IOP higher in eye that gets drops first?

Question:

My latest theory. I wonder if pressure tends to be higher in the first eye that you put your drops in. For me, it’s the right eye. I notice the drops usually start running down my cheek as I am trying to see to put them in my left eye. I then close both eyes for a bit and that keeps the left drops in. I have now switched to putting drops in the left eye first and will be interested to know if there is any change in pressure. It would be interesting to know if most people put their right drops in first, or if it’s strictly random. And it would be interesting to know if others have noticed that the eye they treat first has the higher pressure.

Response:

In article <373E69B6.B377F…@globalnet.co.uk>, John Worthington <jwo…@globalnet.co.uk> wrote:

[...] >Before my diagnosis I was not aware of any problem so that the drops have not >changed the any physical / visual attributes that I may have. I kmow that the >drops now are to reduce any possible future damage. As far as I am aware there is >no damge present. >If, as sometimes, I forget to take my drops (I know that I’m a dozy bugger) I >don’t notice any difference. So how do you know ?

– John:  You have put your finger on one of the most insidious factors relating to this ailment. 1.  First of all, you don’t notice any problems. 2.  And when you take your medicine faithfully, you don’t notice any improvement. 3.  And, finally, when you skip your drops (you dozy bugger you don’t notice any difference. What a tremendous *negative* incentive to follow your treatment faithfully. There have been studies on why patients stop using their drops.  Most of the reasons relate to the three factors above. There is no magic answer.  But, just be aware, that glaucoma, if untreated, is likely to result in major visual loss over a period of twenty or thirty years.  You have to look at your treatment as a life style.  Put the drops in in the morning *without fail*.  Put the drops in at night *without fail*.  If you "cheat" — whom do you think you are cheating? My own case (common open-angle glaucoma) was diagnosed when I was 39 in 1970.  I started using pilocarpine drops four times a day.  After a few years I added epinephrine drops twice a day.  Then Propine, then Timoptic, then Betoptic, then Alphagan, then Trusopt, then Xalatan. Today, twenty-nine years later, my visual acuity is 20-20.  I use Xalatan once a day, Propine (generic) twice a day, and Cosopt (a combination of two glaucoma drugs) twice a day. The procedure to me is so routine, it’s like putting on my socks!  Each morning and each evening, while in bed, I go through the routine.  It’s trivial! I’m now 68 with very good vision.  I see a very good ophthalmologist about three or four times a year.  I have field tests once a year.  I take, in addition to the drops, ginkgo biloba twice a day. My advice is to get into the habit of taking your medications on schedule.  Don’t cheat.  I realize that you cannot percieve any benefit on a daily basis.  Think of this as your long-term insurance against major visual loss. And good luck! earle —                __             __/_            /_/_/              /_/_   earle               /_/   jones Handgun murders in 1996: New Zealand      2 Australia       13 Japan           15 Great Britain   30 Canada         106 Germany        213 USA          9,390

Response:

On 16 May 1999 11:19:33 GMT, halt…@aol.com (Halterb) wrote: ………. >but I am always >suspicious when (as after switching to a generic version of Timoptic) they feel >"stiff" and generally uncomfortable.

That could only be the result of a different applicative formulation, right?  Timolol is timolol, right? Ray – Hide quoted text — Show quoted text -…….

Response:

Halterb I’ve posed this question before to others. How do you know what your pressures are ?  Do you have your own pressure reading equipment ? Can you tell physically when your pressures are high ? Before my diagnosis I was not aware of any problem so that the drops have not changed the any physical / visual attributes that I may have. I kmow that the drops now are to reduce any possible future damage. As far as I am aware there is no damge present. If, as sometimes, I forget to take my drops (I know that I’m a dozy bugger) I don’t notice any difference. So how do you know ? Yours, mystified, John Worthington – Hide quoted text — Show quoted text -Halterb wrote: > My latest theory. > I wonder if pressure tends to be higher in the first eye that you put your > drops in. > For me, it’s the right eye. I notice the drops usually start running down my > cheek as I am trying to see to put them in my left eye. I then close both eyes

Response:

On Sun, 16 May 1999 22:30:08 +0100, "David Wright" <Djwri…@tesco.net> wrote: >Halterb mentioned that some doctors claim to be able to measure IOP by >palpation of the eye, this method was used years ago before the widespread >availability of tonometers although realistically it was only able to detect >very high pressures. The advice to get unscheduled checks is excellent >although John might like to know that Professor Draeger of Germany is >developing a self tonometer which has been tested by astronaughts

Those are those guys that don’t make it, right?  ;-)  (The others are known as ‘astronauts’.) >in space >and which he hopes to develop for use by glaucoma patients in due course.

