Normal Pressure Glaucoma
Question:
In article <3EADD6B7.55526…@sprynet.com>, Donald Singleton <donal…@sprynet.com> wrote: > Most patients would be thrilled to have > pressures of 14, but I have heard some say their doctors try to keep theirs > around 10 to prevent further deterioration of the nerves.
That’s where I’m being kept: the pressure in my unaffected eye is about 18 and the Cosopt/Travatan-treated eye is about 10 — and my visual field has held steady for the last 2 years. BUT everyone’s mileage varies and the pressure in my affected eye was never through the roof to begin with. > I know a lot of research is ongoing. How great it would be if > scientists discovered a medication that could cause regeneration of > "lost" areas of the retina or other damaged parts of the nerve — I > guess that’s what we’re all hoping for.
It’s my understanding that the greatest hope of nerve regeneration is in the area of stem cell research — which the Bush government has effectively curtailed. So… if you want that research to continue and expand it may be a good idea to make your opinion known to your Congressman, Senator, Member of Parliament or whoever represents you.
Response:
On 30 Apr 2004 20:32:27 -0700, eyegu…@aol.com (Rick Cohn, M.D.) wrote: – Hide quoted text — Show quoted text ->"Bryan Llewellyn" <b.llewel…@tiscali.co.uk> wrote in message <news:4092d477_2@mk-nntp-2.news.uk.tiscali.com>… >> Hi, >> I am 53 and have been diagnosed with the above. My doctor asked if I was >> allergic to sulphur as he put me on something called Xalatan!! for the rest >> of my life. When I drop it in my eye I can taste it my wife does not believe >> me. Tell me I am not going doooolally >> Bryan >Um…"doooolally?" Must be a British thing…here in the States we >generally go crazy, bonkers, or just plain nuts. Anyway, you are none >of the above. Medications on the eye drain into the nasolacrimal >ducts, the little drainage holes close to the nose in both the upper >an lower eyelids. They then drain from the nose down into the back of >the throat. Therefore, many people can "taste" their eyedrops. >Closing your eyes for two minutes after instilling the drops may help >to prevent some of the drop from draining into the nose. >Take care, >Rick Cohn, MD >Glaucoma Specialist >Winter Park, FL >P.S. Send my regards to Prince William and Harry
Dr. Cohn, What is your opinion of punctal occlusion? (I use punctal occlusion for 3 minutes and then immediately "wick" the eye with Kleenex. I have done the gamut of eye drops without any systemic symptoms. But with plenty of eye lid irritation.) Thanks, John
Response:
In article <54e8377c.0304300744.3017f…@posting.google.com>, eyegu…@aol.com (Rick Cohn, M.D.) wrote: > Well, a very nice study performed a few years ago was aimed just > at answering that question (sorry, I don’t have the source info > handy). Patients with LTG were randomized to treatment or no > treatment, and serial visual field exams were performed over several > years. What the authors found was that those treated with drops to > lower their IOP further than their baseline pressures had less > progression of field loss on follow-up field tests. In other words, > using drops helped the LTG patients as well. Therefore we assume that > by reducing the pressure further on an already damaged nerve is > probably beneficial, even if the starting IOP isn’t very high.
Certainly seems to be consistent with my case.
