Heifer…@gmail.com wrote: > Yeah, that’s the IT of it. > My parents had me seen by the Glaucoma Associates of New York and they > knew exactly what to do with me, so that’s where I’ll be having my > surgery. The Indiana docs put me on Diamox a couple weeks ago because I > was having black outs and SEVERE behind-the-eye pain. The Diamox is > helping, but my pressure is still way too high. The doctors in NY said > that the Uveitis messed up the meshwork on a cellular level so they’re > going to have to look at it more closely when I get out there (I > think).

I’m glad you are seeing a doctor you are happier with. I presume they have some Uveitis specialists too. The Uveitis will trash the Trabecular Meswork – that’s why sorting the Uveitis has to be job no 1. What treatment are you on for the Uveitis and the Glaucoma? Did they discuss any dietary or lifestyle changes as well? Good Luck!

Response:

Seems I’ve read in the Saturday Evening Post that there’s a renowned eye clinic at the University of Indiana in Indianapolis.  You might check that out. I don’t know anything about your particular condition.  But I do know steroid eye drops like Pred Forte can raise pressure.  Nevertheless, even glaucoma specialists will require its use for several weeks after eye surgery.  It’s necessary to prevent inflammation and scarring, which could negate the results of the surgery. Laura On 24 Aug 2005 22:32:37 -0700, "Heifer…@gmail.com" – Hide quoted text — Show quoted text -<Heifer…@gmail.com> wrote: >I’m new here. Hey! I’m 20 from Indiana and last year I was roundaboutly >diagnosed with Pars Plantis in only my left eye. I say roundaboutly >because it started in March 04 , I took all the blood tests and x-rays >and nothing was found, but I still never had anyone actually tell me >what it was that was wrong with me until I saw a specialist in CT in >December 04. They put me on Pred-Forte to chill my retina out (which >thankfully helped). Anyway, in July 04 the people here in IN gave me a >Kenalog injection and it’s now August 05 and the deposit of meds is >still in my eye. My Pars Plantis went away, but now I’m stuck with >open-angle glaucoma and a cataract. I’ve been on Alphagan since last >October (I think), Cosopt since May, and Travatan for about a month. My >pressure is still 40 and won’t budge at all. In about two weeks I’m >going to see a specialist in New York because my parents don’t trust >the jerks here in IN. >Erm, I guess what I’m going for here is just people to talk to. I’ve >been told I will have to have surgery on my eye for the glaucoma if it >doesn’t lose the pressure. Damage has already been done to my retina. >Alphagan 3X, Cosopt 2X and Travatan 1X a day and I’m still getting eye >pain and headaches sometimes at night like I’m not taking anything at >all. >Has anyone else had the steroid-induced stuff happen to them? Are your >doctors more worried? My doctors seem to be dragging their feet like >they don’t care… hence my going to NY. Anyone else have a similar >situation??

Response:

I haven’t heard anything about the University of Indiana clinic, which is strange. I also didn’t know that after surgery it’s used. That’s a good and interesting thing to know. It makes sense though.

Response:

- Hide quoted text — Show quoted text -Heifer…@gmail.com wrote: > I’m new here. Hey! I’m 20 from Indiana and last year I was roundaboutly > diagnosed with Pars Plantis in only my left eye. I say roundaboutly > because it started in March 04 , I took all the blood tests and x-rays > and nothing was found, but I still never had anyone actually tell me > what it was that was wrong with me until I saw a specialist in CT in > December 04. They put me on Pred-Forte to chill my retina out (which > thankfully helped). Anyway, in July 04 the people here in IN gave me a > Kenalog injection and it’s now August 05 and the deposit of meds is > still in my eye. My Pars Plantis went away, but now I’m stuck with > open-angle glaucoma and a cataract. I’ve been on Alphagan since last > October (I think), Cosopt since May, and Travatan for about a month. My > pressure is still 40 and won’t budge at all. In about two weeks I’m > going to see a specialist in New York because my parents don’t trust > the jerks here in IN. > Erm, I guess what I’m going for here is just people to talk to. I’ve > been told I will have to have surgery on my eye for the glaucoma if it > doesn’t lose the pressure. Damage has already been done to my retina. > Alphagan 3X, Cosopt 2X and Travatan 1X a day and I’m still getting eye > pain and headaches sometimes at night like I’m not taking anything at > all. > Has anyone else had the steroid-induced stuff happen to them? Are your > doctors more worried? My doctors seem to be dragging their feet like > they don’t care… hence my going to NY. Anyone else have a similar > situation??

This is familiar. I started with Uveitis in my teens and had glaucoma and cataracts. Uveitis is imflammation of the Uveal tract which can affect the Trabecular Mesh (the eyes drainage network) and in turn lead to Glaucoma. Steroidal anti imflammatories are normally used to treat the Uveitis but they can also cause raised IOP and can also promote the growth of a cataract. (There are also non-steroidal anti imflammatories but these have their problems too and are not as effective). So the Uveitis and the treatment for Uveitis can cause glaucoma therefore they need to treat that as a secondary condition. I was given tablets to reduce the pressure (Diamox sustained release) which was effective but led to potassium depletion (eat a banana). The secondary Glaucoma is serious, it can cause permanent optic nerve damage and affect your visual fields – sufficient damage will mean no driving. Once the Uveitis is under control and you are off steroids they can continue to treat any remaining glaucoma which will hopefully be lesser and respond OK for you. Once you have had uveitis there is always a risk of post operative implammation flaring it up again so they will be more careful with you if you ever have surgery. ianad.

Response:

I just had a trabulectomy last Tuesday. The pressure was up to 46. Currently, they have me on Pred-Forte and oral steroids to block any and all inflamation possible while my eye heals. Yeah, these guys in NYC are fantastic. Dr. Samson, the Uveitis guy, is just amazing. He put everything together for me and my parents. As for dietary or lifestyle changes, no. No one has spoken to me about that. I’d like to think that I’m a fairly healthy person… lol. And right after they let me, I’ll go back to exercising properly.

Response:

Yeah, that’s the IT of it. My parents had me seen by the Glaucoma Associates of New York and they knew exactly what to do with me, so that’s where I’ll be having my surgery. The Indiana docs put me on Diamox a couple weeks ago because I was having black outs and SEVERE behind-the-eye pain. The Diamox is helping, but my pressure is still way too high. The doctors in NY said that the Uveitis messed up the meshwork on a cellular level so they’re going to have to look at it more closely when I get out there (I think).

Response:

Heifer…@gmail.com wrote: > I haven’t heard anything about the University of Indiana clinic, which > is strange. > I also didn’t know that after surgery it’s used. That’s a good and > interesting thing to know. It makes sense though.

I can highly recommend The Midwest Eye Institute, http://www.midwesteye.com/home.htm. Dr. Valerie Purvin diagnosed and cured my Giant Cell Arteritis with zero vision loss. Dave in Northern Indiana

Response:

I’m new here. Hey! I’m 20 from Indiana and last year I was roundaboutly diagnosed with Pars Plantis in only my left eye. I say roundaboutly because it started in March 04 , I took all the blood tests and x-rays and nothing was found, but I still never had anyone actually tell me what it was that was wrong with me until I saw a specialist in CT in December 04. They put me on Pred-Forte to chill my retina out (which thankfully helped). Anyway, in July 04 the people here in IN gave me a Kenalog injection and it’s now August 05 and the deposit of meds is still in my eye. My Pars Plantis went away, but now I’m stuck with open-angle glaucoma and a cataract. I’ve been on Alphagan since last October (I think), Cosopt since May, and Travatan for about a month. My pressure is still 40 and won’t budge at all. In about two weeks I’m going to see a specialist in New York because my parents don’t trust the jerks here in IN. Erm, I guess what I’m going for here is just people to talk to. I’ve been told I will have to have surgery on my eye for the glaucoma if it doesn’t lose the pressure. Damage has already been done to my retina. Alphagan 3X, Cosopt 2X and Travatan 1X a day and I’m still getting eye pain and headaches sometimes at night like I’m not taking anything at all. Has anyone else had the steroid-induced stuff happen to them? Are your doctors more worried? My doctors seem to be dragging their feet like they don’t care… hence my going to NY. Anyone else have a similar situation??

Response:

Great Post, Sherry!  All I would add is that if your friend has had a 50% drop in eye pressure with these meds and currently hovers in the low to mid teens, that is likely to be sufficient to prevent any significant futher loss of vision.  If he can get the drops, as Sherry said, as samples from the doc or from the drug companies (all of them have programs to provide free or reduced cost meds to the poor) and actually uses them, hopefully he won’t show progressive loss on his visual field tests.  I would only recommend a trab if definitive progression is present on the fields.  As for the "world class medical centers," they are often not worth half the hype they get.  The patients are often worked-up (and sometimes worked over) by residents and fellows…then the big name attending physician spends five minutes with you.  Many of these, known for publishing a ton of papers and teaching at medical meetings, have absolutely no bedside manner.  When you go to them for surgery, it is done by the fellow with the attending sitting right by his/her side (and the patient can’t tell the difference).  I might get an opinion from a university-based specialist, but I wouldn’t want to hang out there for good. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

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On 12 Aug 2005 19:36:59 -0700, eyegu…@aol.com wrote: >As for the "world class medical >centers," they are often not worth half the hype they get.  The >patients are often worked-up (and sometimes worked over) by residents >and fellows…then the big name attending physician spends five minutes >with you.  Many of these, known for publishing a ton of papers and >teaching at medical meetings, have absolutely no bedside manner.  When >you go to them for surgery, it is done by the fellow with the attending >sitting right by his/her side (and the patient can’t tell the >difference).  I might get an opinion from a university-based >specialist, but I wouldn’t want to hang out there for good. >–Rick Cohn, MD >Glaucoma Specialist >Winter Park, FL

That certainly is "telling it like it is," Dr. Cohn — Thanks! But we must remember that the supply of private-practice surgeons is dependent on University teaching "medical centers."  All experienced surgeons were once "residents," and they won’t live forever. On the issue of "frequently publishing physicians" (Having participated in that game in a different field, I recognize the implications ):  One of my eyes was badly damaged in uncomplicated cataract surgery by a [non-University] surprisingly-young FACS with a slew of publications.  I got the impression that he sometimes used self-invented new techniques. One of them backfired on me. John

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I’m posting this for a friend.  He’s a very talented artist, and has been told that he may well soon go blind from advanced glaucoma.  He’s now 55 years old.  He was first diagnosed with glaucoma in his mid-20’s but did nothing about it until his mid-40’s, when he first began to notice vision loss.  He’s seen an ophthalmologist since 1999, who, upon her initial examination, proclaimed that he had severe optic nerve damage, and advanced glaucoma.  The pressure at that time, in each eye, was over 30.  Through the continued use of alphagan p, cosopt and xalatan, the pressure has dropped substantially and now ordinarily hovers between 10 and 15. His doctor mentioned the possibility of surgery (a trabeculectomy), but this was prior to the stabilization of the pressure, with which she seemed relatively pleased.  She suggested that although surgery could bring the pressure down even further and could last several years before another surgery would be necessary, it would definitely cause even further vision loss.  He recently saw another MD, who looked over his records, did a pressure check, surveyed the optic nerves, and told him that his glaucoma was now in the end stage.  On the other hand, he can still see well enough (at least in one eye) to paint. He’s only seen two doctors for his condition, and I don’t believe either were at world class medical centers.  (He’s in the LA basin area.)  Any recommendations as to possible new treatments, clinical trials, evaluations he should have, etc.?  Any suggestions would be greatly appreciated! P.S.  In addition to waiting far too long to seek treatment (partly driven by financial considerations and no health insurance), he also engages in a number of likely lifestyle no-nos for glaucoma patients. He smokes a pack of cigarettes a day, and drinks 2-3 cups of coffee a day.  Also, about three times a month, he parties, and drinks a six pack of beer at a setting.

Response:

> A trab can cause a small amount of loss of visual acuity, which would > be better than going blind from *not* having a trab.  It’s usually > just a line or so on the Snellen Chart – if he’s seeing 20/20, he > might drop to 20/25 or 20/30.  No big deal.  I see 20/40 after my > trabs and my pressures are holding at 10 without drops.