There are various brands you can buy at present if you have enough moolah.  I doubt his would be cheaper than the lowest price I’ve seen, which was about $750. Ray

Response:

Dear Earle We fully agree that the use of anasthetic is undesirable without proper supervision. I’ll look up the reference and let you know next week, also we are expecting an article from Professor Draeger for our professional journal shortly and as soon as it has undergone review, I’ll let you know the gist. David Wright Chief Executive International Glaucoma Association

Response:

Halterb mentioned that some doctors claim to be able to measure IOP by palpation of the eye, this method was used years ago before the widespread availability of tonometers although realistically it was only able to detect very high pressures. The advice to get unscheduled checks is excellent although John might like to know that Professor Draeger of Germany is developing a self tonometer which has been tested by astronaughts in space and which he hopes to develop for use by glaucoma patients in due course. David Wright Chief Executive International Glaucoma Association

Response:

To:  David Wright The idea of a home-use tonometer has been discussed in this group several times in the past.  Back in 1960, two University of California Optometrists, Dr. Stuart McKay and Dr. Elwin Marg developed a simple applanation tonometer that was very easy to use, with the idea that it could be sold for a few hundred dollars for home use. The problem is the use of an ophthalmic anaesthetic.  No American ophthalmologist (to my knowledge) would allow a patient to anaesthetize his own eye at home. I don’t think that I could use any device that makes contact to the cornea without an anaesthetic.  Perhaps with some training, I might be able to. Perhaps contact lens wearers might be able to do this. There is a real danger, as you know, in the use of ophthalmic anaesthetics.  If one inadvertently scratches the cornea, the anaesthetized eye would present no signal that something was not right. And several things could happen, including infection. The American Optical "Air-puff" tonometer avoided the need for the anaesthetic, but it was large, bulky, and expensive — not a home instrument. I would like to know more about the German Dr. Draeger’s approach that was used by astronauts in space.  Is there a reference? Thanks for your posting — I find it most interesting. best regards, earle — I am an engineer and not a health-care professional. — In article <7hnd7p$io…@epos.tesco.net>, "David Wright" <Djwri…@tesco.net> wrote: >Halterb mentioned that some doctors claim to be able to measure IOP by >palpation of the eye, this method was used years ago before the widespread >availability of tonometers although realistically it was only able to detect >very high pressures. The advice to get unscheduled checks is excellent >although John might like to know that Professor Draeger of Germany is >developing a self tonometer which has been tested by astronaughts in space >and which he hopes to develop for use by glaucoma patients in due course. >David Wright >Chief Executive International Glaucoma Association

               __             __/_            /_/_/              /_/_   earle               /_/   jones Handgun murders in 1996: New Zealand      2 Australia       13 Japan           15 Great Britain   30 Canada         106 Germany        213 USA          9,390

Response:

John Worthington asked: >I’ve posed this question before to others. >How do you know what your pressures are ?  Do you have your own pressure >reading >equipment ? Can you tell physically when your pressures are high ?<

I have my pressures checked regularly by my ophthamalogist. If there is some change in my program, I go in for a non-scheduled test to be certain there are no unexpected problems. As far as telling physically when pressures are high, fortunately they haven’t really been high in recent years, however some doctors claim to be able to detect pressure rather accurately by feeling the hardness of the eyeball. Most of the time, my eyes don’t give any sort of sensation at all, but I am always suspicious when (as after switching to a generic version of Timoptic) they feel "stiff" and generally uncomfortable.  >Before my diagnosis I was not aware of any problem so that the drops have not >changed the any physical / visual attributes that I may have. I kmow that the >drops now are to reduce any possible future damage. As far as I am aware >there is >no damge present. >If, as sometimes, I forget to take my drops (I know that I’m a dozy bugger) I >don’t notice any difference. So how do you know ?<

Again, significant changes in my program are always followed with ophthalmologist checks. – Hide quoted text — Show quoted text ->Yours, mystified,<

Response:

On 16 May 1999 21:08:23 PDT, ejone…@concentric.net (Earle Jones) wrote: ………. >John:  You have put your finger on one of the most insidious factors >relating to this ailment. >1.  First of all, you don’t notice any problems. >2.  And when you take your medicine faithfully, you don’t notice any >improvement. >3.  And, finally, when you skip your drops (you dozy bugger you don’t >notice any difference.

