Glaucoma Disease » Ocular Glaucoma

Longer Age Term from OH to Glaucoma?

admin — Fri, 18 Mar 2005 00:00:00 +0000

Question:

I’m curious….let’s say there was a person who was diagnosed with ocular hypertension at age 21 years old, and another person who is also diagnosed with the same condition at age 40. Would the 21 year old have a bigger chance of getting glaucoma than the 40 year old because of the "longer age term" or a longer age period in ocular hypertension?

Response:

NRushing1…@gmail.com wrote: > I’m curious….let’s say there was a person who was diagnosed with > ocular hypertension at age 21 years old, and another person who is also > diagnosed with the same condition at age 40. > Would the 21 year old have a bigger chance of getting glaucoma than > the 40 year old because of the "longer age term" or a longer age period > in ocular hypertension?

I believe the Ocular Hypertension study showed that ocular hypertensives convert to glaucoma at the rate of about two percent per year. So if that’s all you looked at, then over an average lifespan the 21 year old would be more likely to live long enough to get glaucoma. But there are lots of other factors–for example, the higher the eye pressure, the higher the risk, and thickness of the cornea plays a part too. Also, from what I’ve read, there is some natural thinning of the optic nerve fiber caused by aging, so it might happen that the 40 year old’s optic nerve becomes less resistant to pressure over time. Another thing is that eye pressures often tend to rise as people age anyway. I’m not a doctor, this is just gathered from various sources I’ve read. But my guess is that there are too many factors that influence the development of glaucoma (some people with higher than what is considered normal eye pressures will never have any damage, and of course normal tension glaucoma patients have damage even though they are not considered to have ocular hypertension) that it would be hard to predict. One thing, however, I think is that the 21 year old can pretty much count on better treatments and probably a cure for glaucoma in his lifetime, although possibly the same is true of someone currently age 40. I hope so. -Gudrun

Response:

Home tonometers

admin — Tue, 28 Oct 2003 00:00:00 +0000

Question:

"Tony W." wrote in message

news:3F9E1A58.B56BAA35@hotmail.com… > How can I get a home tonometer? > Go to > How much do they cost? > My recollection is that it cost about $70-$80. > How reliable are they? > How can I find out more information about them?

See http://www.bausch.com.br/br/resource/pharma/proview.jsp

Response:

How can I get a home tonometer? How much do they cost? How reliable are they? How can I find out more information about them?

Response:

- Hide quoted text — Show quoted text -Earle Jones wrote: > In article <3F9E1A58.B56BA…@hotmail.com>, > "Tony W." wrote: > > How can I get a home tonometer? > > How much do they cost? > > How reliable are they? > > How can I find out more information about them? > * > The only home tonometer I know of is one that is made in Germany — I > don’t know much about it — we discussed it here on this newsgroup a > couple of years ago. > There is a fundamental problem in home tonometry — the topical > anesthetic that must be used before the measurement. > The only really accurate tonometers touch the surface of the cornea — > they work by measuring the force required to flatten a given area. > The IOP (intra-ocular pressure) can be inferred from this force. > The doctor gives you a small bit of anesthetic — an eye drop — then > applies the tonometer tip to the eye. > In order to do this at home, it would be necessary to use a similar > anesthetic. I don’t think any responsible ophthalmologist would allow > a patient to do this. The danger is that, when the eye is > anesthesized, the patient would not feel a small corneal scratch or > any other corneal problem. This could be lead to big problems — > infection, etc.

Thanks for the replies. The tonometer I was looking for is the Bausch and Lomb one (http://www.bausch.com.br/br/resource/pharma/proview.jsp), which Sherwin provided the link to in his response. That tonometer — the Proview Eye Pressure Monitor — doesn’t require an anesthetic. Has anyone here tried that one? Tony – Hide quoted text — Show quoted text -> There are two types of tonometers that do not touch the cornea > directly — the "air-puff" and the scleral tonometers. The air-puff > tonometer (made by American Optical (I think)) uses a small calibrated > puff of air on the corneal surface and measures the flattened area. > This approach requires a physically large (and expensive) machine — > not practical for home use. The scleral tonometers measure the force > required to flatten a given area of the sclera — the hard white part > of the eye. These are not nearly as accurate as corneal applanation > tonometers. > And so, for the time being, I suspect that we will not see a > successful home tonometer in use here in the US. > earle > * > I am an engineer and not a health-care professional.