Response:
Hi all, Before I join the discussion on the internal eyeball pressure, I would like to state that I am not a medical professional. I am an electrical engineer by training and profession. I was diagnosed with open angle glaucoma with severe field vision loss in both eyes 7 years ago at the age of 48. The internal pressure, as indicated by the usual IOP, is actually a relative reading measured with respect to the pressure outside the eyeball, ie. atmospheric pressure, which is 760 mm at sea level. Thus if the IOP (aqueous part) has a reading of 18 mm, the absolute internal pressure equals to 760 + 18 mm, or 778 mm. I do not know whether the vitreous part has a different pressure from the aqueous part. Assuming that it has a pressure of 20 mm relative to the atmospheric pressure, then the absolute pressure is 760 + 20 mm or 780 mm. The internal pressure of the vitreous part relative to the aqueous part is then 20 – 18 mm or 2 mm. My speculation is that there should not be much difference, if any, between the two internal pressures. In the old days, the cataract extraction was achieved by the complete removal of the lens. If there were appreciable difference in the pressures, the two types of fluid would mix to equalise the pressures as stated by Earl Jones. Sun, Chong Hong "Halterb" <halt…@aol.com> wrote in message
news:20030501220113.04977.00000424@mb-m05.aol.com… – Hide quoted text — Show quoted text -> Earle Jones wrote: > >I have never heard that the pressure in one part of the eye is different > >from the pressure in another part. If there is any flow possible > >between the compartments, a differental pressure would cause flow and > >equalize the pressures.< > Thanks for your input, Earle. You were quick to pick up my post. I cancelled > the first one and replaced it with one that corrected the multiple in the rear > compartment and used different pressure figures. Instead of some eyes having > double the normal vitreous pressure, it should have read 50% more than normal. > I can respond to your first point more easily than the second. I’m not seeing > the two compartments being connected so that fluid could flow between them, but > two separate compartments within one larger one (the eyeball). Therefore, this > means of equalization wouldn’t apply. > >Think of two balloons. If I inflate them to different pressures and > >them press them together so that the pressure in one is 30 and the > >pressure in the other is 15, there is no place where a pressure of 45 > >would be measured.< > Good point. But if two balloons were placed within one large balloon and each > of the first two (one representing the aqueous and the other the vitreous) > inflated to 15 pounds, then there would seem to be 30 pounds of air that had > entered the large balloon (representing the eyeball). Then, if the rear balloon > (vitreous) is inflated an additional 15 pounds, there would be 45 pounds of > pressure contained within the large balloon (eyeball). > Now, you’ve got a better grasp on pneumodynamics than I, so you may see this > differently. But, adding another complication, I should point out that in the > case of the eye we’re dealing with fluid dynamics. > In common language, the more stuff you push into something, the tighter it > gets!
Response:
"Bryan Llewellyn" <b.llewel…@tiscali.co.uk> wrote in message <news:4092d477_2@mk-nntp-2.news.uk.tiscali.com>… > Hi, > I am 53 and have been diagnosed with the above. My doctor asked if I was > allergic to sulphur as he put me on something called Xalatan!! for the rest > of my life. When I drop it in my eye I can taste it my wife does not believe > me. Tell me I am not going doooolally > Bryan
Um…"doooolally?" Must be a British thing…here in the States we generally go crazy, bonkers, or just plain nuts. Anyway, you are none of the above. Medications on the eye drain into the nasolacrimal ducts, the little drainage holes close to the nose in both the upper an lower eyelids. They then drain from the nose down into the back of the throat. Therefore, many people can "taste" their eyedrops. Closing your eyes for two minutes after instilling the drops may help to prevent some of the drop from draining into the nose. Take care, Rick Cohn, MD Glaucoma Specialist Winter Park, FL P.S. Send my regards to Prince William and Harry
Response:
Olfart’s correct. You also want to keep your drops from getting into the rest of your body via your tear ducts. I keep my eye closed for a couple of minutes (count to 100 at a relaxed pace). There are ways to block your tear ducts with a finger, but I never got comfortable with that. Laura On Fri, 30 Apr 2004 23:34:30 +0100, "Bryan Llewellyn" – Hide quoted text — Show quoted text -<b.llewel…@tiscali.co.uk> wrote: >Hi, >I am 53 and have been diagnosed with the above. My doctor asked if I was >allergic to sulphur as he put me on something called Xalatan!! for the rest >of my life. When I drop it in my eye I can taste it my wife does not believe >me. Tell me I am not going doooolally >Bryan
Response:
- Hide quoted text — Show quoted text -eddc…@aol.com (Eddchen) wrote in message <news:20030428202512.18771.00000176@mb-m23.aol.com>… > My IOP is and has been around 14 in both eyes for a long time. I had cataracts > removed sucessfully with implants in both eyes. I consider my vision to be very > good, no nightdriving problems any more, and I can read without glasses in > decent light. > My doctor has been watching optic nerve condition in one eye for about 2 years, > and I had my first field test a few weeks ago. It showed 2 blind spots in the > eye suspected with nerve damage. My doctor suggested another exam in September > to check IOP. If it increases, he will put me on drops. > My question is that if nerve damage can occur without elevated IOP pressure and > drops are intended to reduce IOP, what would treatment consist of if pressure > does not increase but the nerve damage increases, as evidenced by visual > examination and more field tests ? > I will discuss this in more detail with my doctor in September but would > appreciate heads-up info before then. > Thank you, Eddchen
Many patients out there have what is called either normal tension glaucoma or low tension glaucoma (same thing). These patients develop glaucomatous optic nerve damage without ever having IOP measurments above normal (21 millimeters of mercury). It has been suggested by many that the IOP is not the only critical factor here, and that these patients may suffer from poor blood flow to the optic nerve head. Traditionally this type of glaucoma has been treated the same way as high pressure glaucoma, by lowering the IOP with topical drops. For many years the question remained, "Does this help patients with low tension glaucoma from developing progressive visual field loss?" Well, a very nice study performed a few years ago was aimed just at answering that question (sorry, I don’t have the source info handy). Patients with LTG were randomized to treatment or no treatment, and serial visual field exams were performed over several years. What the authors found was that those treated with drops to lower their IOP further than their baseline pressures had less progression of field loss on follow-up field tests. In other words, using drops helped the LTG patients as well. Therefore we assume that by reducing the pressure further on an already damaged nerve is probably beneficial, even if the starting IOP isn’t very high. Hope that info was helpful. –Rick Cohn, MD glaucoma specialist Winter Park, FL
Response:
On 6 May 2004 14:04:28 -0700, eyegu…@aol.com (Rick Cohn, M.D.) wrote: >I’m honestly not a big fan of it because you can teach a patient where >to pinch or press, but he/she may eventually be doing it in the wrong >place and get no effect. Also, one’s hands may be dirty and increase >the risk of eye infections. How can you mess up simply closing your >eyes, which decreases the pumping action of blinking, which pumps >tears (and meds) down into the nose?