My experience was the exact opposite.  After having cataract and trab surgery I now see 20/25 in both eyes.  With glasses or contacts I never corrected better than 20/30 in one eye and 20/40 in the other eye.  My pressures have been running about 12 and 15 without drops. Don

Response:

mel…@sbcglobal.net wrote in news:1123685857.876592.216080@g49g2000cwa.googlegroups.com: – Hide quoted text — Show quoted text -> I’m posting this for a friend.  He’s a very talented artist, and has > been told that he may well soon go blind from advanced glaucoma. > He’s now 55 years old.  He was first diagnosed with glaucoma in his > mid-20’s but did nothing about it until his mid-40’s, when he first > began to notice vision loss. <snip> > His doctor mentioned the possibility of surgery (a trabeculectomy), > but this was prior to the stabilization of the pressure, with which > she seemed relatively pleased.  She suggested that although surgery > could bring the pressure down even further and could last several > years before another surgery would be necessary, it would definitely > cause even further vision loss.<snip> > He’s only seen two doctors for his condition, and I don’t believe > either were at world class medical centers.  (He’s in the LA basin > area.)  Any recommendations as to possible new treatments, clinical > trials, evaluations he should have, etc.?  Any suggestions would be > greatly appreciated! > P.S.  In addition to waiting far too long to seek treatment (partly > driven by financial considerations and no health insurance), he also > engages in a number of likely lifestyle no-nos for glaucoma > patients. He smokes a pack of cigarettes a day, and drinks 2-3 cups > of coffee a day.  Also, about three times a month, he parties, and > drinks a six pack of beer at a setting.

Oh dear….well, he’s certainly a poster boy for what not to do if you are diagnosed with glaucoma!  Chances are had he paid attention to his doc in the beginning, he’d still be seeing fairly well.  He’s lucky to be in the LA area.  There are two excellent medical schools with great eye clinics – He could go to UC Irvine Doheny Eye Clinic or UCLA Jules Stein Eye Clinic – I’m sure they have accomodations for charity care. A list of glaucoma specialists at those two universities and others (Dr. Weinreb at Shiley Eye Center in La Jolla would also be an excellent choice) can be found at http://www.glaucomaweb.org/patients/find.htm?state=CA Any reason he’s not on MediCal? Also, for meds, a lot of patients will get samples from their glauc docs and never have to buy drops.  Drug companies are offering free meds – try http://www.needymeds.com for more info on that. A trab can cause a small amount of loss of visual acuity, which would be better than going blind from *not* having a trab.  It’s usually just a line or so on the Snellen Chart – if he’s seeing 20/20, he might drop to 20/25 or 20/30.  No big deal.  I see 20/40 after my trabs and my pressures are holding at 10 without drops. There are a lot of visual artists who are blind, so it’s not hopeless that he’ll not be able to continue his art.  Do a google search on "blind visual artists" for a lot of interesting articles. Good luck! Sherry

Response:

Anterior ischemic optic neuropathy (AION) is not similar to glaucoma in symptoms or etiology.  AION is very much like a stroke to the optic nerve that causes immediate and usually permanent visual loss (although not complete…patients are often 20/400, and the loss may only involve the upper or lower half of the vision).  This is from blockage of bloodflow to the optic nerve in the tiny, microscopic vessels that bring blood to the nerve head.  It is common in elderly patients with hypertension and/or diabetes (usually the same group who use Viagra). The optic nerve will look swollen but not cupped out as in glaucoma. IOP is seldom if ever a factor in AION.  AION almost always occurs in one eye only.      Conversely, the vision loss from glaucoma is usually rather slow (over many years), is often but not always associated with elevation in IOP, and may not be noticed by the patient until advanced loss has occured.  There is often no significant association with systemic hypertension.  As many of these articles on Viagra have mentioned, it is hard to say if there is a true cause and effect between Viagra use and AION.  This is because many of those who use Viagra have the same risk factors for developing AION.  This will need to be studied further.  Meanwhile, remember that the number of cases of AION have been relatively few compared to the millions who use these drugs in this country.  I know if I needed Viagra to have a better sexlife, I wouldn’t be throwing away my little blue pills just yet. Hope that was useful. –Rick Cohn, MD Glaucoma Specialist

Response:

In article <1117497318.853728.149…@g49g2000cwa.googlegroups.com>, – Hide quoted text — Show quoted text - eyegu…@aol.com wrote: > Anterior ischemic optic neuropathy (AION) is not similar to glaucoma in > symptoms or etiology.  AION is very much like a stroke to the optic > nerve that causes immediate and usually permanent visual loss (although > not complete…patients are often 20/400, and the loss may only involve > the upper or lower half of the vision).  This is from blockage of > bloodflow to the optic nerve in the tiny, microscopic vessels that > bring blood to the nerve head.  It is common in elderly patients with > hypertension and/or diabetes (usually the same group who use Viagra). > The optic nerve will look swollen but not cupped out as in glaucoma. > IOP is seldom if ever a factor in AION.  AION almost always occurs in > one eye only. >      Conversely, the vision loss from glaucoma is usually rather slow > (over many years), is often but not always associated with elevation in > IOP, and may not be noticed by the patient until advanced loss has > occured.  There is often no significant association with systemic > hypertension.  As many of these articles on Viagra have mentioned, it > is hard to say if there is a true cause and effect between Viagra use > and AION.  This is because many of those who use Viagra have the same > risk factors for developing AION.  This will need to be studied > further.  Meanwhile, remember that the number of cases of AION have > been relatively few compared to the millions who use these drugs in > this country.  I know if I needed Viagra to have a better sexlife, I > wouldn’t be throwing away my little blue pills just yet. > Hope that was useful. > –Rick Cohn, MD > Glaucoma Specialist

* Dr. Cohn — Thanks for your usual explanation of a complex subject. I have a suggestion:  When you post to alt.support.glaucoma you should send a copy of your posting to:    glauc…@yahoogroups.com This would then appear on the Glaucoma mailing list that Yahoo maintains.  Dr. Robert Ritch is the resident Guru there, but he is extremely busy and could use a little help! Many thanks!  Keep up the good work. earle * Diagnosed in 1970 — tried every drop in the book.  Bilateral trabs about six years ago — now age 74 with IOP 15/17 (with no drops) and acuity 20:20 with one diopter of correction.

Response:

The FDA reported that a small number of men (49) who took Viagra and 1 who took cialis developed non-arteritic anterior ischemic optic neuropathy. From the AP News Quote: > It can occur in men who are diabetic or have heart disease, the same

conditions that can cause impotence and thus lead to Viagra use. That neuropathy is a disease whose symptoms are not dissimilar to glaucoma, although the etiology is presumed different. All of us men taking drops to resolve high IOP should be aware of the possible effects of ED drugs, particularly if we have already had some nerve damage. My very non-professional opinion is that extensive daily aerobic exercise not only lowers IOP (published data supports that) but also substantially reduces or eliminates age related ED (personal anecdotal evidence, I know of no published study to support this claim). Exercise sure beats taking drugs, and you are never too old to start excercising!  

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Hi Tom How can you seriously contemplate using an illicit drug, which has never had any research attached to it, and is acknowledged as being harmful to your general system, to address a local (eye) problem when you cannot measure the effectiveness of the treatment, since no qualified practitioner would ever agree to monitor your progress, as they would be implicated in an illegal act and could jeopardise their Practicing License.  Please understand that all drugs can have side-effects, which vary from person to person, but your probability of successful, long term treatment on correct Doctor-prescribed drugs is much higher than your probability of success using a non-recognised, non-regulated and non-controlled course of action.  I don’t know how old you are, but you must also consider the effect of using marijuana for decades, and also consider that this course of action will prevent you from ever boarding an international flight, as you will not be able to take your stash with you. I beg you to think carefully about this course of action. Best wishes for Christmas Mark Optometrist Sydney, Australia "tom" <l…@home.com> wrote in message

news:F45wd.576635$D%.503257@attbi_s51… – Hide quoted text — Show quoted text -> I have been studying the drug options for > glaucoma.  I dont have any idea with regards to > effectiveness, but there is no doubt in my mind > anyway that marijuana is far and away the safest > of all the alternatives. > I am a bit scared of taking any of the other > medications for any period of time.  They all > seem to be very potent and dangerous drugs > if they enter the bloodstream.

Response:

I don’t know.  I guess that would be more for the doctor to answer.  I do know that with certain preservative-free products, such as single-use lubricant vials like Bion Tears, I have to be more careful and use them within a certain amount of time after opening the packet because they don’t have preservatives.  I still use them because some preservatives irritate my eyes. Laura – Hide quoted text — Show quoted text -On Wed, 22 Dec 2004 03:12:41 GMT, "tom" <l…@home.com> wrote: >So is there any more danger of infection with glaucoma >eye drops than there is for soft contact lens rewetting >solution for example?  It seems from reading the >product information for these drugs that the bottle >is easily contaminated.

Response:

"Sun Chong Hong" <n…@spam.com> wrote in message news:cpujt6$mdm$1@mawar.singnet.com.sg… > Check out the information provided here: > http://www.mfiles.org/Marijuana/medicinal_use/b3_glaucoma.html > Sun Chong Hong

Lets hear from the other side: http://www.marijuanamyths.com/med-glaucoma.php3 It is interesting that anti-marijuana website contains blatant falsehoods where this website is much more careful with the facts. One question in particular.  What side effect or danger would there be in taking a large oral dose of marijuana before bedtime?

Response:

While it is true that the harmful side effects of marijuana may be overstated, it has not been found to be a useful IOP-lowering agent because of its short duration of action.  In order to keep your IOP low enough to protect your optic nerve, you would have to be stoned 24/7. Hard to go around leading a productive life that way.  Also, last time I checked it was…ILLEGAL!!! While we’re talking about "overstating" and "not knowing what you are talking about," lets address your comments about death and blindness from glaucoma drops.  In my nine years as a glaucoma specialist and twelve years treating eye diseases, I have only seen ONE patient admitted to the hospital as a result of glaucoma treatment (an asthmatic patient became short of breath on Betoptic S…he did fine with oxygen, a nebulizer treatment, and discontinuation of the drops). I have seen no deaths or blindness caused by these drops in over 10,000 patients I have treated.  The worst ocular side effect I have seen from these drops has been allergy or corneal irritation, which goes away after you stop them.  Systemically, I have seen fatigue or depression from Alphagan or Timoptic.  As for long track records, while these drops haven’t been around for thousands of years, many have been around for decades (Timoptic’s been around for over 30 years…that’s not enough for you?).  Most of these drops, like Xalatan, for instance, have been around almost 10 years and were in research for several years before that.  Xalatan is safe and effective and is an excellent medication…I’m certain it has prevented many of my patients from losing sight to glaucoma. I agree with others here that it sounds like you are just looking for a way to get cheaper and legalized recreational pot…don’t waste our time promoting it as a useful glaucoma therapy. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

"Steve" <no.tha…@nospam.net> wrote in message

news:s4qwd.1144$_t4.35@newsfe2-win.ntli.net… – Hide quoted text — Show quoted text -> tom wrote: > > I have been studying the drug options for > > glaucoma.  I dont have any idea with regards to > > effectiveness, but there is no doubt in my mind > > anyway that marijuana is far and away the safest > > of all the alternatives. > > I am a bit scared of taking any of the other > > medications for any period of time.  They all > > seem to be very potent and dangerous drugs > > if they enter the bloodstream. > Bad idea, I have heard that Marijuana is used as a painkiller for pain > in chronic conditions like MS, Glaucoma etc. It’s not a treatment of > Glaucoma itself and painful eyes are eyes that are self destructing … > It’s a bit like having a broken leg and smoking for the pain. You’d > still put the leg in plaster wouldn’t you?

Marijuana lowers the pressure in your eye.  Your analogy is not quite accurate.  In fact you dont know what you are talking about.

Response:

I have been studying the drug options for glaucoma.  I dont have any idea with regards to effectiveness, but there is no doubt in my mind anyway that marijuana is far and away the safest of all the alternatives. I am a bit scared of taking any of the other medications for any period of time.  They all seem to be very potent and dangerous drugs if they enter the bloodstream.

Response:

"tom" <l…@home.com> wrote in news:Pasxd.528834$wV.376588@attbi_s54: <snip> > Dr. Cohn wrote the following: > "While it is true that the harmful side effects of marijuana may be > overstated, it has not been found to be a useful IOP-lowering agent > because of its short duration of action.  In order to keep your IOP > low enough to protect your optic nerve, you would have to be stoned > 24/7." > I would be grateful if Dr. Cohn posted the details of any scientific > studies which lead to this conclusion.