Response:

- Hide quoted text — Show quoted text -"Tony W." wrote in message … > Earle Jones wrote: > > In article <3F9E1A58.B56BA…@hotmail.com>, > > "Tony W." wrote: > > > How can I get a home tonometer? > > > How much do they cost? > > > How reliable are they? > > > How can I find out more information about them? > > * > > The only home tonometer I know of is one that is made in Germany — I > > don’t know much about it — we discussed it here on this newsgroup a > > couple of years ago. > > There is a fundamental problem in home tonometry — the topical > > anesthetic that must be used before the measurement. > > The only really accurate tonometers touch the surface of the cornea — > > they work by measuring the force required to flatten a given area. > > The IOP (intra-ocular pressure) can be inferred from this force. > > The doctor gives you a small bit of anesthetic — an eye drop — then > > applies the tonometer tip to the eye. > > In order to do this at home, it would be necessary to use a similar > > anesthetic. I don’t think any responsible ophthalmologist would allow > > a patient to do this. The danger is that, when the eye is > > anesthesized, the patient would not feel a small corneal scratch or > > any other corneal problem. This could be lead to big problems — > > infection, etc. > Thanks for the replies. > The tonometer I was looking for is the Bausch and Lomb one > (http://www.bausch.com.br/br/resource/pharma/proview.jsp), which Sherwin > provided the link to in his response. > That tonometer — the Proview Eye Pressure Monitor — doesn’t require an anesthetic. > Has anyone here tried that one? > Tony > > There are two types of tonometers that do not touch the cornea > > directly — the "air-puff" and the scleral tonometers. The air-puff > > tonometer (made by American Optical (I think)) uses a small calibrated > > puff of air on the corneal surface and measures the flattened area. > > This approach requires a physically large (and expensive) machine — > > not practical for home use. The scleral tonometers measure the force > > required to flatten a given area of the sclera — the hard white part > > of the eye. These are not nearly as accurate as corneal applanation > > tonometers. > > And so, for the time being, I suspect that we will not see a > > successful home tonometer in use here in the US. > > earle > > * > > I am an engineer and not a health-care professional.

I examined the Proview by B & L myself in the office. This is a small cylindrical device with a spring and plunger inside and a tiny gauge on the side to read the IOP. You are supposed to press this on the upper outer corner of the closed eyelid until the image of a ring is seen by the patient (as you would see if you closed your eye and pushed on your eyelid with your finger). I found this device to be difficult in producing a well-visualized and constant endpoint for the patient. If it is not terribly accurate, what is the point? The company was hoping to sell it to the ophthalmologist for $75 each and allowing us to offer it for $150 to patients. From what I can see, these devices have not achieved any widespread support or use in the ophthalmic community. Save your money. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

In article <3F9E1A58.B56BA…@hotmail.com>, "Tony W." wrote: > How can I get a home tonometer? > How much do they cost? > How reliable are they? > How can I find out more information about them?

* The only home tonometer I know of is one that is made in Germany — I don’t know much about it — we discussed it here on this newsgroup a couple of years ago. There is a fundamental problem in home tonometry — the topical anesthetic that must be used before the measurement. The only really accurate tonometers touch the surface of the cornea — they work by measuring the force required to flatten a given area. The IOP (intra-ocular pressure) can be inferred from this force. The doctor gives you a small bit of anesthetic — an eye drop — then applies the tonometer tip to the eye. In order to do this at home, it would be necessary to use a similar anesthetic. I don’t think any responsible ophthalmologist would allow a patient to do this. The danger is that, when the eye is anesthesized, the patient would not feel a small corneal scratch or any other corneal problem. This could be lead to big problems — infection, etc. There are two types of tonometers that do not touch the cornea directly — the "air-puff" and the scleral tonometers. The air-puff tonometer (made by American Optical (I think)) uses a small calibrated puff of air on the corneal surface and measures the flattened area. This approach requires a physically large (and expensive) machine — not practical for home use. The scleral tonometers measure the force required to flatten a given area of the sclera — the hard white part of the eye. These are not nearly as accurate as corneal applanation tonometers. And so, for the time being, I suspect that we will not see a successful home tonometer in use here in the US. earle * I am an engineer and not a health-care professional.