Well am I glad to read that! I got very tired of the nose-pinching thing and I really am not sure if I ever did it correctly anyway. I’ve just been closing my eyes (looking through a somewhat greasy film of eyedrop isn’t very appealing anyway). I began working on some needlework I had put away before I was diagnosed with glaucoma. I can barely see what I’m doing with my glasses on but see close-up just fine without them. Oh no, it’s time for the dreaded BIFOCALS. Eek! I’ve had more appointments with various flavors of eye doctor in the last six months than in my entire life before, I think. =) Leigh — "Why pay for cologne when mustard is free?" – Filburt
Response:
I’m not a doctor, but punctal occlusion is the practice of pinching the tear ducts closed for a couple of minutes after instilling drops, to minimize the body’s systemic absorption of the medication. One pinches the ducts at the top of the nose bridge, closing them temporarily. – Hide quoted text — Show quoted text -Don wrote: > John wrote: > > What is your opinion of punctal occlusion? > What is punctal occlusion? > Don
Response:
My IOP is and has been around 14 in both eyes for a long time. I had cataracts removed sucessfully with implants in both eyes. I consider my vision to be very good, no nightdriving problems any more, and I can read without glasses in decent light. My doctor has been watching optic nerve condition in one eye for about 2 years, and I had my first field test a few weeks ago. It showed 2 blind spots in the eye suspected with nerve damage. My doctor suggested another exam in September to check IOP. If it increases, he will put me on drops. My question is that if nerve damage can occur without elevated IOP pressure and drops are intended to reduce IOP, what would treatment consist of if pressure does not increase but the nerve damage increases, as evidenced by visual examination and more field tests ? I will discuss this in more detail with my doctor in September but would appreciate heads-up info before then. Thank you, Eddchen
Response:
Thanks Sherry for Both suggetions .
Response:
I am gratified by the interest in this topic which my inquiry generated. As a layman and novice to this condition, I am learning from all your inputs and want to thank each one of the participants for their instructive comments. Sincerely, Eddchen
Response:
I can’t seem to access this Sherry –with web tv ; ( ~~~~~~~~~~~~~~~~~~ later , Trish
Response:
eyegu…@aol.com (Rick Cohn, M.D.) wrote in news:54e8377c.0405061304.13a38b81@posting.google.com: <snip> > I’m honestly not a big fan of it because you can teach a patient > where to pinch or press, but he/she may eventually be doing it in > the wrong place and get no effect. Also, one’s hands may be dirty > and increase the risk of eye infections. How can you mess up simply > closing your eyes, which decreases the pumping action of blinking, > which pumps tears (and meds) down into the nose? > –Dr. Cohn
What about keeping your head tipped back at the same time? Do you think that helps? I would think it would, rather than tipping the head forward which might encourage the drops to go down the tear ducts. I always kept my eyes closed while pinching and still would get stuff down my tear ducts. I could taste it in the back of my throat and the beta blockers gave me nasty systemic side effects even with punctal occlusion. I can’t imagine doing the punctal occlusion with open eyes! I was told *always* to wash my hands before doing the drops for fear that I might accidentally touch the tip of the bottle and contaminating the contents. Seriously, though, what is the risk of infection with unwashed hands? I can’t imagine many people putting in drops with seriously dirty hands (but I’m sure they do it). Sherry
Response:
John wrote: > What is your opinion of punctal occlusion?
