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Eyedrops don't work well

Question:

- Hide quoted text — Show quoted text -John <j…@nospam.net> wrote in message <news:iumfovs0plgag2prhp9toapfiod63egi7m@4ax.com>… > On Sat, 11 Oct 2003 00:15:55 GMT, stefa…@yahoo.com (Steve) wrote: > >As regarding the laser surgery I understand the new SLT is much, much better > >than the older laser. It’s more selective in what it opens up and can be > >redone many more times as opposed to just twice. > >Obviously I’m no doctor and just posting (paraphrasing) what I remember from > >this Group. > >It would be appreciated if someone with better knowledge of the SLT would post > >so we can have better information to argue with when our doctors start > >suggesting  Argon lasers. > SLT is not available in the San Diego area; suggesting that this relatively > inexpensive ($65000 per machine) treatment is not highly regarded by > ophthalmologists. > Does Dr. Cohn have a comment? > John

Sure do, John.  I think you’re wrong here on several accounts.  First of all, I am certain SLT can be found in San Diego…I know a few people who do it here in Orlando, a much smaller city.  I would inquire at U.C.S.D. with Dr. Robert Weinreb, one of the country’s more respected glaucoma specialists…I’m sure he must have one.  Second of all, most of us are quite impressed with the results of SLT studies. Most of us, though, already have argon lasers, and since SLT doesn’t work so much better than ALT, why buy a brand new machine?  The argon laser has the additional benefit of being useful to treat diabetic retinopathy and to cut sutures after a trabeculectomy, neither of which can be done with the SLT. Lastly, most of us do not consider $65,000 to be "relatively inexpensive."  That is over three times what I spent for my argon laser 3 years ago, which I haven’t even come close to paying off. Keep in mind that an insurance company may pay $400 for a laser procedure in the office…at that rate, one would have to do over 160 procedures to pay off the machine.  I have a busy glaucoma practice but couldn’t see doing more than one of these every week or two.  At that rate the machine wouldn’t be paid for for several years.  It would only be worth such a purchase if the technology were leaps and bounds above other types of glaucoma treatments or were significantly safer for the patient. -Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

stefa…@yahoo.com (Steve) wrote in message <news:3f874b6a_1@news3.prserv.net>… > As regarding the laser surgery I understand the new SLT is much, much better > than the older laser. It’s more selective in what it opens up and can be > redone many more times as opposed to just twice. > Obviously I’m no doctor and just posting (paraphrasing) what I remember from > this Group. > It would be appreciated if someone with better knowledge of the SLT would post > so we can have better information to argue with when our doctors start > suggesting  Argon lasers. > Thanks, > Steven

Studies in the British Journal of Ophthalmology and Archives of Ophthalmology show that SLT is as effective as SLT, but not "much, much better."  Both were equally effective at lowering IOP.  The advantages of SLT is that the burn in the trabecular meshwork is more selective for the pigment-containing cells, thus it causes less damage to the trabecular meshwork as a whole.  It can be performed safely multiple times, and has been shown to be more effective as a second treatment after ALT (argon laser) as compared with adding additional argon treatments.  Nevertheless, as with multiple argon treatments, you lose some of the original brisk IOP lowering response with each successive treatment.  Therefore, most docs would not treat more than 2 -3 times.  Hope that helps. Rick Cohn, MD. Glaucoma Specialist Winter Park, FL

Response:

Laser has worked very well for me, although the results have not been as long-lasting as I had hoped.  I had two rounds in both eyes; each time the pressures were lowered to the 11-12 range, and each time the pressures rose again to the 18-20 range over the course of two or three years.  Currently, Xalatan and Cosopt have been keeping them in the 11-13 range.    Good luck to you. – Hide quoted text — Show quoted text -Roger wrote: > Hello there, > I’m 59 now and I got my first eyedrops more than 3 years ago, when my IOP > was measured between 24 en 27. I started with Timoptol (timolol), but it > didn’t get the pressure much lower. Afterwards I tried different other > drops, like Alphagan, Xalatan, Cosopt and I must have forgotten one or two. > Only Cosopt could bring the pressure down to 20-21. Although my > ophthalmologist considered this still a bit high, she eventually was > satisfied with the result, and I could keep it at this level for a couple of > years. My visual field is still relatively good: the test I did this year > was even better than last year’s. > But in August, my IOP had risen again to 23. So I was put on other drops > again, this time Xalacom (Xalatan + timolol). But a month later, my IOP was > 24. As a last resort, I am now on Lumigan. I found on the Internet some > studies which show  that Lumigan gives lower IOP’s than Xalatan en can even > work with people who don’t respond to other drops. But of course, my hopes > are not very high, and I suspect that on Monday, when the pressure is > measured again, my ophthalmologist will direct me to the laser. > My questions: are there others out there who respond so badly to eyedrops? > Are there still other and better drops (or combinations) possible? On the > other hand, how good are the results of  laser surgery? Does it always bring > the pressure down, and how long lasting are the results? > Thanks for all possible help, > Roger (from Belgium)

Response:

On Sat, 11 Oct 2003 00:15:55 GMT, stefa…@yahoo.com (Steve) wrote: >As regarding the laser surgery I understand the new SLT is much, much better >than the older laser. It’s more selective in what it opens up and can be >redone many more times as opposed to just twice. >Obviously I’m no doctor and just posting (paraphrasing) what I remember from >this Group. >It would be appreciated if someone with better knowledge of the SLT would post >so we can have better information to argue with when our doctors start >suggesting  Argon lasers.