Response:

Tony, A Google search on "home tonometer" just now produced over 5,000 results. Help yourself. This question has come up many times over the years, and my recollection of the responses is that the devices available are a) very expensive, and b) impractical, imprecise and not worth much. But, never having tried one, I can’t give you any direct testimony on them. Good luck to you. Don Singleton – Hide quoted text — Show quoted text -"Tony W." wrote: > How can I get a home tonometer? > How much do they cost? > How reliable are they? > How can I find out more information about them?

Response:

Invitation to 'test our test' for finding hidden blindspots in your field of vision

admin — Mon, 22 Sep 2003 00:00:00 +0000

Question:

Another problem I see right off the bat….the test instructions are very difficult to read due to background colour and poor definition of print…as a person with a very restricted visual field, problems with glare and poor acuity, I find white on black and black on white the best with at least a 12 point font. I know you can increase font size on web sites, but that sometimes alters presentation of the functional part of the website. Anyway, I did not enjoy the colour schemes…a small but difficult area for a lot of us to cope with. Bill

Response:

May I respectfully reply to those who disagree with self-testing of the visual field on the internet. First of all, our test measures the visual field to 24 degrees and not just 5 degrees, and this is possible because we use multiple fixation points. Second, our test is not designed to replace any conventional examinations and not intended as a means to avoid seeing a qualified practitioner. The purpose of our test is to bring visual field defects to attention so that proper care from a qualified practitioner can be obtained at an early stage. Third, the aim of our test is to detect moderate and advanced visual field defects indicating disease requiring the most urgent treatment. Fourth, self-testing of the visual field under medical supervision as an adjunct to clinic examinations has long been considered useful practice in selected patients, using the Amsler grid, for example in patients with macular degeneration. There is no reason why our test should not be used in the same way, if our research confirms its validity. We are still investigating our test to find out how well it works and are certainly not suggesting that it should replace other methods. If anyone wishes to try our test, do a search in Google for ‘Damato Visual Field Test’. Our test is free and we are non-commercial. Bertil Damato With regards to fears about failing, better to try and fail than not to try at all, as they say.

Response:

- Hide quoted text — Show quoted text -jimlaw…@tabbytail.freeserve.co.uk (Jim Lawton) wrote in message … > On Fri, 26 Sep 2003 04:05:55 GMT, Earle Jones wrote: > >In article , > > kpatt…@hotmail.com (lasik advocate with flap melt) wrote: > >> The links didn’t work on this. Is it working yet? > >> Earle Jones wrote in message > >> … > >> > In article <2317138e.0309220952.528f1…@posting.google.com>, > >> > ber…@damato.co.uk (Bertil Damato) wrote: > >> > > http://www.testvision.org/ > >> > * > >> > As of 3:53 PM PDT on 9-22-03, the above link works up to the "Basic – > >> > Standard – Advanced" screen and then hangs up. > >> > earle > >> > * > >* > >The link is still broken at 9:04 PM PDT on 9-25-03. > The basic test worked for right eye, but didn’t let me proceed to left eye. > the advanced intermediate test worked ok. Not tried advanced yet … > J > >earle > >*Sorry to learn that the basic test does not let you proceed from the right eye to the left eye. This should be fixed this weekend. Please continue to let us know of any problems so that we can correct them. It is surprisingly difficult for us developers to detect our own errors. Your feedback is therefore very helpful.