What is punctal occlusion? Don
Response:
Dr. Cohn wrote, in part: >…using drops helped the LTG patients as well. Therefore we assume that >by reducing the pressure further on an already damaged nerve is >probably beneficial, even if the starting IOP isn’t very high.<
That gets to a message I posted a while ago regarding vitreous pressure (the pressure in the rear compartment of the eyeball). I never was able to find much on the subject even after a lot of looking, but I can’t help but wonder if those whose IOP (aqueous IOP in the front compartment) appears not to be very high, might in fact have high pressure in the rear compartment, where the optic nerve enters into the eyeball. I did find some comments about people having as much as double the normal pressure in the rear compartment. It would seem that if pressure damaged the optic nerve, then the pressure could be either in the front or rear areas. I’m not aware of any method to check the rear area in a living being. As an example, if the pressure in the front of the eye is 15 and the rear of the eye 15, then the total pressure would be 30 (perhaps that’s the normal pressure on the optic nerve in a healthy individual). However, if the front pressure is 15 and the rear pressure rises to 30, then the total pressure is 45. As another way of looking at it, a rise of 15 points in the rear area would then be equivalent to a pressure of 30 in the front, perhaps enough to cause damage. I’d be interested in reactions to this.
Response:
- Hide quoted text — Show quoted text -> What about keeping your head tipped back at the same time? Do you think > that helps? I would think it would, rather than tipping the head > forward which might encourage the drops to go down the tear ducts. > I always kept my eyes closed while pinching and still would get stuff > down my tear ducts. I could taste it in the back of my throat and the > beta blockers gave me nasty systemic side effects even with punctal > occlusion. I can’t imagine doing the punctal occlusion with open eyes! > I was told *always* to wash my hands before doing the drops for fear > that I might accidentally touch the tip of the bottle and contaminating > the contents. Seriously, though, what is the risk of infection with > unwashed hands? I can’t imagine many people putting in drops with > seriously dirty hands (but I’m sure they do it). > Sherry
Blinking even once or twice after instilling the drops but before doing punctal occlusion allows some small amount to enter the puncta. I doubt tilting one’s head back does anything. I also don’t think the risk of infection is that great with hands washed or unwashed. I still prefer telling patients just to close their eyes…then I don’t have to worry whether they are occluding correctly or not…everyone knows how to close their eyes. –Dr. Cohn
Response:
> Dr. Cohn, > What is your opinion of punctal occlusion? > (I use punctal occlusion for 3 minutes and then immediately "wick" the eye > with Kleenex. I have done the gamut of eye drops without any systemic > symptoms. But with plenty of eye lid irritation.) > Thanks, > John
I’m honestly not a big fan of it because you can teach a patient where to pinch or press, but he/she may eventually be doing it in the wrong place and get no effect. Also, one’s hands may be dirty and increase the risk of eye infections. How can you mess up simply closing your eyes, which decreases the pumping action of blinking, which pumps tears (and meds) down into the nose? –Dr. Cohn
Response:
Dr. Cohn wrote, in part: >…using drops helped the LTG patients as well. Therefore we assume that >by reducing the pressure further on an already damaged nerve is >probably beneficial, even if the starting IOP isn’t very high.<
That gets to a message I posted a while ago regarding vitreous pressure (the pressure in the rear compartment of the eyeball). I never was able to find much on the subject even after a lot of looking, but I can’t help but wonder if those whose IOP (aqueous IOP in the front compartment) appears not to be very high, might in fact have high pressure in the rear compartment, where the optic nerve enters into the eyeball. I did find some comments about people having as much as 50% more than the normal pressure in the rear compartment. It would seem that if pressure damaged the optic nerve, then the pressure could be either in the front or rear areas. I’m not aware of any method to check the rear area in a living being. As an example, if the pressure in the front of the eye is 18 and the rear of the eye 18, then the total pressure would be 36 (perhaps that’s the normal pressure on the optic nerve in a healthy individual). However, if the front pressure is 18 and the rear pressure rises to 27, then the total pressure is 45. As another way of looking at it, a rise of 9 points in the rear area would then be equivalent to a pressure of 27 in the front, perhaps enough to cause damage. I’d be interested in reactions to this.