I’m not Dr. Cohn, but you can find reference here   http://www.medmjscience.org/Pages/reports/nihpt4.bhtml (first reference that came up when I did a google search on "marijuana iop") "The dose of marijuana necessary to produce a clinically relevant effect in the short term appears to produce an unacceptable level of undesirable side effects such as euphoria, systemic hypotension, and/or dry eye and conjunctival hyperemia in the majority of glaucoma patients in whom the drug has been carefully studied. No data have been published on studies of long-term ocular and systemic effects of the use of marijuana by glaucoma patients." Mind you, hypotension is a serious risk factor *for* glaucoma.   Glaucoma is *not* elevated intraocular pressure, but damage to the optic nerve and if the optic nerve isn’t well "fed" by an adequate blood supply, damage will ensue. A study done in 1975 indicated that the IOP returned to baseline about 4 hours after smoking. The Glaucoma Research Foundation also has an article on their website at http://www.glaucoma.org/treating/treatment/marijuana.html which states "The high dose of marijuana necessary to produce a clinically relevant effect on IOP in the short term requires constant inhalation, as much as every three hours. The number of significant side effects generated by long-term oral use of marijuana or long-term inhalation of marijuana smoke make marijuana a poor choice in the treatment of glaucoma, a chronic disease requiring proven and effective treatment." Sherry

Response:

Tom, I did not read any opposite agenda in Dr. Cohn message. Instead, I always have seen him, for a long time, trying to help us, glaucoma sufferers, explaining and clarifying many aspects of the disease. Small pupil ( a glaucoma sufferer) Tom wrote:

" <eyegu…@aol.com> wrote in message

news:1103335401.798055.175620@z14g2000cwz.googlegroups.com… > While it is true that the harmful side effects of marijuana may be >—

Product information about Xalatan: http://www.pfizer.com/download/uspi_xalatan.pdf This does not strike me as exactly safe, and this is the research from Pfizer and we can see with Celebrax that we cannot be completely confident in that which a drug company says about their product when they are making so much money from their product. I am also disturbed that you are impugning my motives here.  This suggests that you have an agenda.  I do have an agenda, which is to find out as much as possible about all possible treatments to reduce IOP.  Apparently your agenda is exactly the opposite. "

Response:

Check out the information provided here: http://www.mfiles.org/Marijuana/medicinal_use/b3_glaucoma.html Sun Chong Hong

Response:

<eyegu…@aol.com> wrote in message

news:1103335401.798055.175620@z14g2000cwz.googlegroups.com… – Hide quoted text — Show quoted text -> While it is true that the harmful side effects of marijuana may be > overstated, it has not been found to be a useful IOP-lowering agent > because of its short duration of action.  In order to keep your IOP low > enough to protect your optic nerve, you would have to be stoned 24/7. > Hard to go around leading a productive life that way.  Also, last time > I checked it was…ILLEGAL!!! > While we’re talking about "overstating" and "not knowing what you > are talking about," lets address your comments about death and > blindness from glaucoma drops.  In my nine years as a glaucoma > specialist and twelve years treating eye diseases, I have only seen ONE > patient admitted to the hospital as a result of glaucoma treatment (an > asthmatic patient became short of breath on Betoptic S…he did fine > with oxygen, a nebulizer treatment, and discontinuation of the drops). > I have seen no deaths or blindness caused by these drops in over 10,000 > patients I have treated.  The worst ocular side effect I have seen from > these drops has been allergy or corneal irritation, which goes away > after you stop them.  Systemically, I have seen fatigue or depression > from Alphagan or Timoptic.  As for long track records, while these > drops haven’t been around for thousands of years, many have been around > for decades (Timoptic’s been around for over 30 years…that’s not > enough for you?).  Most of these drops, like Xalatan, for instance, > have been around almost 10 years and were in research for several years > before that.  Xalatan is safe and effective and is an excellent > medication…I’m certain it has prevented many of my patients from > losing sight to glaucoma. > I agree with others here that it sounds like you are just looking > for a way to get cheaper and legalized recreational pot…don’t waste > our time promoting it as a useful glaucoma therapy. > –Rick Cohn, MD > Glaucoma Specialist > Winter Park, FL

I am not very vain, but if my choice is between being stoned all day long or changing the color of these baby blues, I rather be stoned all day long.

Response:

On Thu, 16 Dec 2004 00:58:13 GMT, "tom" <l…@home.com> wrote: >I have been studying the drug options for >glaucoma.  I dont have any idea with regards to >effectiveness, but there is no doubt in my mind >anyway that marijuana is far and away the safest >of all the alternatives. >I am a bit scared of taking any of the other >medications for any period of time.  They all >seem to be very potent and dangerous drugs >if they enter the bloodstream.

I seriously doubt that you will find much useful, accurate or impartial information about the medical uses of cannabis in the current American political climate. ++++++++++++++++++++++++++++++++++++++++++ REMEMBER TO VOTE… "NONE OF THE ABOVE"

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"tom" <l…@home.com> wrote in news:F45wd.576635$D%.503257@attbi_s51: > I have been studying the drug options for > glaucoma.  I dont have any idea with regards to > effectiveness, but there is no doubt in my mind > anyway that marijuana is far and away the safest > of all the alternatives. > I am a bit scared of taking any of the other > medications for any period of time.  They all > seem to be very potent and dangerous drugs > if they enter the bloodstream.

Marijuana is implicated in lung cancer, paranoia, apathy, etc.  It’s only effective at lowering the IOP for a very short period of time so you need to smoke several times a day and can never stop. Don’t worry about using glaucoma drops.  Some have less side effects than others, some people never experience any of the side effects.  I was on Xalatan for 5 years with no problems. Get a good glaucoma specialist and follow his or her instructions for you. Sherry

Response:

"Sherry" <she…@excite.com> wrote in message

news:Xns95C5EE69A7AD7TansyRagwortNetscape@130.133.1.4… – Hide quoted text — Show quoted text -> "tom" <l…@home.com> wrote in news:O5Mxd.216770$5K2.177763@attbi_s03: > <snip> > > I have read studys that indicate the lower your > > blood pressure the better.  I doubt very much > > that hypotension is a problem for the optic nerve. > > I also am not so sure that THC causes hypotension. > "Marijuana and delta9-tetrahydrocannabinol (THC) increase heart rate, > slightly increase supine blood pressure, and on occasion produce marked > orthostatic hypotension." > http://www.cannabis.net/cardiovascular/ > The lower the better for your heart, not your eyes.  Both hypertension > and hypotension have been implicated as possible risk factors for > normal tension glaucoma. > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? > cmd=Retrieve&db=PubMed&list_uids=10416743&dopt=Abstract > "Patients who had field progression showed significantly lower > nocturnal blood pressure variables, with the dips of the systolic, > diastolic, and mean arterial pressure significantly larger " > > I am wondering if there is anything further on the > > following: > > ". . . Because the possibility exists that marijuana (or its > > components) may be useful in treating glaucoma, the American Academy > > on Ophthalmology Committee on Drugs believes that a long term > > clinical study, designed to test the safety and efficacy of > > marijuana in the prevention of progressive optic nerve damage and > > consequent visual field loss, appears appropriate." > "The American Academy of Ophthalmology (1992) stated: "There is > evidence that marijuana (or its components), taken orally or by > inhalation can lower intraocular pressure. However, there are no > conclusive studies to date to indicate that marijuana (or its > components) can safely and effectively lower intraocular pressure > enough to prevent optic nerve damage. . . . The dose of marijuana > necessary to produce a clinically relevant effect in the short term > appears to produce an unacceptable level of undesirable side effects > such as euphoria, systemic hypotension, and/or dry eye and conjunctival > hyperemia in the majority of glaucoma patients in whom the drug has > been carefully studied. No data have been published on studies of long- > term ocular and systemic effects of the use of marijuana by glaucoma > patients." > http://www.hivpositive.com/f-Nutrition/MedicalMarijuana/MM- > Glaucoma.html > > I have also read the warnings for Xalatan which > > apparently is one of the safer drops to lower IOP. > > I do not understand why infection is an issue with > > this drug and seemingly all the others.  Infection does > > not appear to be an issue with contact lens solution. > > Or visine for that matter. > Infection is a risk with any eye drops if the tip of the bottle and > consequently the fluid itself gets contaminated.  Infection is a > serious problem with glaucoma patients who have had cutting surgery – > trabs, shunts, etc.  Contact lens wearers are not only at risk of > infection but also corneal ulcers.

I guess if you have heart failure or some other cardiovascular disease  you may not want to lower your blood pressure.  But for the most part, low blood pressure is good for your organs. I am pretty certain that low blood pressure is good for your brain, and therefore it must be good for your optic nerve.  I am not a doctor but I would be very surprised to be wrong here. I also dont think that THC reduces blood pressure or this would be another medicinal use for it and I dont think this is the case.  I would be less surprised if I was wrong here there.

Response:

I think I’d like to see the evidence for your claim that marijuana is efficacious in lowering IOP. It would seem that marijuana is often seen as a "cure all" according to some people. Of course it has been around for thousands of years and so has glaucoma but no one seems to have managed to use this readily available substance as anything other than a recreational drug. Research has been carried out here in the UK into the medicinal use of the drug for certain illnesses and conditions. It was reported that it sort of worked for some people in some circumstances. I don’t recall that it was credited with universal curative properties or was even a significant advance in medical science. There were however lots of addicts advocating its use for medical reasons. Most people came to the conclusion that they simply wanted the recreational use of the substance to be made legal. I wonder if that record is playing again? I think that professionals researching treatments would consider any substance, particularly something as cheap as marijuana, without needing much advice. I expect it’s been tried but maybe not. Checkout.

Response:

"Tom" <lf…@spam.net> wrote in message

news:zeidnVE1qv2ig_7fRVn-qg@comcast.com… > It has been suggested that determing whether > marijuana could be effective as a glaucoma > medication would be a long process. > It seems to me that it would not be all that > difficult.  The first step would be to determine > whether oral dosing lowers IOP. > If oral dosing reduces IOP, then marijuana could then > soaked in various solvents and solutions.  If any of > these lowered IOP with oral dosing, then it would > seem natural that direct application to the eye of these > solutions should also lower IOP.

It’s a great pity that marijuana does not reduce imbecility Tom then you might just benefit. Do you suffer from Glaucoma or are you just a troll? Since you reappear here on a regular basis and complain if anyone objects to your outlandish views I think it more likely that the former is correct.

Response:

It has been suggested that determing whether marijuana could be effective as a glaucoma medication would be a long process. It seems to me that it would not be all that difficult.  The first step would be to determine whether oral dosing lowers IOP. If oral dosing reduces IOP, then marijuana could then soaked in various solvents and solutions.  If any of these lowered IOP with oral dosing, then it would seem natural that direct application to the eye of these solutions should also lower IOP.

Response:

Hello again Tom I’m not going to comment on the posting directly, but I would like to say that you have stimulated one of the most interesting discussion threads that I have seen in my time perusing this newsgroup.  Thank you for commencing this thread. Best wishes Mark Schmidt Optometrist Sydney, Australia "tom" <l…@home.com> wrote in message

news:F45wd.576635$D%.503257@attbi_s51… – Hide quoted text — Show quoted text -> I have been studying the drug options for > glaucoma.  I dont have any idea with regards to > effectiveness, but there is no doubt in my mind > anyway that marijuana is far and away the safest > of all the alternatives. > I am a bit scared of taking any of the other > medications for any period of time.  They all > seem to be very potent and dangerous drugs > if they enter the bloodstream.

Response:

"tom" <l…@home.com> wrote in news:O5Mxd.216770$5K2.177763@attbi_s03: <snip> > I have read studys that indicate the lower your > blood pressure the better.  I doubt very much > that hypotension is a problem for the optic nerve. > I also am not so sure that THC causes hypotension.

"Marijuana and delta9-tetrahydrocannabinol (THC) increase heart rate, slightly increase supine blood pressure, and on occasion produce marked orthostatic hypotension." http://www.cannabis.net/cardiovascular/ The lower the better for your heart, not your eyes.  Both hypertension and hypotension have been implicated as possible risk factors for normal tension glaucoma. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10416743&dopt=Abstract "Patients who had field progression showed significantly lower nocturnal blood pressure variables, with the dips of the systolic, diastolic, and mean arterial pressure significantly larger " > I am wondering if there is anything further on the > following: > ". . . Because the possibility exists that marijuana (or its > components) may be useful in treating glaucoma, the American Academy > on Ophthalmology Committee on Drugs believes that a long term > clinical study, designed to test the safety and efficacy of > marijuana in the prevention of progressive optic nerve damage and > consequent visual field loss, appears appropriate."