Bertil Damato

Response:

In article <2317138e.0309220952.528f1…@posting.google.com>, ber…@damato.co.uk (Bertil Damato) wrote: > http://www.testvision.org/

* As of 3:53 PM PDT on 9-22-03, the above link works up to the "Basic – Standard – Advanced" screen and then hangs up. earle *

Response:

Well Donald I decided to abstain -since i fear failing the darn thing — ; )

~~~~~~~~~~~~~~~~later trish ~

Response:

For what it’s worth, I agree totally with Dr. Cohen. I looked at the web site, and I suppose it could be helpful to some people. But what came to my mind was the old proverb, "Man who acts as his own lawyer has a fool for a client." Insert "opthalmologist" for "lawyer" and "patient" for "client." (And add "or woman" to include the other half of the human race! :-) – Hide quoted text — Show quoted text -Bertil Damato wrote: > Mr Carl Groenewald and I are consultant eye surgeons in England. In > our spare time, we have developed a visual field test for the > internet, which allows anyone to perform self-examination, using a > personal computer and at their own convenience, free of charge. > Our test may enable people to become aware of visual loss and perhaps > to check whether they are improving or getting worse. Some might > become detect new defects so that they can obtain medical advice or > take special precautions, for example if they drive a car. > Conditions causing visual field loss include glaucoma, retinal > detachment, macular degeneration, pituitary tumours, other brain > tumours, strokes, Sturge Weber syndrome, von Hippel Lindau disease, > and many others. Not all visual field defects indicate serious disease > and false positive and negative results can occur (with any test). > I would be grateful if anyone could participate in our research > project and help us evaluate our test. We urgently need persons with > visual field defects to visit our website and send us feedback so that > we can make improvements. Hopefully the test will be found > interesting, a little like a computer game. It is quite different from > conventional tests so please read the instructions, see the demo and > do a rehearsal before trying the test. If you could perform the > sensitive version of the test, this would be ideal. > Our website is at http://www.testvision.org/ > Please remember to e-mail us the results with your email address if we > may reply to you (but note that we are only able to comment on your > result and not on any ocular or medical problem you might have). > It would be helpful if you let us know what you like or don’t like > about our test. > Yours faithfully, > (Professor) Bertil Damato PhD FRCOphth > St Paul’s Eye Unit > Royal Liverpool University Hospital > Prescot St > Liverpool L7 8XP > Tel: +44 (0)151 706 3973 > Fax: +44 (0) 151 706 5436 > E-mail: Ber…@damato.co.uk

Response:

Bertil Damato wrote: > May I respectfully reply to those who disagree with self-testing of > the visual field on the internet. > … > We are still investigating our test to find out how well it works and > are certainly not suggesting that it should replace other methods.

I found the test instructions confusing: look at the blue dot and put the red one in the normal blind spot — I have not a clue what that means. There also seems to be a test consistency problem vis a vis use of the mouse. Assuming the mouse stays where it is, placing the opposite hand over an eye will likely garner different results than using a foreign object (tissue, cloth) to cover an eye, but then getting that object to stay in place is not so easy without taping. Gene Goldenfeld

Response:

The links didn’t work on this. Is it working yet? – Hide quoted text — Show quoted text -Earle Jones wrote in message … > In article <2317138e.0309220952.528f1…@posting.google.com>, > ber…@damato.co.uk (Bertil Damato) wrote: > > http://www.testvision.org/ > * > As of 3:53 PM PDT on 9-22-03, the above link works up to the "Basic – > Standard – Advanced" screen and then hangs up. > earle > *

Response:

The advanced test does not work properly the smiley appears…..I click on it….a black circle appears…..and then is replaced by a smiley….*before* i click on it.

Response:

Dear group: what causes hemorrhages on the optic nerve? Leigh

Response:

- Hide quoted text — Show quoted text -On Fri, 26 Sep 2003 04:05:55 GMT, Earle Jones wrote: >In article , > kpatt…@hotmail.com (lasik advocate with flap melt) wrote: >> The links didn’t work on this. Is it working yet? >> Earle Jones wrote in message >> … >> > In article <2317138e.0309220952.528f1…@posting.google.com>, >> > ber…@damato.co.uk (Bertil Damato) wrote: >> > > http://www.testvision.org/ >> > * >> > As of 3:53 PM PDT on 9-22-03, the above link works up to the "Basic – >> > Standard – Advanced" screen and then hangs up. >> > earle >> > * >* >The link is still broken at 9:04 PM PDT on 9-25-03.

The basic test worked for right eye, but didn’t let me proceed to left eye. the advanced intermediate test worked ok. Not tried advanced yet … J – Hide quoted text — Show quoted text ->earle >*

Response:

Thanks for replyng DR. Cohn .