Response:
TNARTL…@webtv.net (( TN Artist, trish,tn )) wrote in news:12194- 4094289E-…@storefull-3252.bay.webtv.net: > I keep a box of cleanex close by my meds as it seems more sanitary to > press the cleanex over the tear duct
However you must be *very* careful that the tissue doesn’t wick the med out of the eye! Sherry
Response:
On Thu, 06 May 2004 11:13:01 GMT, Donald Singleton <donal…@sprynet.com> wrote: > I’m not a doctor, but punctal occlusion is the practice of pinching >the tear ducts closed for a couple of minutes after instilling drops, to >minimize the body’s systemic absorption of the medication. One pinches >the ducts at the top of the nose bridge, closing them temporarily.
"Press," rather than "pinch" might make it clearer to some people.
Response:
"olfart" <olfar…@excite.com> wrote in news:c6us0p$fu8go$1@ID-34582.news.uni-berlin.de: <snip> > It’s probably running into your tear ducts and then your sinuses and > down to where you can taste it. You might want to talk to the Doc or > someone in this group about the technique of applying the drops. > When I was using drops I held my tear ducts (at the junction of nose > and eyes) closed for about a minute after inserting the drops. You > get more meds to the eye and less wasted runoff that way.
You can find an excellent guide on putting eye drops in your eyes at http://glaucomafoundation.org/docs/EyedropGuide.pdf or a video at http://www.nyee.edu/video.html on "How to Put Drops in Your Eyes: The Ritch-Sussman Technique" Sherry
Response:
TNARTL…@webtv.net (( TN Artist, trish,tn )) wrote in news:12196-40942A65-31@storefull-3252.bay.webtv.net: > I can’t seem to access this Sherry –with web tv ; ( > ~~~~~~~~~~~~~~~~~~ later , Trish
Are you referring to the link for the video on punctual occlusion? I wouldn’t be suprised… Maybe you can go to a local library or a friend’s that has internet access and watch it from there. It’s well worth it. Sherry
Response:
Earle Jones wrote: >I have never heard that the pressure in one part of the eye is different >from the pressure in another part. If there is any flow possible >between the compartments, a differental pressure would cause flow and >equalize the pressures.<
Thanks for your input, Earle. You were quick to pick up my post. I cancelled the first one and replaced it with one that corrected the multiple in the rear compartment and used different pressure figures. Instead of some eyes having double the normal vitreous pressure, it should have read 50% more than normal. I can respond to your first point more easily than the second. I’m not seeing the two compartments being connected so that fluid could flow between them, but two separate compartments within one larger one (the eyeball). Therefore, this means of equalization wouldn’t apply. >Think of two balloons. If I inflate them to different pressures and >them press them together so that the pressure in one is 30 and the >pressure in the other is 15, there is no place where a pressure of 45 >would be measured.<
Good point. But if two balloons were placed within one large balloon and each of the first two (one representing the aqueous and the other the vitreous) inflated to 15 pounds, then there would seem to be 30 pounds of air that had entered the large balloon (representing the eyeball). Then, if the rear balloon (vitreous) is inflated an additional 15 pounds, there would be 45 pounds of pressure contained within the large balloon (eyeball). Now, you’ve got a better grasp on pneumodynamics than I, so you may see this differently. But, adding another complication, I should point out that in the case of the eye we’re dealing with fluid dynamics. In common language, the more stuff you push into something, the tighter it gets!
Response:
In article <20030430142738.25728.00000…@mb-m21.aol.com>, – Hide quoted text — Show quoted text - halt…@aol.com (Halterb) wrote: > Dr. Cohn wrote, in part: > >…using drops helped the LTG patients as well. Therefore we assume that > >by reducing the pressure further on an already damaged nerve is > >probably beneficial, even if the starting IOP isn’t very high.< > That gets to a message I posted a while ago regarding vitreous pressure (the > pressure in the rear compartment of the eyeball). I never was able to find > much > on the subject even after a lot of looking, but I can’t help but wonder if > those whose IOP (aqueous IOP in the front compartment) appears not to be very > high, might in fact have high pressure in the rear compartment, where the > optic > nerve enters into the eyeball. I did find some comments about people having > as > much as double the normal pressure in the rear compartment. It would seem > that > if pressure damaged the optic nerve, then the pressure could be either in the > front or rear areas. I’m not aware of any method to check the rear area in a > living being. > As an example, if the pressure in the front of the eye is 15 and the rear of > the eye 15, then the total pressure would be 30 (perhaps that’s the normal > pressure on the optic nerve in a healthy individual). However, if the front > pressure is 15 and the rear pressure rises to 30, then the total pressure is > 45. As another way of looking at it, a rise of 15 points in the rear area > would > then be equivalent to a pressure of 30 in the front, perhaps enough to cause > damage. > I’d be interested in reactions to this.
