Glaucoma Disease

Seeking Treatment/Evaluation Advice for Advanced Glaucoma

Question:

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

Response:

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

Response:

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:

Filed under: Glaucoma Drops

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