"The American Academy of Ophthalmology (1992) stated: "There is evidence that marijuana (or its components), taken orally or by inhalation can lower intraocular pressure. However, there are no conclusive studies to date to indicate that marijuana (or its components) can safely and effectively lower intraocular pressure enough to prevent optic nerve damage. . . . The dose of marijuana necessary to produce a clinically relevant effect in the short term appears to produce an unacceptable level of undesirable side effects such as euphoria, systemic hypotension, and/or dry eye and conjunctival hyperemia in the majority of glaucoma patients in whom the drug has been carefully studied. No data have been published on studies of long- term ocular and systemic effects of the use of marijuana by glaucoma patients." http://www.hivpositive.com/f-Nutrition/MedicalMarijuana/MM- Glaucoma.html > I have also read the warnings for Xalatan which > apparently is one of the safer drops to lower IOP. > I do not understand why infection is an issue with > this drug and seemingly all the others.  Infection does > not appear to be an issue with contact lens solution. > Or visine for that matter.

Infection is a risk with any eye drops if the tip of the bottle and consequently the fluid itself gets contaminated.  Infection is a serious problem with glaucoma patients who have had cutting surgery – trabs, shunts, etc.  Contact lens wearers are not only at risk of infection but also corneal ulcers.

Response:

"Sherry" <she…@excite.com> wrote in message

news:Xns95C4D115F50D4TansyRagwortNetscape@130.133.1.4… – Hide quoted text — Show quoted text -> "tom" <l…@home.com> wrote in news:Pasxd.528834$wV.376588@attbi_s54: > <snip> > > Dr. Cohn wrote the following: > > "While it is true that the harmful side effects of marijuana may be > > overstated, it has not been found to be a useful IOP-lowering agent > > because of its short duration of action.  In order to keep your IOP > > low enough to protect your optic nerve, you would have to be stoned > > 24/7." > > I would be grateful if Dr. Cohn posted the details of any scientific > > studies which lead to this conclusion. > I’m not Dr. Cohn, but you can find reference here > http://www.medmjscience.org/Pages/reports/nihpt4.bhtml > (first reference that came up when I did a google search on "marijuana > iop") > "The dose of marijuana necessary to produce a clinically relevant > effect in the short term appears to produce an unacceptable level of > undesirable side effects such as euphoria, systemic hypotension, and/or > dry eye and conjunctival hyperemia in the majority of glaucoma patients > in whom the drug has been carefully studied. No data have been > published on studies of long-term ocular and systemic effects of the > use of marijuana by glaucoma patients." > Mind you, hypotension is a serious risk factor *for* glaucoma. > Glaucoma is *not* elevated intraocular pressure, but damage to the > optic nerve and if the optic nerve isn’t well "fed" by an adequate > blood supply, damage will ensue. > A study done in 1975 indicated that the IOP returned to baseline about > 4 hours after smoking. > The Glaucoma Research Foundation also has an article on their website > at http://www.glaucoma.org/treating/treatment/marijuana.html which > states "The high dose of marijuana necessary to produce a clinically > relevant effect on IOP in the short term requires constant inhalation, > as much as every three hours. The number of significant side effects > generated by long-term oral use of marijuana or long-term inhalation of > marijuana smoke make marijuana a poor choice in the treatment of > glaucoma, a chronic disease requiring proven and effective treatment." > Sherry

I have read studys that indicate the lower your blood pressure the better.  I doubt very much that hypotension is a problem for the optic nerve. I also am not so sure that THC causes hypotension. I am wondering if there is anything further on the following: ". . . Because the possibility exists that marijuana (or its components) may be useful in treating glaucoma, the American Academy on Ophthalmology Committee on Drugs believes that a long term clinical study, designed to test the safety and efficacy of marijuana in the prevention of progressive optic nerve damage and consequent visual field loss, appears appropriate." I have also read the warnings for Xalatan which apparently is one of the safer drops to lower IOP. I do not understand why infection is an issue with this drug and seemingly all the others.  Infection does not appear to be an issue with contact lens solution. Or visine for that matter.

Response:

"Mark Schmidt" <mark_schm…@hotmail.com> wrote in message

news:41c142b0$0$13948$afc38c87@news.optusnet.com.au… – Hide quoted text — Show quoted text -> Hi Tom > How can you seriously contemplate using an illicit drug, which has never had > any research attached to it, and is acknowledged as being harmful to your > general system, to address a local (eye) problem when you cannot measure the > effectiveness of the treatment, since no qualified practitioner would ever > agree to monitor your progress, as they would be implicated in an illegal > act and could jeopardise their Practicing License.  Please understand that > all drugs can have side-effects, which vary from person to person, but your > probability of successful, long term treatment on correct Doctor-prescribed > drugs is much higher than your probability of success using a > non-recognised, non-regulated and non-controlled course of action.  I don’t > know how old you are, but you must also consider the effect of using > marijuana for decades, and also consider that this course of action will > prevent you from ever boarding an international flight, as you will not be > able to take your stash with you. > I beg you to think carefully about this course of action. > Best wishes for Christmas > Mark > Optometrist > Sydney, Australia > "tom" <l…@home.com> wrote in message > news:F45wd.576635$D%.503257@attbi_s51… > > I have been studying the drug options for > > glaucoma.  I dont have any idea with regards to > > effectiveness, but there is no doubt in my mind > > anyway that marijuana is far and away the safest > > of all the alternatives. > > I am a bit scared of taking any of the other > > medications for any period of time.  They all > > seem to be very potent and dangerous drugs > > if they enter the bloodstream.

At this point I am not contemplating anything.  I am trying to gather information. I know for a fact that the risks of marijuana are overstated.  This drug has been around for thousands of years and noone ever has died from it.  All the other drugs that I have seen to treat IOP can kill you, and further if they dont kill you they can blind you. It is also bothersome that these drugs dont have the long track record that marijuana has.  For example, I was worried about viox when it first came out because it lacked history.  Aspirin is safer than all the newer drugs at least with respect to the fact that it has been around for so long.  Marijuana has a much longer history than aspirin. What I dont understand is why people that suffer from IOP are not putting some major heat on the powers that be for research on the benefits of marijuana with respect to IOP. I am also wondering if marijuana is effective against IOP if ingested instead of smoked.  If it is effective taken orally, this would be one huge point in its favor.

Response:

"tom" <l…@home.com> wrote in news:JC5yd.270077$HA.56023@attbi_s01: <snip> > So is there any more danger of infection with glaucoma > eye drops than there is for soft contact lens rewetting > solution for example?  It seems from reading the > product information for these drugs that the bottle > is easily contaminated.

Product information from Drugs.com for Visine which can be found at (using TinyURL for the link) http://tinyurl.com/6ew85: "Do not touch the dropper to any surface, including the eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in the eye." I have several bottles of different types of lubricating drops – they all warn about not touching the tip to anything to avoid contamination. Contact lenses, if not properly cared for, can cause serious eye infection.  I would think that anyone who has purchased contact lenses would be given the instructions for proper care at the time of first getting them.  At http://www.eyesearch.com/contact.lens.solutions.htm is instructions for the different types of lenses mentioning the need for disinfecting. Sherry

Response:

"Laura" <mcki…@hotmail.com> wrote in message

news:ve6fs0djnf7jdrj4ltkcfd59lo042q9eos@4ax.com… > Seems to me infection is a possibility with * anything * you put in > your eye, simply because you’re putting something foreign into it. > Hence, wash your hands, don’t touch the bottle tip, etc. > Laura > On Tue, 21 Dec 2004 02:43:58 GMT, "tom" <l…@home.com> wrote: > >I have also read the warnings for Xalatan which > >apparently is one of the safer drops to lower IOP. > >I do not understand why infection is an issue with > >this drug and seemingly all the others.  Infection does > >not appear to be an issue with contact lens solution. > >Or visine for that matter.

So is there any more danger of infection with glaucoma eye drops than there is for soft contact lens rewetting solution for example?  It seems from reading the product information for these drugs that the bottle is easily contaminated.

Response:

tom wrote: > I have been studying the drug options for > glaucoma.  I dont have any idea with regards to > effectiveness, but there is no doubt in my mind > anyway that marijuana is far and away the safest > of all the alternatives. > I am a bit scared of taking any of the other > medications for any period of time.  They all > seem to be very potent and dangerous drugs > if they enter the bloodstream.

Bad idea, I have heard that Marijuana is used as a painkiller for pain in chronic conditions like MS, Glaucoma etc. It’s not a treatment of Glaucoma itself and painful eyes are eyes that are self destructing … It’s a bit like having a broken leg and smoking for the pain. You’d still put the leg in plaster wouldn’t you?

Response:

<eyegu…@aol.com> wrote in message

news:1103335401.798055.175620@z14g2000cwz.googlegroups.com… – Hide quoted text — Show quoted text -> While it is true that the harmful side effects of marijuana may be > overstated, it has not been found to be a useful IOP-lowering agent > because of its short duration of action.  In order to keep your IOP low > enough to protect your optic nerve, you would have to be stoned 24/7. > Hard to go around leading a productive life that way.  Also, last time > I checked it was…ILLEGAL!!! > While we’re talking about "overstating" and "not knowing what you > are talking about," lets address your comments about death and > blindness from glaucoma drops.  In my nine years as a glaucoma > specialist and twelve years treating eye diseases, I have only seen ONE > patient admitted to the hospital as a result of glaucoma treatment (an > asthmatic patient became short of breath on Betoptic S…he did fine > with oxygen, a nebulizer treatment, and discontinuation of the drops). > I have seen no deaths or blindness caused by these drops in over 10,000 > patients I have treated.  The worst ocular side effect I have seen from > these drops has been allergy or corneal irritation, which goes away > after you stop them.  Systemically, I have seen fatigue or depression > from Alphagan or Timoptic.  As for long track records, while these > drops haven’t been around for thousands of years, many have been around > for decades (Timoptic’s been around for over 30 years…that’s not > enough for you?).  Most of these drops, like Xalatan, for instance, > have been around almost 10 years and were in research for several years > before that.  Xalatan is safe and effective and is an excellent > medication…I’m certain it has prevented many of my patients from > losing sight to glaucoma. > I agree with others here that it sounds like you are just looking > for a way to get cheaper and legalized recreational pot…don’t waste > our time promoting it as a useful glaucoma therapy. > –Rick Cohn, MD > Glaucoma Specialist > Winter Park, FL

Product information about Xalatan: http://www.pfizer.com/download/uspi_xalatan.pdf This does not strike me as exactly safe, and this is the research from Pfizer and we can see with Celebrax that we cannot be completely confident in that which a drug company says about their product when they are making so much money from their product. I am also disturbed that you are impugning my motives here.  This suggests that you have an agenda.  I do have an agenda, which is to find out as much as possible about all possible treatments to reduce IOP.  Apparently your agenda is exactly the opposite.

Response:

Seems to me infection is a possibility with * anything * you put in your eye, simply because you’re putting something foreign into it. Hence, wash your hands, don’t touch the bottle tip, etc. Laura – Hide quoted text — Show quoted text -On Tue, 21 Dec 2004 02:43:58 GMT, "tom" <l…@home.com> wrote: >I have also read the warnings for Xalatan which >apparently is one of the safer drops to lower IOP. >I do not understand why infection is an issue with >this drug and seemingly all the others.  Infection does >not appear to be an issue with contact lens solution. >Or visine for that matter.

Response:

"Looker" <loo…@firstpobox.com> wrote in message

news:926da283.0412190859.5113c11b@posting.google.com… > Tom, > I did not read any opposite agenda in Dr. Cohn message. Instead, I > always have seen him, for a long time, trying to help us, glaucoma > sufferers, explaining and clarifying many aspects of the disease. > Small pupil ( a glaucoma sufferer)

If my response was rude, I apologize. Dr. Cohn wrote the following: "While it is true that the harmful side effects of marijuana may be overstated, it has not been found to be a useful IOP-lowering agent because of its short duration of action.  In order to keep your IOP low enough to protect your optic nerve, you would have to be stoned 24/7." I would be grateful if Dr. Cohn posted the details of any scientific studies which lead to this conclusion.