~~~~~~~~~~~~~~~~later trish ~

Response:

"Rick Cohn, M.D." wrote: > Isolated disc hemorrhages are most commonly seen in low tension > glaucoma or primary open angle glaucoma. Those associated with nearby > bleeding, or bleeding elsewhere in the retina are common in diabetics > with active retinopathy or in those with a retinal vein occlusion.

Do hemorrhages on the optic disc result in more damage of the optic nerve? Gudny I.

Response:

In article <54e8377c.0309280723.5a134…@posting.google.com>, eyegu…@aol.com (Rick Cohn, M.D.) wrote: – Hide quoted text — Show quoted text -> TNARTL…@webtv.net (( TN Artist, trish,tn )) wrote in message > … > > What is this about ? Did you check this out ? Is is legit ? > Here’s my take on these "Check your visual field at home on your PC" > type of tests (this is not a new thing…there have been others). > First of all, a Humphrey field analyzer has a screen that more or less > wraps around you to test a much larger angle of your field. The 30-2, > the most commonly used field testing program, tests the central 30 > degrees of your field. As most people are 16 to 20 inches away from > their monitors, the monitor takes up a much smaller area of your > retina, maybe the central 5 – 10 degrees. This will vary, of course, > depending on the size of one’s monitor and the distance from the > screen. In glaucoma, by the time your field loss is significant enough > to encroach on the central 5 degrees, you have already lost a very > large area of vision and probably have greater than 85-95% optic nerve > damage. > While there is some basic usefulness in these types of tests, it > ONLY resides in there ability to get some people thinking and talking > about glaucoma. It may raise concern just enough in a few to get an > eye exam where they otherwise might not. It is very important to keep > in mind that even the most sensitive field tests (e.g. the SWAP > blue-on-yellow test, which detects glaucoma earlier than the standard > field test) do not detect any field loss till the optic nerve > essentially has a 0.6 cup or greater. In other words, some optic > nerve damage has clearly already occured before field loss shows up. > Mostly, this online field test is a fun little exercise to be tried at > home, but it should NEVER take the place of routine follow-up and > annual field tests in your ophthalmologist’s office. I can’t stress > that enough. Hope that helps. > Sincerely, > Rick Cohn, MD > Glaucoma Specialist > Winter Park, FL

I’ve taken the liberty of reposting this to the Yahoo.com glaucoma mailing list.

Response:

> >Yes, in fact with time the hemorrhage will resolve, often leading to a > >focal "notch" in the rim of the optic nerve…this usually corresponds > >to a defect near the center of vision on the visual field test. > >Again, this is most commonly seen in low-tension glaucoma. > >–Rick Cohn, MD > What should one do if one of these hemorrhages occurs?

Usually this is an indication that one’s intraocular pressure is not sufficiently controlled. Usually the ophthalmologist will work towards lowering the IOP somewhat more with a change in medications or adding and additional eyedrop. –Dr. Cohn

Response:

On 15 Oct 2003 19:29:29 -0700, eyegu…@aol.com (Rick Cohn, M.D.) wrote: – Hide quoted text — Show quoted text ->"Isachsen" wrote in message … >> "Rick Cohn, M.D." wrote: >> > Isolated disc hemorrhages are most commonly seen in low tension >> > glaucoma or primary open angle glaucoma. Those associated with nearby >> > bleeding, or bleeding elsewhere in the retina are common in diabetics >> > with active retinopathy or in those with a retinal vein occlusion. >> Do hemorrhages on the optic disc result in more damage of the >> optic nerve? >> Gudny I. >Yes, in fact with time the hemorrhage will resolve, often leading to a >focal "notch" in the rim of the optic nerve…this usually corresponds >to a defect near the center of vision on the visual field test. >Again, this is most commonly seen in low-tension glaucoma. >–Rick Cohn, MD

What should one do if one of these hemorrhages occurs?