* I don’t think it works that way. The pressures are not additive. I have never heard that the pressure in one part of the eye is different from the pressure in another part. If there is any flow possible between the compartments, a differental pressure would cause flow and equalize the pressures. Think of two balloons. If I inflate them to different pressures and them press them together so that the pressure in one is 30 and the pressure in the other is 15, there is no place where a pressure of 45 would be measured. earle * I am an engineer and not a health care professional.
Response:
Eddchen, As a fellow glaucoma patient, I look forward to learning your doctor’s answer to this question. As I understand it, the only affirmative treatments for glaucoma available at the moment are various pressure-lowering medications, along with several types of surgical interventions, all also designed to lower IOP and thereby take pressure off our optic nerves. Most patients would be thrilled to have pressures of 14, but I have heard some say their doctors try to keep theirs around 10 to prevent further deterioration of the nerves. I know a lot of research is ongoing. How great it would be if scientists discovered a medication that could cause regeneration of "lost" areas of the retina or other damaged parts of the nerve — I guess that’s what we’re all hoping for. Meantime, the best we can do is find the best doctors and follow their recommendations, and hope — and pray — for the best. Best of luck to you. Don Singleton – Hide quoted text — Show quoted text -Eddchen wrote: > My IOP is and has been around 14 in both eyes for a long time. I had cataracts > removed sucessfully with implants in both eyes. I consider my vision to be very > good, no nightdriving problems any more, and I can read without glasses in > decent light. > My doctor has been watching optic nerve condition in one eye for about 2 years, > and I had my first field test a few weeks ago. It showed 2 blind spots in the > eye suspected with nerve damage. My doctor suggested another exam in September > to check IOP. If it increases, he will put me on drops. > My question is that if nerve damage can occur without elevated IOP pressure and > drops are intended to reduce IOP, what would treatment consist of if pressure > does not increase but the nerve damage increases, as evidenced by visual > examination and more field tests ? > I will discuss this in more detail with my doctor in September but would > appreciate heads-up info before then. > Thank you, Eddchen
Response:
I keep a box of cleanex close by my meds as it seems more sanitary to press the cleanex over the tear duct
Response:
Hi, I am 53 and have been diagnosed with the above. My doctor asked if I was allergic to sulphur as he put me on something called Xalatan!! for the rest of my life. When I drop it in my eye I can taste it my wife does not believe me. Tell me I am not going doooolally Bryan
Response:
"Bryan Llewellyn" <b.llewel…@tiscali.co.uk> wrote in message
news:4092d477_2@mk-nntp-2.news.uk.tiscali.com… > Hi, > I am 53 and have been diagnosed with the above. My doctor asked if I was > allergic to sulphur as he put me on something called Xalatan!! for the rest > of my life. When I drop it in my eye I can taste it my wife does not believe > me. Tell me I am not going doooolally > Bryan
It’s probably running into your tear ducts and then your sinuses and down to where you can taste it. You might want to talk to the Doc or someone in this group about the technique of applying the drops. When I was using drops I held my tear ducts (at the junction of nose and eyes) closed for about a minute after inserting the drops. You get more meds to the eye and less wasted runoff that way.
Response:
I don’t think I have tasted the xalatan –however I did wake up with an awfull taste of sulfer in myy mouth once and I blamed it on the chemical plant down the road ???? I really would like to know what Number is a NOrmal IOP ?
~~~~~~~~~~~~~~~~later trish ~
Response:
- Hide quoted text — Show quoted text -Rick Cohn, M.D. wrote: >>Dr. Cohn, >>What is your opinion of punctal occlusion? >>(I use punctal occlusion for 3 minutes and then immediately "wick" the eye >>with Kleenex. I have done the gamut of eye drops without any systemic >>symptoms. But with plenty of eye lid irritation.) >>Thanks, >>John > I’m honestly not a big fan of it because you can teach a patient where > to pinch or press, but he/she may eventually be doing it in the wrong > place and get no effect. Also, one’s hands may be dirty and increase > the risk of eye infections. How can you mess up simply closing your > eyes, which decreases the pumping action of blinking, which pumps > tears (and meds) down into the nose? > –Dr. Cohn
So, you believe that closing the eyes has as good an effect, or at least without the risks that you noted, as the punctal occlusion? That wouldbe a relief, as I find myself doing shorter occlusions… Thanks, — A contented malcontent. http://www.equalizers.org
Response:
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