Response:

Well you know the answer Tom; get stoned, stay stoned and let us know how you got on 10 years from now. In the meantime, I’ll stick to prescribed medication which has prevented deterioration of my sight for the past five years. Checkout.

Response:

Thanks for the reply. I have now replaced Cosopt by just the Trusopt component, thus eliminating the beta-blocker (timolol). I am wondering how one measures the timolol residue in the body as alluded to in your post.Heart rate this AM was 54 instead of the previous 45-46, but we’ll see. Now, of course, I will wait and see if my pressure elevates significantly (you didn’t address that aspect in your examples). I am currently on alphagan (twice/day), xalatan (once/day) and formerly cosopt, now trusopt (twice/day). Use pilocarpine in the  right eye only at bedtime. Have had SLT (180 degree arc in both eyes). Pressure has varied from 18 to 25, depending on time of day, etc. HRT showed no significant loss in either eye….BT

Response:

Any words of wisdom on blockers as a possible cause Bradycardia? I have been using drops for 34 years for Primary Open-Angle Glaucoma, including timolol (alone and in cosopt). My heart rate has been gradually slowing up over the years and is presently as low as 45 beats per minute resting (and I am no super athelete). I am now 64. Recent searches on the internet reveal a possible connection. Specific cases are cited: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2003;volume… Now, no ophthalmologists ever seem to inquire about non-obvious side effects, but I myself am now wondering. Any thoughts from those in the know? Benjamin Trimble

Response:

btrim…@yahoo.com wrote: > Any words of wisdom on blockers as a possible cause Bradycardia? I have > been using drops for 34 years for Primary Open-Angle Glaucoma, > including timolol (alone and in cosopt). My heart rate has been > gradually slowing up over the years and is presently as low as 45 beats > per minute resting (and I am no super athelete). I am now 64. Recent > searches on the internet reveal a possible connection. Specific cases > are cited:

http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2003;volume… > Now, no ophthalmologists ever seem to inquire about non-obvious side > effects, but I myself am now wondering. > Any thoughts from those in the know? > Benjamin Trimble

Bradycardia is certainly a possible side effect of ocular beta blocker drops.  I have had to discontinue Timoptic in a few patients over the years for just this reason.  This was usually at the request of their cardiologist.  In each case (I think there were only two), the heart rate did not climb significantly once I washed the Timoptic out of the patient’s system (this can take 4 – 6 weeks).  Both patients eventually needed pacemakers placed, and both did just fine.  Ask your ophthalmologist if there is something else you can take in place of the beta blocker, and see if your heart rate goes up.  Good luck to you…let us know what happens. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

Hi Axel,      Unfortunately, hard to say if your doc is a "good one" or not…to me the tools are not as important as the communication and your level of comfort.  It does sound, based on your description, that you probably do have glaucoma, but without seeing your optic nerve I can’t know for sure.  I’m sorry I don’t know anyone in Dayton, but if you are concerned, a second opinion certainly couldn’t hurt.       I seldom start Travatan as a first line agent because of the redness.  I almost always start with its cousin, Xalatan, first as it is much better tolerated.  Well fewer than 1/2 of a percent of my patients require surgery because they can’t tolerate ANY of the drops out there.  Even if they are allergic to the preservatives in them, there are preservative-free versions of several available.  Good luck to you, Rick Cohn, MD

Response:

"Axel Grease" <A…@Grease.org> wrote in news:1153v9jjp8qig31@corp.supernews.com: > Thanks Dr Cohn, > Here is more info to go on… > My opthalmologist is a DO, not an MD.  He was chosen because my > insurance plan at work pays for glasses through his office and other > vision care companies are too far away and/or have no evening or > Saturday office hours. The medical part of this is being paid for by > my major med insurance plan (separate from glasses plan).<snip> > Axel

Normally, regular medical insurance will pay for eye conditions other than routine eye exams and glasses for refractive problems.  Check with your insurance – bet they’ll cover a ophthalmologist or glaucoma specialist for glaucoma.  Because of the glaucoma diagnosis when I get a refraction, my medical insurance will cover that – however, not glasses. No way would I see an optometrist to treat glaucoma!  Sorry if I offend any optometrists monitoring the list with my comment, but that’s just the way it is – glaucoma is a *medical* condition that needs a *medical* doctor and preferably a specialist, at least for proper diagnosis and to get treatment started. I’m being followed by my ophthalmologist but he refers me back to the glauc doc when necessary. I really don’t think optometrists keep on top of medical conditions of eyes – some even still think glaucoma is diagnosed by elevated IOP – wrong! If I had no major problems with my eyes and only needed glasses, I’d go to an optometrist – went to one for years – and my glauc doc has an optometrist in his office for refractions after surgery. Sherry

Response:

Thanks Dr Cohn, Here is more info to go on… My opthalmologist is a DO, not an MD.  He was chosen because my insurance plan at work pays for glasses through his office and other vision care companies are too far away and/or have no evening or Saturday office hours. The medical part of this is being paid for by my major med insurance plan (separate from glasses plan). Initially, a *Optomap* device made a scan which seemed to show some "cupping" of the rim of the optic nerve around the blood vessels at the back of the eye.  The doc admitted that may be a birth defect since he had no previous scans to compare to.  However, a visual field map showed loss of vision in some regions. After 2 doses of the Travatan the redness of the sclera was very severe, but the IOP went down.  Also, Travatan seems to have had a carry-over effect even 5 days out.  My IOP was back down to 18 or a bit less.  My opthalmologist wants to get the numbers down more.  He gave me a sample af ALPHAGAN-P (Brimonidine Tartrate Ophthalmic Solution, 0.15%; Alpha-agonist ) to use once per day for a week and then 2x daily for 3 weeks if I can tolerate it. After one dose, I am not seeing redness with the ALPHAGAN-P drops, but it does "itch" for a while after I put them in, just prior to going to sleep. Axel <eyegu…@aol.com> wrote in message

news:1112332189.077148.217000@g14g2000cwa.googlegroups.com… – Hide quoted text — Show quoted text -> Hi Axel, >     Unfortunately, hard to say if your doc is a "good one" or not…to > me the tools are not as important as the communication and your level > of comfort.  It does sound, based on your description, that you > probably do have glaucoma, but without seeing your optic nerve I can’t > know for sure.  I’m sorry I don’t know anyone in Dayton, but if you are > concerned, a second opinion certainly couldn’t hurt. >      I seldom start Travatan as a first line agent because of the > redness.  I almost always start with its cousin, Xalatan, first as it > is much better tolerated.  Well fewer than 1/2 of a percent of my > patients require surgery because they can’t tolerate ANY of the drops > out there.  Even if they are allergic to the preservatives in them, > there are preservative-free versions of several available.  Good luck > to you, > Rick Cohn, MD

Response:

"Axel Grease" <A…@Grease.org> wrote in news:1156knibrsf5v90@corp.supernews.com: > Sherry, > If elevated IOP is not the criteria, then what tests should I be > looking for? > I need to know because there seems to be a shortage of glaucoma > specialist MDs around here.  I want the right tests and the right > Doc. > I also tested as having some loss of visual field.  I noticed what > seems to be progressive night blindness starting about a year or > more ago,b ut thought it was just "age".  My eyes hurt frequently, > but I also have allergies and horrid sinus trouble.  I’ve only had > one sinus headache in my lfe.  It started in 1953 and it is still > going. Axel

Glaucoma is diagnosed based on damage to the optic nerve.  Visual fields, HRT, gDX and a good dilated visual exam of the optic nerve by a glaucoma specialist are good ways of determining the presence of glaucoma. Some people have ocular hypertension – elevated IOP – and never develop glaucoma.  Others have normal pressures and have glaucoma. According to http://www.retina-international.org/nightbld.htm, loss of peripheral vision can result in night blindness, however night blindness has to do with the rods and not everyone who has night blindness has glaucoma. Sherry

Response:

Dr.  Cohn, I live in southwestern Ohio, near Dayton. I have been seeing an opthalmologist, but have no idea if he is really all that good.  I am trying to figure out if I should I get a second Dx or just trust this guy.  Obviously, this is a seriuos matter.  He Dx’ed my eyes as having glaucoma.  He seems to have a well equipped office.  With a couple of differenct computer based Dx devices, he has mapped my eye inside and found nerve impairment and/or damaged areas.  He measured my pressures as varying quite a bit from day to day, ranging from 20 to 27. His tools sseem impressive, but I wonder how reliable the results are and how can I know if an opthalmologist is a good one or not? My next appointment is Wed, 30 March.  I was already taken off of travoprost (after 2 days) because of the excessive redness it caused in my eyes.  I have rather bad hay fever too. How many patients end up needing some kind of surgery because the drops/drugs have too many adverse side-effects? Axel

Response:

Sherry, If elevated IOP is not the criteria, then what tests should I be looking for? I need to know because there seems to be a shortage of glaucoma specialist MDs around here.  I want the right tests and the right Doc. I also tested as having some loss of visual field.  I noticed what seems to be progressive night blindness starting about a year or more ago,b ut thought it was just "age".  My eyes hurt frequently, but I also have allergies and horrid sinus trouble.  I’ve only had one sinus headache in my lfe.  It started in 1953 and it is still going. Axel "Sherry" <she…@excite.com> wrote in message

news:Xns962EDAF65FE99TansyRagwortNetscape@216.196.97.142… – Hide quoted text — Show quoted text -> "Axel Grease" <A…@Grease.org> wrote in > news:1153v9jjp8qig31@corp.supernews.com: > No way would I see an optometrist to treat glaucoma! <snip> > I really don’t think optometrists keep on top of medical conditions of > eyes – some even still think glaucoma is diagnosed by elevated IOP – > wrong! > If I had no major problems with my eyes and only needed glasses, I’d go > to an optometrist – went to one for years – and my glauc doc has an > optometrist in his office for refractions after surgery. > Sherry

Response:

Sherry, I do thank you for that clarification.  Now, perhaps I can procede on a more reliabel track. Axel "Sherry" <she…@excite.com> wrote in message

news:Xns962FDD52746E4TansyRagwortNetscape@216.196.97.142… – Hide quoted text — Show quoted text -> "Axel Grease" <A…@Grease.org> wrote in > news:1156knibrsf5v90@corp.supernews.com: >> Sherry, >> If elevated IOP is not the criteria, then what tests should I be >> looking for? >> I need to know because there seems to be a shortage of glaucoma >> specialist MDs around here.  I want the right tests and the right >> Doc. >> I also tested as having some loss of visual field.  I noticed what >> seems to be progressive night blindness starting about a year or >> more ago,b ut thought it was just "age".  My eyes hurt frequently, >> but I also have allergies and horrid sinus trouble.  I’ve only had >> one sinus headache in my lfe.  It started in 1953 and it is still >> going. Axel > Glaucoma is diagnosed based on damage to the optic nerve.  Visual > fields, HRT, gDX and a good dilated visual exam of the optic nerve by a > glaucoma specialist are good ways of determining the presence of > glaucoma. > Some people have ocular hypertension – elevated IOP – and never develop > glaucoma.  Others have normal pressures and have glaucoma. > According to http://www.retina-international.org/nightbld.htm, loss of > peripheral vision can result in night blindness, however night > blindness has to do with the rods and not everyone who has night > blindness has glaucoma. > Sherry

Response:

Greetings!  Every year or so I like to post the details of my own glaucoma case — it is a very positive story! I was first diagnosed as a glaucoma suspect 35 years ago in 1970.  I was only 39 years old at the time.  I  will be 74 next month.  My intraocular pressures (IOP) were typically 22/25 mmHg. I went through some tests including field measurements and several tests that are not done any longer — for example, the "water-provocative" test, where the patient drinks about six glasses of water in a short period of time and the IOP is measured at brief intervals.  I was diagnosed with common open-angle glaucoma and pilocarpine was prescribed — one drop four times per day in each eye.  This brought the IOP down to something like 18 or 20.  I had very little visual field damage. Pilocarpine, in addition to its short-term activity (only about four to six hours), is a terrible drug!  It hurts!  It gave me a ‘brow ache’ for the first 30 minutes or so.  In addition, it reduces the pupil down to a very small size, which makes driving in the dark very scary.  And finally, it induces myopia (at the age of 39 I still had pretty good accommodation — that means the ability of the eye lens to focus at different distances).  My myopia after taking pilocarpine was six diopters!  (I measured it myself.)  Six diopters of myopia means that the eye is focused about six or seven inches away.  This would last about 45 minutes after taking the drops. After a few years the pressures were creeping up and so we added epinephrine to the regimen.  And that worked for a while.  About every five years or so, we would add a new drug in order to stay ahead of the problem. Timoptic, Cosopt, Alphagan, Betoptic, you name it. Over a period of about 25 years, I think I used every drop known to man.  The most recent drop I used was Xalatan (and I have the curly lashes to prove it!) I also had argon-laser trabeculoplasty (ALT), which did not seem to do any good. My right eye was beginning to show the presence of a cataract, which was probably induced by the years of pilocarpine therapy. About five years ago my ophthalmologist suggested that it is time we considered trabeculectomy surgery.  We scheduled a combination of trab surgery and cataract/lens replacement at the same time.  The surgery went well.  We operated both eyes, about six weeks apart (no surgeon will operate both eyes at the same time — the danger of infection could be catastrophic). The outcome:  Fast forward to today.  My IOP is typically 15/16 with *NO* drops at all.  I have a little more than one diopter of myopia (this was chosen by me, by the way, when we selected the implant lenses.  This means that I am now naturally focused at about 20 inches distance — perfect for reading, computer operating, etc. — I wear -1.25 diopter glasses when I drive.)  I have a few small peripheral scotoma (areas in the retina of reduced sensitivity) which are not significant. My corrected central visual acuity is 20:20; I have no problems driving at night.  I see my ophthalmologist three times a year.  She is my hero! My ophthalmologist is Mary Ann Lloyd, MD at the Palo Alto Medical Clinic in California. My advice to *all* glaucoma patients:  You must first satisfy yourself that you have a very good glaucoma specialist.  Then, do what you are told.  Follow the doctor’s orders.  The use of drops should become a routine like brushing your teeth.  Don’t miss a drop! And I hope your outcome will be as positive as mine was. Good luck! earle * (I am an engineer and not a health-care professional.) —

Response:

Earle, Thank you for sharing your happy story and experiences. It is encouraging. Continued success, Carolyb – Hide quoted text — Show quoted text -Earle Jones wrote: > Greetings!  Every year or so I like to post the details of > my own glaucoma case — it is a very positive story!

Response:

Checkout wrote: > I was not diagnosed early and had moderate loss of vision in my right > eye when initially treated just over five years ago. Thus far there > has been no further deterioration. Medication and treatment has been > changed from time to time, either because the drops were not as > efficatious as expected or because I developed side effects. > Good luck > Checkout

Thank you. It’s encouraging to know that over five years you have not had any further deterioration. I have just started on Xalatan but won’t know for another ten days whether it is working. I have normal tension glaucoma so that is apparently harder to treat. -Gudrun

Response:

Hubert Mak wrote: > The following factors may change the outcome of your treatment, > just for example: > 1 – your age.

Age in terms of how much longer you need to be able to see? Or is there a difference between the way the elderly and younger people respond to treatment? > 2 – your life style. > 3 – over use.(such as watch late-nite show or movie after 8 hours >               on computer.) > 4 – your general health condition.

So if you are in good health, the visual damage is less likely to progress? > 5 – side effects.(such as some side effects may kill you before >                   you get blind.) > 6 – your financial health condition.

Meaning whether you can afford to see a top specialist? > 7 – your luck.(healthcare professional are human, sometime >                may do some mistakes. just for example)

Yes, I know, I had the great misfortune of having lost more vision due to original misdiagnosis. I sure hope my luck changes at some point. – Hide quoted text — Show quoted text -> Hope this helps. > ————————————————————— > Just an average dummie, I’m not healthcare professional or > engineer. > —————————————————————- > On 12 Feb 2005, gudrun17 wrote: > > I am newly diagnosed with moderate visual field loss in one eye. Or > > that’s what the GS said; I perceive a lot of loss. I’d like to hear > > from people who were not diagnosed early, meaning before they had > > vision loss, for whom progressive loss was stopped or greatly slowed > > once treatment began. Like most new patients I am terrified of going > > blind in that eye. All the GS said was "you have a lot of nerve fiber > > left," which was supposed to be encouraging, but if you supposedly lose > > half the nerve fiber before there is visual field loss, how could you > > have "a lot" left? > > Anyway, thanks for any encouragement. > > -Gudrun

Response:

Dr. Leukoma wrote: > Gudrun, > I have been following your story with interest.  I haven’t yet read > that you have been diagnosed with glaucoma, despite having consulted > with a glaucoma specialist.  Do you now have a diagnosis of glaucoma > for your visual field loss?  Also, is this visual field defect > repeatable? > DrG

Thank you for your interest, Dr. G. Yes, I was diagnosed with normal tension glaucoma although the glaucoma specialist said my case is "atypical." He said the appearance of the optic nerve head does not quite match the visual field defect, and he also said I am seeing more visual disturbance than the visual field test shows. Yes, I had two visual field tests about ten days apart and although I didn’t get a chance to get a good look at them, other than over the doctor’s shoulder, they appeared to be similar so I guess that means it was repeatable. There is obviously a visual field defect and there is some thinning of the optic nerve fiber layer as shown by OCT. As I noted in another post, there are a couple of other seemingly unusual things about my case–for example, the GS said with the kind of visual field defect I have there ought to be a difference in pupillary reaction and although he tested with the flashlight for a long time, he couldn’t see any. He finally asked if I detected any difference in brightness between the two eyes. I’m not sure of the significance of any of these "atypical" things; he just said he would need to follow my case more closely. I am on Xalatan. Basically the GS said although there are some unusal aspects, it is glaucoma because there was nothing else he knew of that it could be. Your comments are most welcome and appreciated. -Gudrun

Response:

- Hide quoted text — Show quoted text -gudrun17 wrote: > Dr. Leukoma wrote: > > Gudrun, > > I have been following your story with interest.  I haven’t yet read > > that you have been diagnosed with glaucoma, despite having consulted > > with a glaucoma specialist.  Do you now have a diagnosis of glaucoma > > for your visual field loss?  Also, is this visual field defect > > repeatable? > > DrG > Thank you for your interest, Dr. G. Yes, I was diagnosed with normal > tension glaucoma although the glaucoma specialist said my case is > "atypical." He said the appearance of the optic nerve head does not > quite match the visual field defect, and he also said I am seeing more > visual disturbance than the visual field test shows. Yes, I had two > visual field tests about ten days apart and although I didn’t get a > chance to get a good look at them, other than over the doctor’s > shoulder, they appeared to be similar so I guess that means it was > repeatable. There is obviously a visual field defect and there is some > thinning of the optic nerve fiber layer as shown by OCT. As I noted in > another post, there are a couple of other seemingly unusual things > about my case–for example, the GS said with the kind of visual field > defect I have there ought to be a difference in pupillary reaction and > although he tested with the flashlight for a long time, he couldn’t see > any. He finally asked if I detected any difference in brightness > between the two eyes. I’m not sure of the significance of any of these > "atypical" things; he just said he would need to follow my case more > closely. I am on Xalatan. > Basically the GS said although there are some unusal aspects, it is > glaucoma because there was nothing else he knew of that it could be. > Your comments are most welcome and appreciated. > -Gudrun

Hmmm.  A diagnosis based on exclusion.  I’m sure the the usual suspects were ruled-out, such as a vitreoretinal cause, or optic neuritis… Anyway, I hope that the Xalatan does the trick. DrG

Response:

I am newly diagnosed with moderate visual field loss in one eye. Or that’s what the GS said; I perceive a lot of loss. I’d like to hear from people who were not diagnosed early, meaning before they had vision loss, for whom progressive loss was stopped or greatly slowed once treatment began. Like most new patients I am terrified of going blind in that eye. All the GS said was "you have a lot of nerve fiber left," which was supposed to be encouraging, but if you supposedly lose half the nerve fiber before there is visual field loss, how could you have "a lot" left? Anyway, thanks for any encouragement. -Gudrun

Response:

Gudrun, I have been following your story with interest.  I haven’t yet read that you have been diagnosed with glaucoma, despite having consulted with a glaucoma specialist.  Do you now have a diagnosis of glaucoma for your visual field loss?  Also, is this visual field defect repeatable? DrG – Hide quoted text — Show quoted text -gudrun17 wrote: > Hubert Mak wrote: > > The following factors may change the outcome of your treatment, > > just for example: > > 1 – your age. > Age in terms of how much longer you need to be able to see? Or is there > a difference between the way the elderly and younger people respond to > treatment? > > 2 – your life style. > > 3 – over use.(such as watch late-nite show or movie after 8 hours > >               on computer.) > > 4 – your general health condition. > So if you are in good health, the visual damage is less likely to > progress? > > 5 – side effects.(such as some side effects may kill you before > >                   you get blind.) > > 6 – your financial health condition. > Meaning whether you can afford to see a top specialist? > > 7 – your luck.(healthcare professional are human, sometime > >                may do some mistakes. just for example) > Yes, I know, I had the great misfortune of having lost more vision due > to original misdiagnosis. I sure hope my luck changes at some point. > > Hope this helps. > > ————————————————————— > > Just an average dummie, I’m not healthcare professional or > > engineer. > > —————————————————————- > > On 12 Feb 2005, gudrun17 wrote: > > > I am newly diagnosed with moderate visual field loss in one eye. Or > > > that’s what the GS said; I perceive a lot of loss. I’d like to hear > > > from people who were not diagnosed early, meaning before they had > > > vision loss, for whom progressive loss was stopped or greatly > slowed > > > once treatment began. Like most new patients I am terrified of > going > > > blind in that eye. All the GS said was "you have a lot of nerve > fiber > > > left," which was supposed to be encouraging, but if you supposedly > lose > > > half the nerve fiber before there is visual field loss, how could > you > > > have "a lot" left? > > > Anyway, thanks for any encouragement. > > > -Gudrun

Response:

beside the treatment itself, these seven factors are essential for your decision making process and it is definitly effects the outcomes of the treatment. please do some search in the internet for more details, i guess the google search is a good start.  you must do this work yourself, any individual case are different and privacy problem involved. —————————————————— On 18 Feb 2005, gudrun17 wrote: > Hubert Mak wrote: > > The following factors may change the outcome of your treatment, > > just for example: > > 1 – your age. > Age in terms of how much longer you need to be able to see? Or is there > a difference between the way the elderly and younger people respond to > treatment?

yes, this only one of the reasons. ask your doctor. > > 2 – your life style. > > 3 – over use.(such as watch late-nite show or movie after 8 hours > >               on computer.) > > 4 – your general health condition. > So if you are in good health, the visual damage is less likely to > progress?

