptol. I have been taking these now for about 3 weeks, and next monday (May 28) I see  my doctor and the tonometer again. If results are not satisfying again, should I accept laser therapy? I’ve read more than once here and on the web that the older you are, the better the laser works, so I would like to go on with medicins for some time. Maybe I should go back to Cosopt? There were side effects, but not too bad. Or do you know other drops or combinations which could give better results? Maybe I should go to another ophthalmologist to get a second opinion? I wonder why most drops have so little effect on me. Are there other persons with the same experience? Thank you for any advice, Greetings from Belgium, Roger

Response:

Roger,     I’d say you’re doing the right thing by being aggressive about the problem, but you’re far from the end of the line on it.  Work with your doctor on combinations of drops (I’ve been having good luck with Cosopt and Xalatan, but I know that combination doesn’t work equally well for others.)  And if the laser you’re talking about is the argon, see above reply to Colorado Gal on the same subject.     Best of luck to you!     Don Singleton – Hide quoted text — Show quoted text -Roger De Paepe wrote: > Eye there, > I see that there are not many postings in this group. Still, I hope  someone > out there reads this and can give me some  advice. > I am 57, and was diagnosed with glaucoma at the end of last year. IOP > readings were first 24/25, next time 27/28. Visual field test showed some > loss in the right eye. > I got Timoptol 0.5% eyedrops (same as Timolol), but after about three months > my IOP was still 23, and my ophthalmologist wanted it to come down to below > 20. She prescribed Cosopt, which after about  2 months gave a result of 21. > Better, but not good enough, and I had  some side effects: stinging eyes, > dry mouth and sometimes a bad taste in the mouth… So I got Xalatan, but > after one month on these drops my IOP was again 24! So this one didn’t seem > not to help very much. > The eye specialist then suggested  laser treatment, but was willing to try > one more combination of drops: Alphagan together with Timoptol. I have been > taking these now for about 3 weeks, and next monday (May 28) I see  my > doctor and the tonometer again. > If results are not satisfying again, should I accept laser therapy? I’ve > read more than once here and on the web that the older you are, the better > the laser works, so I would like to go on with medicins for some time. Maybe > I should go back to Cosopt? There were side effects, but not too bad. Or do > you know other drops or combinations which could give better results? Maybe > I should go to another ophthalmologist to get a second opinion? > I wonder why most drops have so little effect on me. Are there other persons > with the same experience? > Thank you for any advice, > Greetings from Belgium, > Roger

Response:

- Hide quoted text — Show quoted text -James "Chris" Christenson wrote in message … >I had been diagnosed with a slightly raised IOP about nine months ago, low >20s in both eyes. Time of day didn’t seem to matter. I have gone for a >second opinion and tested every three months. IOP is now in the mid-20s. >Field-of-vision tests show no peripheral vision loss.  Visual examination >of dialated eyes shows no "obvious" damage of optic nerves, but one (the >one with the slightly higher IOP) looks "different". >My specialist calls definate diagnosis of glaucoma "an inexact science", >and an "art form". He sighs and says that he wishes he could determine >definately whether or not I have glaucoma, or am in the early stages or >not. He goes on to say that because elevated IOP affects each individual >so differently, he knows he is prescribing drops for people who probably >do not have glaucoma and not prescribing drops for people who probably do >have glaucoma. >So, I have been lurking on the sidelines of this group and I wonder at >what point we decide if I do have glaucoma and should start taking the >drops? Any thoughts on this. >Thanks, Chris

I have herd that elevated eye pressure can be caused by diabetes.  I know someone that lost their sight to diabetes.  You may want to look more into that too. Dan Bowdell

Response:

Hi- I am 72 and was diagnosed with open angle glaucoma in Jan. following a field test showing loss of vision in the left eye. For the past five mos. my opth. has advised using the following meds in this order; Azopt, Xalatan, Xalatan with Betoptic S, Xalatan with Cosopt, Xalatan as monotherapy, Xalatan with Cosopt, and just this week Xalatan with Alphagan. I have been complaining about the side effects particularly on the GI tract as well as muscle or joint weakness. Except for the initial reduction of the IOP following the first use of Xalatan, nine separate measurements in the a.m. (with no drops taken prior to the visit) have shown the IOP virtually the same in the 20-22 range. I’m sure the opth. would like to get the IOP down to the 18 or below range. Any suggestions for alternatives?

Response:

Thank you for your reminder of DeJa News. I had forgotten about that. As far as I know there is no familial history of glaucoma, though because the family is spread far and wide that isn’t ruled out. I have severe near-sightedness. I am 48. Chris – Hide quoted text — Show quoted text -In article <34a8cddd.37778…@news.sirius.com>, Raymond A. Chamberlin wrote: > On Mon, 29 Dec 1997 22:35:27 -0700, pakch…@ix.netcom.com (James > "Chris" Christenson) wrote: > >I had been diagnosed with a slightly raised IOP about nine months ago, low > >20s in both eyes. Time of day didn’t seem to matter. I have gone for a > >second opinion and tested every three months. IOP is now in the mid-20s. > >Field-of-vision tests show no peripheral vision loss.  Visual examination > >of dialated eyes shows no "obvious" damage of optic nerves, but one (the > >one with the slightly higher IOP) looks "different". > >My specialist calls definate diagnosis of glaucoma "an inexact science", > >and an "art form". He sighs and says that he wishes he could determine > >definately whether or not I have glaucoma, or am in the early stages or > >not. He goes on to say that because elevated IOP affects each individual > >so differently, he knows he is prescribing drops for people who probably > >do not have glaucoma and not prescribing drops for people who probably do > >have glaucoma. > >So, I have been lurking on the sidelines of this group and I wonder at > >what point we decide if I do have glaucoma and should start taking the > >drops? Any thoughts on this. > I think most of the thoughts have been voiced in past posts to this > NG.  Have you checked out any of them in the DejaNews archives?  Your > specialist sounds pretty tuned into where the state of the art > presently stands (or more truthfully, lies down).  You could get more > MDs to form a consensus on the state of your optical-nerve heads, or > you could, at some point start showing a defect in your visual fields, > but armed with either or both of these, you still wouldn’t know > whether taking any kind of drops, even if they do lower the pressure > without side effects, actually are going to prevent progression of > such visual defects as might show up.  Do you have any familial > history of glaucoma and do you have any other eye problems? > Ray (not an eye-tretment professional)

Response:

On Mon, 29 Dec 1997 22:35:27 -0700, pakch…@ix.netcom.com (James – Hide quoted text — Show quoted text -"Chris" Christenson) wrote: >I had been diagnosed with a slightly raised IOP about nine months ago, low >20s in both eyes. Time of day didn’t seem to matter. I have gone for a >second opinion and tested every three months. IOP is now in the mid-20s. >Field-of-vision tests show no peripheral vision loss.  Visual examination >of dialated eyes shows no "obvious" damage of optic nerves, but one (the >one with the slightly higher IOP) looks "different". >My specialist calls definate diagnosis of glaucoma "an inexact science", >and an "art form". He sighs and says that he wishes he could determine >definately whether or not I have glaucoma, or am in the early stages or >not. He goes on to say that because elevated IOP affects each individual >so differently, he knows he is prescribing drops for people who probably >do not have glaucoma and not prescribing drops for people who probably do >have glaucoma. >So, I have been lurking on the sidelines of this group and I wonder at >what point we decide if I do have glaucoma and should start taking the >drops? Any thoughts on this. >Thanks, Chris

Not being a professional, I would not dare to provide any advice but, as I am about in the same situation as you are, I can express my feeling on what you describe: I would say that your specialist is honest enough to share with you his doubts as to whether you could develop a glaucoma or not. This is not an usual attitude and you should credit him for that! Now it can be understandable that, being in doubt, the specialist would prescribe drops just as a precaution (for himself?), if he thinks there is no important side effect to occur. It is apparently what my specialist thought in prescribing to me Timoptol (timolol maleate) after he measured an IOP of 24, but without otherwise glaucoma suspicion from visual field test (though the test on left eye is somewhat disturbed by an evolving cataract) and optical disk examination. My only possible risk factors for glaucoma are age (67) and perhaps hypermetropia (3 diopters). Previous routine IOP measurements were around 20 only. An examination after two weeks showed that IOP had dropped to 16 in both eyes. I am now using drops for 2 months and next month I intend to discuss with my specialist the pertinence of continuing the medication in absence of other indications of a possible glaucoma. Just the reverse question you are wondering, quite in line with the comments from your specialist….but that does not help very much! — Jacques Christ

Response:

On Mon, 29 Dec 1997 22:35:27 -0700, pakch…@ix.netcom.com (James – Hide quoted text — Show quoted text -"Chris" Christenson) wrote: >I had been diagnosed with a slightly raised IOP about nine months ago, low >20s in both eyes. Time of day didn’t seem to matter. I have gone for a >second opinion and tested every three months. IOP is now in the mid-20s. >Field-of-vision tests show no peripheral vision loss.  Visual examination >of dialated eyes shows no "obvious" damage of optic nerves, but one (the >one with the slightly higher IOP) looks "different". >My specialist calls definate diagnosis of glaucoma "an inexact science", >and an "art form". He sighs and says that he wishes he could determine >definately whether or not I have glaucoma, or am in the early stages or >not. He goes on to say that because elevated IOP affects each individual >so differently, he knows he is prescribing drops for people who probably >do not have glaucoma and not prescribing drops for people who probably do >have glaucoma. >So, I have been lurking on the sidelines of this group and I wonder at >what point we decide if I do have glaucoma and should start taking the >drops? Any thoughts on this.

I think most of the thoughts have been voiced in past posts to this NG.  Have you checked out any of them in the DejaNews archives?  Your specialist sounds pretty tuned into where the state of the art presently stands (or more truthfully, lies down).  You could get more MDs to form a consensus on the state of your optical-nerve heads, or you could, at some point start showing a defect in your visual fields, but armed with either or both of these, you still wouldn’t know whether taking any kind of drops, even if they do lower the pressure without side effects, actually are going to prevent progression of such visual defects as might show up.  Do you have any familial history of glaucoma and do you have any other eye problems? Ray (not an eye-tretment professional)

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