Response:

In article , kpatt…@hotmail.com (lasik advocate with flap melt) wrote: > The links didn’t work on this. Is it working yet? > Earle Jones wrote in message > … > > In article <2317138e.0309220952.528f1…@posting.google.com>, > > ber…@damato.co.uk (Bertil Damato) wrote: > > > http://www.testvision.org/ > > * > > As of 3:53 PM PDT on 9-22-03, the above link works up to the "Basic – > > Standard – Advanced" screen and then hangs up. > > earle > > *

* The link is still broken at 9:04 PM PDT on 9-25-03. earle *

Response:

"Isachsen" wrote in message … > "Rick Cohn, M.D." wrote: > > Isolated disc hemorrhages are most commonly seen in low tension > > glaucoma or primary open angle glaucoma. Those associated with nearby > > bleeding, or bleeding elsewhere in the retina are common in diabetics > > with active retinopathy or in those with a retinal vein occlusion. > Do hemorrhages on the optic disc result in more damage of the > optic nerve? > Gudny I.

Yes, in fact with time the hemorrhage will resolve, often leading to a focal "notch" in the rim of the optic nerve…this usually corresponds to a defect near the center of vision on the visual field test. Again, this is most commonly seen in low-tension glaucoma. –Rick Cohn, MD

Response:

Mr Carl Groenewald and I are consultant eye surgeons in England. In our spare time, we have developed a visual field test for the internet, which allows anyone to perform self-examination, using a personal computer and at their own convenience, free of charge. Our test may enable people to become aware of visual loss and perhaps to check whether they are improving or getting worse. Some might become detect new defects so that they can obtain medical advice or take special precautions, for example if they drive a car. Conditions causing visual field loss include glaucoma, retinal detachment, macular degeneration, pituitary tumours, other brain tumours, strokes, Sturge Weber syndrome, von Hippel Lindau disease, and many others. Not all visual field defects indicate serious disease and false positive and negative results can occur (with any test). I would be grateful if anyone could participate in our research project and help us evaluate our test. We urgently need persons with visual field defects to visit our website and send us feedback so that we can make improvements. Hopefully the test will be found interesting, a little like a computer game. It is quite different from conventional tests so please read the instructions, see the demo and do a rehearsal before trying the test. If you could perform the sensitive version of the test, this would be ideal. Our website is at http://www.testvision.org/ Please remember to e-mail us the results with your email address if we may reply to you (but note that we are only able to comment on your result and not on any ocular or medical problem you might have). It would be helpful if you let us know what you like or don’t like about our test. Yours faithfully, (Professor) Bertil Damato PhD FRCOphth St Paul’s Eye Unit Royal Liverpool University Hospital Prescot St Liverpool L7 8XP Tel: +44 (0)151 706 3973 Fax: +44 (0) 151 706 5436 E-mail: Ber…@damato.co.uk

Response:

joell…@aol.com (JoellynR) wrote in message … > Dear group: what causes hemorrhages on the optic nerve? Leigh

Isolated disc hemorrhages are most commonly seen in low tension glaucoma or primary open angle glaucoma. Those associated with nearby bleeding, or bleeding elsewhere in the retina are common in diabetics with active retinopathy or in those with a retinal vein occlusion. -Rick Cohn, MD Glaucoma specialist Winter Park, FL

Response:

What is this about ? Did you check this out ? Is is legit ?

~~~~~~~~~~~~~~~~later trish ~

Response:

nutritional suppliments

admin — Wed, 08 Jan 2003 00:00:00 +0000

Question:

I heard that yesterday too…was wondering the same thing! — Helen ————————————— http://home.attbi.com/~hkolln66 "mark robey" wrote in message

news:7P5T9.1841$io.83472@iad-read.news.verio.net… – Hide quoted text — Show quoted text -> Do these help?? Ocular nutrition is one popular brand that claims to have > helped people with glaucoma and macular degeneration. > Has anyone tried any of these vitamin formulas designed to improve eye > health?? The ads on the Paul Harvey show have people > saying how they greatly improved their vision just by taking " Ocular > nutrition" and they offer a 1-800 number for you to call and > order.

Response:

Do these help?? Ocular nutrition is one popular brand that claims to have helped people with glaucoma and macular degeneration. Has anyone tried any of these vitamin formulas designed to improve eye health?? The ads on the Paul Harvey show have people saying how they greatly improved their vision just by taking " Ocular nutrition" and they offer a 1-800 number for you to call and order.

Response:

Thanks , Ann , this is a keeper !