Yes, this is one of the reasons. please do some search,and ask your doctor. > > 5 – side effects.(such as some side effects may kill you before > >                   you get blind.) > > 6 – your financial health condition. > Meaning whether you can afford to see a top specialist?

definitely yes. but this is one of the reasons, there are many other factors if your are poor. please do some more search yourself. > > 7 – your luck.(healthcare professional are human, sometime > >                may do some mistakes. just for example) > Yes, I know, I had the great misfortune of having lost more vision due > to original misdiagnosis. I sure hope my luck changes at some point.

misdiagnosis is not the only one factor, you must do some more search to understand how this business setup and running, just for example. > > Hope this helps. > > ————————————————————— > > Just an average dummie, I’m not healthcare professional or > > engineer. > > —————————————————————- > > > Anyway, thanks for any encouragement. > > > -Gudrun

———————————————————————-

Response:

- Hide quoted text — Show quoted text -Fred May wrote: > Gudrun > You asked for advice from anyone with Normal Tension Glaucoma, > who had suffered some vision loss before diagnosis, but had the loss > of vision halted by medical intervention.  Well I fit the bill. > I was first diagnosed with possible glaucoma in September 1997 with > pressures > in both eyes of 23.  I was placed on Betagan drops to reduce the pressures > to 19. > Unfortunately this was not enough and although visiting the Glaucoma > specialist > six times in the following 9 months, I lost 11% of my vision in the right > eye. > The dead patch was just above the fovea in the close-in vision.  The most > annoying thing about it was that I had to discover it for myself, a few days > after my > penultimate visit to this incompetent fool, whose advice to me had been > "Come back in 5 months time."  How much of my vision would have been left if > I > had followed this advice I shudder to think. > Well the end of this long story is that I consulted my G.P. to get a second > opinion > from the leading specialist in Sydney and he diagnosed NTG and reduced my > pressures > to around 11 by a combination of medication and laser treatment. This > stopped the > deterioration in my vision immediately.  He suggested that the maximum > pressure in the right eye, > which had the worst NTG, should be kept below 14.  The left eye is not so > critical but probably > should be kept below 16.  I have had further laser treatment in the right > eye 18 months ago as the > pressures have gradually increased.  There has been no significant further > deterioration in either eye > since changing my specialist. > Fred May > Aged 75

Thank you for your post. Yes, I can sympathize–my retina specialist kept telling me my diminishing peripheral vision was due to a detached vitreous and would get better on its own, and when I kept telling him it was getting worse, that’s what he would say, come back in two months. I wish I had done what you did and got a third opinion right away instead of trusting him and his colleagues and losing more vision over five months. Right now I have seen two glaucoma specialists–the first one is not in any hurry and put me on Xalatan and said come back in a month. Fortunately the good one I saw right after him put me on Xalatan for two weeks, to which I did not respond, and now has me on Lumigan. I will find out next week if that’s doing anything. The other doctor would have left me to lose more vision over a month of using Xalatan doing nothing at all. I would guess that if the medications do not work the next step is laser surgery–I had heard it is often not too effective for NTG so I’m glad to hear it helped with yours. I personally would rather not go through months of trying all sorts of eyedrops and losing more vision if none work or work well enough. Wish I could find someone to take a more aggressive approach, as your specialist has. -Gudrun

Response:

"gudrun17" <yng…@aol.com> wrote in message

news:1108928203.100298.318580@l41g2000cwc.googlegroups.com… – Hide quoted text — Show quoted text -> Dr. Leukoma wrote: >> gudrun17 wrote: >> > Dr. Leukoma wrote: >> > > Gudrun, >> > > I have been following your story with interest.  I haven’t yet > read >> > > that you have been diagnosed with glaucoma, despite having >> consulted >> > > with a glaucoma specialist.  Do you now have a diagnosis of >> glaucoma >> > > for your visual field loss?  Also, is this visual field defect >> > > repeatable? >> > > DrG >> > Thank you for your interest, Dr. G. Yes, I was diagnosed with > normal >> > tension glaucoma although the glaucoma specialist said my case is >> > "atypical." He said the appearance of the optic nerve head does not >> > quite match the visual field defect, and he also said I am seeing >> more >> > visual disturbance than the visual field test shows. Yes, I had two >> > visual field tests about ten days apart and although I didn’t get a >> > chance to get a good look at them, other than over the doctor’s >> > shoulder, they appeared to be similar so I guess that means it was >> > repeatable. There is obviously a visual field defect and there is >> some >> > thinning of the optic nerve fiber layer as shown by OCT. As I noted >> in >> > another post, there are a couple of other seemingly unusual things >> > about my case–for example, the GS said with the kind of visual > field >> > defect I have there ought to be a difference in pupillary reaction >> and >> > although he tested with the flashlight for a long time, he couldn’t >> see >> > any. He finally asked if I detected any difference in brightness >> > between the two eyes. I’m not sure of the significance of any of >> these >> > "atypical" things; he just said he would need to follow my case > more >> > closely. I am on Xalatan. >> > Basically the GS said although there are some unusal aspects, it is >> > glaucoma because there was nothing else he knew of that it could > be. >> > Your comments are most welcome and appreciated. >> > -Gudrun >> Hmmm.  A diagnosis based on exclusion.  I’m sure the the usual > suspects >> were ruled-out, such as a vitreoretinal cause, or optic neuritis… >> Anyway, I hope that the Xalatan does the trick. >> DrG > Thank you, Dr. G. I assume that optic neuritis would have been detected > during dilated eye exams. I also assume that a vitreoretinal cause, if > not detected over several months of exams by the retinal specialist, > would have been ruled out when the OCT showed thinning of the optic > nerve fiber layer. > I am not very comfortable with being considered an atypical case by all > of the specialists I have been seeing; I still fear that something is > being missed. I am getting a second opinion but so far he has not done > any other kinds of tests–I’ve only had the visual fields, the OCT, > some photos of the optic nerve and dilated eye exams/pressure checks, > of course. I am still scared something is being missed. I can’t by > myself of course tell if the Xalatan is helping–I’ve only been on it > about ten days–so although I still feel I am continuing to lose > vision, at this point I don’t know what else I can do but take the > drops and wait. Thank you again for your good wishes and interest. > -Gudrun

Gudrun You asked for advice from anyone with Normal Tension Glaucoma, who had suffered some vision loss before diagnosis, but had the loss of vision halted by medical intervention.  Well I fit the bill. I was first diagnosed with possible glaucoma in September 1997 with pressures in both eyes of 23.  I was placed on Betagan drops to reduce the pressures to 19. Unfortunately this was not enough and although visiting the Glaucoma specialist six times in the following 9 months, I lost 11% of my vision in the right eye. The dead patch was just above the fovea in the close-in vision.  The most annoying thing about it was that I had to discover it for myself, a few days after my penultimate visit to this incompetent fool, whose advice to me had been "Come back in 5 months time."  How much of my vision would have been left if I had followed this advice I shudder to think. Well the end of this long story is that I consulted my G.P. to get a second opinion from the leading specialist in Sydney and he diagnosed NTG and reduced my pressures to around 11 by a combination of medication and laser treatment.  This stopped the deterioration in my vision immediately.  He suggested that the maximum pressure in the right eye, which had the worst NTG, should be kept below 14.  The left eye is not so critical but probably should be kept below 16.  I have had further laser treatment in the right eye 18 months ago as the pressures have gradually increased.  There has been no significant further deterioration in either eye since changing my specialist. Fred May Aged 75

Response:

- Hide quoted text — Show quoted text -Dr. Leukoma wrote: > gudrun17 wrote: > > Dr. Leukoma wrote: > > > Gudrun, > > > I have been following your story with interest.  I haven’t yet read > > > that you have been diagnosed with glaucoma, despite having > consulted > > > with a glaucoma specialist.  Do you now have a diagnosis of > glaucoma > > > for your visual field loss?  Also, is this visual field defect > > > repeatable? > > > DrG > > Thank you for your interest, Dr. G. Yes, I was diagnosed with normal > > tension glaucoma although the glaucoma specialist said my case is > > "atypical." He said the appearance of the optic nerve head does not > > quite match the visual field defect, and he also said I am seeing > more > > visual disturbance than the visual field test shows. Yes, I had two > > visual field tests about ten days apart and although I didn’t get a > > chance to get a good look at them, other than over the doctor’s > > shoulder, they appeared to be similar so I guess that means it was > > repeatable. There is obviously a visual field defect and there is > some > > thinning of the optic nerve fiber layer as shown by OCT. As I noted > in > > another post, there are a couple of other seemingly unusual things > > about my case–for example, the GS said with the kind of visual field > > defect I have there ought to be a difference in pupillary reaction > and > > although he tested with the flashlight for a long time, he couldn’t > see > > any. He finally asked if I detected any difference in brightness > > between the two eyes. I’m not sure of the significance of any of > these > > "atypical" things; he just said he would need to follow my case more > > closely. I am on Xalatan. > > Basically the GS said although there are some unusal aspects, it is > > glaucoma because there was nothing else he knew of that it could be. > > Your comments are most welcome and appreciated. > > -Gudrun > Hmmm.  A diagnosis based on exclusion.  I’m sure the the usual suspects > were ruled-out, such as a vitreoretinal cause, or optic neuritis… > Anyway, I hope that the Xalatan does the trick. > DrG

Thank you, Dr. G. I assume that optic neuritis would have been detected during dilated eye exams. I also assume that a vitreoretinal cause, if not detected over several months of exams by the retinal specialist, would have been ruled out when the OCT showed thinning of the optic nerve fiber layer. I am not very comfortable with being considered an atypical case by all of the specialists I have been seeing; I still fear that something is being missed. I am getting a second opinion but so far he has not done any other kinds of tests–I’ve only had the visual fields, the OCT, some photos of the optic nerve and dilated eye exams/pressure checks, of course. I am still scared something is being missed. I can’t by myself of course tell if the Xalatan is helping–I’ve only been on it about ten days–so although I still feel I am continuing to lose vision, at this point I don’t know what else I can do but take the drops and wait. Thank you again for your good wishes and interest. -Gudrun

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Dr. Leukoma wrote: > Hi Gudrun. > The doctors seem not to be responding so much to your perception of the > field loss as to their objective measurements of your field loss. > Would that be an accurate statement? > DrG

Yes, because the only "real" visual field tests I have had were done three weeks ago, about nine days apart. I was told there wasn’t much difference between those two tests. I don’t have any visual field tests from Sept. when I first noticed the loss of vision, so I have no objective measurement to show the doctors that I have been progressively losing more vision. I had been keeping track of it myself the only way that was available to me, which an online visual field test. The doctors do have those printouts which show I was progressively missing more dots within twenty and now within ten degrees of fixation, but I realize that’s not the same as a professional in-office visual field analyzer. So basically, I cannot prove that I have been losing more vision over the past six months because my retina specialist only just now agreed to order a visual field test–previously his advice was just to wait and see if it got better. I am scheduled for another visual field test in about two weeks. If it shows no more progression, then I’ll be relieved. If it does show progression, I hope my glaucoma specialist will consider more aggressive treatment. -Gudrun

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Gee, it’s not very encouraging that only one person had no more or very little progression once treatment started. Is it that unusual? -Gudrun, adding to first message

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"gudrun17" <yng…@aol.com> wrote in message

news:1108268946.844595.243180@f14g2000cwb.googlegroups.com… I am newly diagnosed with moderate visual field loss in one eye. Or that’s what the GS said; I perceive a lot of loss. I’d like to hear from people who were not diagnosed early, meaning before they had vision loss, for whom progressive loss was stopped or greatly slowed once treatment began. Like most new patients I am terrified of going blind in that eye. All the GS said was "you have a lot of nerve fiber left," which was supposed to be encouraging, but if you supposedly lose half the nerve fiber before there is visual field loss, how could you have "a lot" left? Anyway, thanks for any encouragement. -Gudrun I was not diagnosed early and had moderate loss of vision in my right eye when initially treated just over five years ago. Thus far there has been no further deterioration. Medication and treatment has been changed from time to time, either because the drops were not as efficatious as expected or because I developed side effects. Good luck Checkout

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To be honest, Gudrun, you don’t sound that atypical to me.  It is uncommon to see pupillary abnormalities in glaucoma, unless the GS was looking for optic neuritis, in which they are quite common.  I don’t spend much time studying the pupils in glaucoma patients.  In anyone who is considered atypical based on their field loss vs. the region of possible optic nerve damage, I would recommend neuro imaging with an MRI.  It is unlikely to show anything, but still, looking for signs of demyelination (as in optic neuritis or multiple sclerosis) or any potential compressive lesion (e.g. benign pituitary tumors, optic nerve gliomas, etc.) is a reasonable idea.  It certainly couldn’t hurt (unless you are particularly claustrophobic).      Keep your chin up!  Studies show that even in low tension (or normal tension) glaucoma, lowering the IOP does help to slow progressive VF loss.  Keep us informed. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

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Thank you, Dr. Cohn. Yes, what the glaucoma specialist said was atypical is that the appearance of the optic nerve head does not quite match the visual field defect, and that I am seeing more vision loss than was shown on the visual field tests. For what it’s worth, and I guess it doesn’t mean much, I had HRT today which actually only showed one borderline measurement in the affected eye; the rest were within normal limits. Of course I can’t interpret the test but the GS said that probably the reason everyone missed the glaucoma diagnosis was because there is some natural asymmetry between the two optic nerves but otherwise they both look pretty healthy. I realize that HRT is used to track changes rather than diagnose. You are right, I guess the other GS was looking for optic neuritis when he spent so much time comparing pupillary reaction. Possibly because the color red does look more faded in the bad eye–both doctors remarked on that but didn’t seem to pursue it any further. Thank you–I am trying to keep my chin up but am not doing very well. Xalatan had no effect so now I am starting Lumigan. I am very afraid that I am going to turn out to be one of those patients for whom no treatment works and I will just keep losing vision. The GS said that Lumigan works in 70 percent of patients who don’t respond to Xalatan so I hope for once my luck will change. This whole ordeal has been just one misfortunate turn after another. -Gudrun – Hide quoted text — Show quoted text -eyegu…@aol.com wrote: > To be honest, Gudrun, you don’t sound that atypical to me.  It is > uncommon to see pupillary abnormalities in glaucoma, unless the GS was > looking for optic neuritis, in which they are quite common.  I don’t > spend much time studying the pupils in glaucoma patients.  In anyone > who is considered atypical based on their field loss vs. the region of > possible optic nerve damage, I would recommend neuro imaging with an > MRI.  It is unlikely to show anything, but still, looking for signs of > demyelination (as in optic neuritis or multiple sclerosis) or any > potential compressive lesion (e.g. benign pituitary tumors, optic nerve > gliomas, etc.) is a reasonable idea.  It certainly couldn’t hurt > (unless you are particularly claustrophobic). >      Keep your chin up!  Studies show that even in low tension (or > normal tension) glaucoma, lowering the IOP does help to slow > progressive VF loss.  Keep us informed. > –Rick Cohn, MD > Glaucoma Specialist > Winter Park, FL