SLT is not available in the San Diego area; suggesting that this relatively inexpensive ($65000 per machine) treatment is not highly regarded by ophthalmologists. Does Dr. Cohn have a comment? John

Response:

On 14 Oct 2003 17:06:44 -0700, eyegu…@aol.com (Rick Cohn, M.D.) wrote: – Hide quoted text — Show quoted text ->John <j…@nospam.net> wrote in message <news:iumfovs0plgag2prhp9toapfiod63egi7m@4ax.com>… >> On Sat, 11 Oct 2003 00:15:55 GMT, stefa…@yahoo.com (Steve) wrote: >> >As regarding the laser surgery I understand the new SLT is much, much better >> >than the older laser. It’s more selective in what it opens up and can be >> >redone many more times as opposed to just twice. >> >Obviously I’m no doctor and just posting (paraphrasing) what I remember from >> >this Group. >> >It would be appreciated if someone with better knowledge of the SLT would post >> >so we can have better information to argue with when our doctors start >> >suggesting  Argon lasers. >> SLT is not available in the San Diego area; suggesting that this relatively >> inexpensive ($65000 per machine) treatment is not highly regarded by >> ophthalmologists. >> Does Dr. Cohn have a comment? >> John >Sure do, John.  I think you’re wrong here on several accounts.  First >of all, I am certain SLT can be found in San Diego…I know a few >people who do it here in Orlando, a much smaller city.  I would >inquire at U.C.S.D. with Dr. Robert Weinreb, one of the country’s more >respected glaucoma specialists…I’m sure he must have one.  Second of >all, most of us are quite impressed with the results of SLT studies. >Most of us, though, already have argon lasers, and since SLT doesn’t >work so much better than ALT, why buy a brand new machine?  The argon >laser has the additional benefit of being useful to treat diabetic >retinopathy and to cut sutures after a trabeculectomy, neither of >which can be done with the SLT. >Lastly, most of us do not consider $65,000 to be "relatively >inexpensive."  That is over three times what I spent for my argon >laser 3 years ago, which I haven’t even come close to paying off. >Keep in mind that an insurance company may pay $400 for a laser >procedure in the office…at that rate, one would have to do over 160 >procedures to pay off the machine.  I have a busy glaucoma practice >but couldn’t see doing more than one of these every week or two.  At >that rate the machine wouldn’t be paid for for several years.  It >would only be worth such a purchase if the technology were leaps and >bounds above other types of glaucoma treatments or were significantly >safer for the patient. >-Rick Cohn, MD >Glaucoma Specialist >Winter Park, FL

—————————– Dr. Cohn, Re: SLT in San Diego Thanks for your response.  Very informative, as always. My couple-of-year-old "survey" was conducted by contacting the SLT machine salesman for southern CA.  He didn’t list Dr. Weinreb, but I recently contacted Dr. Weinreb’s office anyway.  One of Dr. Weinreb’s technicians said they did not offer SLT treatment.   There is an installation in LA. There was also an SLT installation in a distant San Diego suburb, but that physician went out of business and his SLT machine was listed for sale, on the internet. My latest information is that Kaiser Permanente has acquired an SLT machine "for evaluation." John

Response:

As regarding the laser surgery I understand the new SLT is much, much better than the older laser. It’s more selective in what it opens up and can be redone many more times as opposed to just twice. Obviously I’m no doctor and just posting (paraphrasing) what I remember from this Group. It would be appreciated if someone with better knowledge of the SLT would post so we can have better information to argue with when our doctors start suggesting  Argon lasers. Thanks, Steven

Response:

Roger wrote: >I’m 59 now and I got my first eyedrops more than 3 years ago, when my IOP >was measured between 24 en 27. I started with Timoptol (timolol), but it >didn’t get the pressure much lower. Afterwards I tried different other >drops, like Alphagan, Xalatan, Cosopt and I must have forgotten one or two.

(etc.)> Roger, there is a big assumption here–that your pressures are being accurately measured. Many specialists feel the Goldmann instrument is the most reliable of several different alternatives. In my own case, I find the Tonopens are inaccurate by 5 points. Then there is the issue of corneal thickness, which can be checked by a simple and inexpensive test–if your corneas are thicker than normal the pressure may read higher than it really is, and if thinner, your pressure may read lower than it really is. Again, in my case my corneas are a bit thicker than normal, enough to skew the readings upwards by about 2 points. You really don’t know what’s going on without knowing the instrument being used and your corneal thickness. (Not a professional response)

Response:

Hello there, I’m 59 now and I got my first eyedrops more than 3 years ago, when my IOP was measured between 24 en 27. I started with Timoptol (timolol), but it didn’t get the pressure much lower. Afterwards I tried different other drops, like Alphagan, Xalatan, Cosopt and I must have forgotten one or two. Only Cosopt could bring the pressure down to 20-21. Although my ophthalmologist considered this still a bit high, she eventually was satisfied with the result, and I could keep it at this level for a couple of years. My visual field is still relatively good: the test I did this year was even better than last year’s. But in August, my IOP had risen again to 23. So I was put on other drops again, this time Xalacom (Xalatan + timolol). But a month later, my IOP was 24. As a last resort, I am now on Lumigan. I found on the Internet some studies which show  that Lumigan gives lower IOP’s than Xalatan en can even work with people who don’t respond to other drops. But of course, my hopes are not very high, and I suspect that on Monday, when the pressure is measured again, my ophthalmologist will direct me to the laser. My questions: are there others out there who respond so badly to eyedrops? Are there still other and better drops (or combinations) possible? On the other hand, how good are the results of  laser surgery? Does it always bring the pressure down, and how long lasting are the results? Thanks for all possible help, Roger (from Belgium)

Response:

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