And 4.  Since MDs, who make out real well with this scheme, which has no feedback of a success measure, insist on retaining the right to associate lower pressure with less sight loss (without scientific support), the makers of the drops make out like bunnies, without having to prove to the FDA that their drops do *any*thing against nerve damage, only that they drop IOPs in some people. >What a tremendous *negative* incentive to follow your treatment faithfully. >There have been studies on why patients stop using their drops.  Most of >the reasons relate to the three factors above. >There is no magic answer.  But, just be aware, that glaucoma, if >untreated, is likely to result in major visual loss over a period of >twenty or thirty years.  

And if treated, can result in same within many fewer years.  Take your pick. >You have to look at your treatment as a life >style.  

That’s a good description of it, OK. >Put the drops in in the morning *without fail*.  Put the drops in >at night *without fail*.  If you "cheat" — whom do you think you are >cheating? >My own case (common open-angle glaucoma) was diagnosed when I was 39 in >1970.  

At that age, I suppose the diagnosis was significant, but how high exactly *were* the pressures? >I started using pilocarpine drops four times a day.  After a few >years I added epinephrine drops twice a day.  Then Propine, then Timoptic, >then Betoptic, then Alphagan, then Trusopt, then Xalatan. >Today, twenty-nine years later, my visual acuity is 20-20.  I use Xalatan >once a day, Propine (generic) twice a day, and Cosopt (a combination of >two glaucoma drugs) twice a day.

And likely the guy down the street who started drops about the same time but quit them a couple years later probably also sees 20/20.  And the guy further on down, who has also faithfully taken his drops for 29 years may have all kinds of medical problems he wouldn’t have had if he *hadn’t* taken them, but would not’ve lost any sight. >The procedure to me is so routine, it’s like putting on my socks!  Each >morning and each evening, while in bed, I go through the routine.  It’s >trivial! >I’m now 68 with very good vision.  I see a very good ophthalmologist about >three or four times a year.  I have field tests once a year.  I take, in >addition to the drops, ginkgo biloba twice a day. >My advice is to get into the habit of taking your medications on >schedule.  Don’t cheat.  I realize that you cannot percieve any benefit on >a daily basis.  

But if they don’t even lower the pressure after, say, 6 mo, forget them. >Think of this as your long-term insurance against major >visual loss.

Think of that happening maybe once in a while, under certain circumstances, not *most* of the time. >And good luck!

I love that phrase. 8-(((((((((((((  Always makes you feel so secure in the preceding advice.  It’s a favorite one with lawyers. Ray

Response:

On Sun, 16 May 1999 07:46:14 +0100, John Worthington <jwo…@globalnet.co.uk> wrote: >Halterb >I’ve posed this question before to others. >How do you know what your pressures are ?  Do you have your own pressure reading >equipment ? Can you tell physically when your pressures are high ? >Before my diagnosis I was not aware of any problem so that the drops have not >changed the any physical / visual attributes that I may have. I kmow that the >drops now are to reduce any possible future damage.

That’s the theory — if you believe it. >As far as I am aware there is >no damge present. >If, as sometimes, I forget to take my drops (I know that I’m a dozy bugger) I >don’t notice any difference. So how do you know ?

When you see those hell fires, you know you blew it. – Hide quoted text — Show quoted text ->Yours, mystified, >John Worthington >Halterb wrote: >> My latest theory. >> I wonder if pressure tends to be higher in the first eye that you put your >> drops in. >> For me, it’s the right eye. I notice the drops usually start running down my >> cheek as I am trying to see to put them in my left eye. I then close both eyes

Response:

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