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- Hide quoted text — Show quoted text -gudrun17 wrote: > Fred May wrote: > > Gudrun > > You asked for advice from anyone with Normal Tension Glaucoma, > > who had suffered some vision loss before diagnosis, but had the loss > > of vision halted by medical intervention.  Well I fit the bill. > > I was first diagnosed with possible glaucoma in September 1997 with > > pressures > > in both eyes of 23.  I was placed on Betagan drops to reduce the > pressures > > to 19. > > Unfortunately this was not enough and although visiting the Glaucoma > > specialist > > six times in the following 9 months, I lost 11% of my vision in the > right > > eye. > > The dead patch was just above the fovea in the close-in vision. The > most > > annoying thing about it was that I had to discover it for myself, a > few days > > after my > > penultimate visit to this incompetent fool, whose advice to me had > been > > "Come back in 5 months time."  How much of my vision would have been > left if > > I > > had followed this advice I shudder to think. > > Well the end of this long story is that I consulted my G.P. to get a > second > > opinion > > from the leading specialist in Sydney and he diagnosed NTG and > reduced my > > pressures > > to around 11 by a combination of medication and laser treatment. > This > > stopped the > > deterioration in my vision immediately.  He suggested that the > maximum > > pressure in the right eye, > > which had the worst NTG, should be kept below 14.  The left eye is > not so > > critical but probably > > should be kept below 16.  I have had further laser treatment in the > right > > eye 18 months ago as the > > pressures have gradually increased.  There has been no significant > further > > deterioration in either eye > > since changing my specialist. > > Fred May > > Aged 75 > Thank you for your post. Yes, I can sympathize–my retina specialist > kept telling me my diminishing peripheral vision was due to a detached > vitreous and would get better on its own, and when I kept telling him > it was getting worse, that’s what he would say, come back in two > months. I wish I had done what you did and got a third opinion right > away instead of trusting him and his colleagues and losing more vision > over five months. Right now I have seen two glaucoma specialists–the > first one is not in any hurry and put me on Xalatan and said come back > in a month. Fortunately the good one I saw right after him put me on > Xalatan for two weeks, to which I did not respond, and now has me on > Lumigan. I will find out next week if that’s doing anything. The other > doctor would have left me to lose more vision over a month of using > Xalatan doing nothing at all. I would guess that if the medications do > not work the next step is laser surgery–I had heard it is often not > too effective for NTG so I’m glad to hear it helped with yours. I > personally would rather not go through months of trying all sorts of > eyedrops and losing more vision if none work or work well enough. Wish > I could find someone to take a more aggressive approach, as your > specialist has. > -Gudrun

Hi Gudrun. The doctors seem not to be responding so much to your perception of the field loss as to their objective measurements of your field loss. Would that be an accurate statement? DrG

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The following factors may change the outcome of your treatment, just for example: 1 – your age. 2 – your life style. 3 – over use.(such as watch late-nite show or movie after 8 hours               on computer.) 4 – your general health condition. 5 – side effects.(such as some side effects may kill you before                   you get blind.) 6 – your financial health condition. 7 – your luck.(healthcare professional are human, sometime                may do some mistakes. just for example) Hope this helps. ————————————————————— Just an average dummie, I’m not healthcare professional or engineer. —————————————————————- On 12 Feb 2005, gudrun17 wrote: – Hide quoted text — Show quoted text -> I am newly diagnosed with moderate visual field loss in one eye. Or > that’s what the GS said; I perceive a lot of loss. I’d like to hear > from people who were not diagnosed early, meaning before they had > vision loss, for whom progressive loss was stopped or greatly slowed > once treatment began. Like most new patients I am terrified of going > blind in that eye. All the GS said was "you have a lot of nerve fiber > left," which was supposed to be encouraging, but if you supposedly lose > half the nerve fiber before there is visual field loss, how could you > have "a lot" left? > Anyway, thanks for any encouragement. > -Gudrun

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- Hide quoted text — Show quoted text -eyegu…@aol.com wrote: >>just had a full eye exam with full dilation and my first corneal >>thickness measurement, by a Pachmate device.  I was happy that the >>cornea is thick,with the suggestion that my eye pressure can be >>considered four points below the IOP measurement. >>An hour after I left the office, I felt pain in the outer right eye > and >>there was sbleeding. > Corneal pachymetry machines all work by touching a probe to the cornea > gently to determine the corneal thickness using ultrasound.  There is > no contact with the probe and the conjunctiva, the membrane over the > white of the eye that has blood vessels.  It is therefore impossible > for the pachymeter to have caused a subconjunctival hemorrhage.  If the > probe accidentally grazed the conjunctiva (by technician error) or if > you rubbed the eye this could have occurred.  Also, yes, medications > that thin the blood could be implicated, as could anything that raises > blood pressure a bit (straining at lifting something, constipation, > holding your breath, sneezing, coughing, etc.)…and…sometimes these > things JUST HAPPEN.  It is absolutely nothing to worry about. > Subconjunctival hemorrhages always go away on their own and never hurt > the eye.  Take care, > Rick Cohn, MD

Dear Dr. Rick Cohn ("Eye Guy") Thanks for the concurring opinion..I was confident that you would be informative and reassuring. I now believe that these things really can "JUST HAPPEN."    Thank you! You’ve been so helpful each time. Again, I wish that you practiced in NJ  >"< Is there a way to make a small contribution to your practice, in appreciation? Just let me know.. With appreciation, Carolyn — A contented malcontent. http://www.equalizers.org

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That’s very sweet, Carolyn…it’s my pleasure to help out.  As for my practice, the only contribution I usually accept is baked goods, especially those with chocolate!  I’m not sure how brownies would keep in the mail.  Of course, if you ever wanted to make a charitable contribution in my name, I would be grateful.  I just found a wonderful website called "charitynavigator.org" which rates charities, I guess by how well they fund raise and by how they distrubute their money. Unfortunately, the Glaucoma Research Foundation was rated quite low. Several guide dog foundations were rated well, getting 3 out of 4 stars.  I think giving toward the training of guide dogs is a very noble cause.  Anyway, it was very nice of you to offer, and anything you do would be very much appreciated. Take Care, Rick Cohn, MD

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I have had ocular hypertension for about 25 years, treated with drops.I just had a full eye exam with full dilation and my first corneal thickness measurement, by a Pachmate device.  I was happy that the cornea is thick,with the suggestion that my eye pressure can be considered four points below the IOP measurement. An hour after I left the office, I felt pain in the outer right eye and there was sbleeding. The pain resolved soon, and  the blood residue is gradually getting absorbed.  When I called my glaucoma doc, he said to use an antibiotic drop and see him after the weekend.  The eye then looked OK to him; it was not scratched. He asked if I have hypettension ( am on Dyazide & BP is not high) or was on Motrin, aspirin,etc., or had rubbed it.(No.) Since the event came spontaneously, I wonder if there could be any connection to the pupil dilators or the Pachmate, which I believe touches the eye. I did have a similar unexplained event in the left eye a year or twoago, which resolved. At that time, the same Dr. just said to use sterile water on the eye. Any thoughts, for future reference. If it could be the Pachmate, I think the experience shouild be made know to hte manufacturer. Thanks! Carolyn — A contented malcontent. http://www.equalizers.org

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- Hide quoted text — Show quoted text -Carolyn Schwebel wrote: > I have had ocular hypertension for about 25 years, treated with drops.I > just had a full eye exam with full dilation and my first corneal > thickness measurement, by a Pachmate device.  I was happy that the > cornea is thick,with the suggestion that my eye pressure can be > considered four points below the IOP measurement. > An hour after I left the office, I felt pain in the outer right eye and > there was sbleeding. The pain resolved soon, and  the blood residue is > gradually getting absorbed.  When I called my glaucoma doc, he said to > use an antibiotic drop and see him after the weekend.  The eye then > looked OK to him; it was not scratched. > He asked if I have hypettension ( am on Dyazide & BP is not high) or was > on Motrin, aspirin,etc., or had rubbed it.(No.) Since the event came > spontaneously, I wonder if there could be any connection to the pupil > dilators or the Pachmate, which I believe touches the eye. > I did have a similar unexplained event in the left eye a year or twoago, > which resolved. At that time, the same Dr. just said to use sterile > water on the eye. > Any thoughts, for future reference. If it could be the Pachmate, I think > the experience shouild be made know to hte manufacturer. > Thanks! > Carolyn

Corneal pachymetry machines all work by touching a probe to the cornea gently to determine the corneal thickness using ultrasound.  There is no contact with the probe and the conjunctiva, the membrane over the white of the eye that has blood vessels.  It is therefore impossible for the pachymeter to have caused a subconjunctival hemorrhage.  If the probe accidentally grazed the conjunctiva (by technician error) or if you rubbed the eye this could have occurred.  Also, yes, medications that thin the blood could be implicated, as could anything that raises blood pressure a bit (straining at lifting something, constipation, holding your breath, sneezing, coughing, etc.)…and…sometimes these things JUST HAPPEN.  It is absolutely nothing to worry about. Subconjunctival hemorrhages always go away on their own and never hurt the eye.  Take care, Rick Cohn, MD

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no, contact lenses have nothing to do with cataracts in any way.  You may wear them. –Dr. C

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Cataracts can develop VERY variably in different patients (between six months and 25 years).  Nothing has been shown to be significantly preventative.  Sunbathing with eyes closed is worse for the skin than the eyes.  Many eyeglass lenses and almost all sunglass lenses have UV protection.  Don’t worry too much about cataracts…if you can still drive comfortably at night without too much glare, you’ll be just fine. –Rick Cohn, MD

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Dear Dr. Cohn, Thank you very much for your reply! May I ask you just another question? I wear 1-day soft contact lenses: do you know whether contact lenses are contraindicated in case of (initial) cataract? Best wishes Alberto <eyegu…@aol.com> ha scritto nel messaggio news:1106710857.696302.241430@c13g2000cwb.googlegroups.com… – Hide quoted text — Show quoted text -> Cataracts can develop VERY variably in different patients (between six > months and 25 years).  Nothing has been shown to be significantly > preventative.  Sunbathing with eyes closed is worse for the skin than > the eyes.  Many eyeglass lenses and almost all sunglass lenses have UV > protection.  Don’t worry too much about cataracts…if you can still > drive comfortably at night without too much glare, you’ll be just fine. > –Rick Cohn, MD

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Hi, I was a glaucoma suspect because of a IOP of 20 and I decided to go to a glaucoma specialist. During the visit I found out that my IOP had gone down from 20 to 15 without taking any drops (the pressure was measured always at the same time). After examining the results of visual field test and GDX, the specialist performed a gonioscopy and told me that my optic nerve was fine, that I don’t have glaucoma, although my cornea is quite thin and so I may be at risk in the future. He said, however, that I have  I have early symptoms of cataract (I’m forty now). Do you know how long it takes on the average for the cataract to "mature"? Can it increase my risk of developing glaucoma? What can you do to prevent cataract from growing worse? I’ve read that UV rays can cause cataract. Do you know whether sunbathing with one’s eyes shut but without sunglasses may be dangerous for the eye? And what if a person likes getting sunlight behind a window, again with his/her eyes shut: does glass boost the effect of harmful sun rays? I wear eyeglasses (I am shortsighted): do normal lens (without specific UV protection) in some way protect from UV rays or do they increase their harmful effect? Sorry if I bothered you with questions about cataract, but I couldn’t find a newsgroup devoted to the subject: if you know one, could you please tell me? Thank you very much to all of you Alberto

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