~~~~~~~~~~~~~~~~later trish ~

Response:

Let me know if you ever see or hear an ad where the advertiser says his product DOESN’T work. I would be highly skeptical of any such claim. Let doctors provide health care and ignore all the crap you see, hear, and read on TV, radio, and newspapers. – Hide quoted text — Show quoted text ->The ads on the Paul Harvey show have people >saying how they greatly improved their vision just by taking " Ocular >nutrition"

Response:

I suspect it’s hard to really know if and how much they help without controlled experiments that test all the substances both alone and in combination. That said, I believe that certain supplements do benefit different parts of the body; after all, we are what we eat, aren’t we? (I prefer to go the natural route whenever I can, and it has served me surprisingly well in the past with none ofthe side-effect & toxicity problems of pharmaceuticals). Someone gave me the following website to read more about Glaucoma and natural treatments; I found it very informative and wrote down the supplements they recommend to discuss with my GS at my appointment next week.. http://www.lef.org/protocols/prtcl-053.shtml On Thu, 09 Jan 2003 12:20:17 GMT, "Helen Kolln" wrote: >I heard that yesterday too…was wondering the same thing!

Cheers, Ann

Response:

Hi Mark: Except for Lutein, I’m confused at to which nutrients these vitamin formulas agree on. Here’s a comparison chart: http://eyecare.freeyellow.com/compare.html Some time ago, I asked Dr. Robert Ritch about Lipoic acid which I understood then to be a primary ingredient. He answered, "it might be of some benefit. No proof yet." All the formulas I’ve come across have a wide range of ingredients including many one would get in a standard multivitamin. Makes me suspicious. Regards, Ray Bonar – Hide quoted text — Show quoted text -"mark robey" wrote: >Do these help?? Ocular nutrition is one popular brand that claims to have >helped people with glaucoma and macular degeneration. >Has anyone tried any of these vitamin formulas designed to improve eye >health?? The ads on the Paul Harvey show have people >saying how they greatly improved their vision just by taking " Ocular >nutrition" and they offer a 1-800 number for you to call and >order.

Response:

Hi Mark -maybe the med that my Opthamalogis told me to buy fits this discription -It’s called I -Caps -over the counter -Has heavy duty vit A ? I cant say if it has helped for sure -do know my IOP has been stable -however I will see the DR. In Feb after an 8 MO interval between appts -I have complained that this time span between appts is too long ?

Response:

Yeas, my glauc doc has been seeing me every three months, if only for a pressure check.. TN ARTIST wrote: > Hi Mark -maybe the med that my Opthamalogis told me to buy fits this > discription -It’s called I -Caps -over the counter -Has heavy duty vit A > ? I cant say if it has helped for sure -do know my IOP has been stable > -however I will see the DR. In Feb after an 8 MO interval between appts > -I have complained that this time span between appts is too long ?

– A contented malcontent. http://www.equalizers.org

Response:

combination therapy of glaucoma

admin — Mon, 02 Apr 2001 00:00:00 +0000

Question:

Besides the risk of fatal asthmatic attack if you have an asthma history? Cardiac failure, migraines, fatigue…. It also contains a sulfonamide, so if you’re allergic to sulfa drugs, it’s a no-no. http://www.rxlist.com/cgi/generic2/dorzol_ad.htm for "side effects & drug interactions". Also check out the tab "warnings, precautions" Sherry ICanSee wrote in <3ACFFB39.B13E2…@bellatlantic.net>: – Hide quoted text — Show quoted text ->I think it important you advise the group what these severe side >effects may have been. >Roy Davidson wrote: >> I was on Xalatan monotherapy and then put on Cosopt (a combination >> CAI and Beta Blocker) along with the Xalatan. There was possibly a >> slight decrease in IOP when measured from 22 to 21 or 20 with the >> combination. However, I believe there are severe side effects with >> the Cosopt and have discontinued it for the past week or so.

Response:

Some of the side-effects of Cosopt include a bad taste in the mouth, exacerbation of respiratory problems, increased need to go to the bathroom, loss of sleep, fatigue, muscular weakness and soreness. Despite this and other possible side effects mentioned in the instruction sheet, it may be worth using if it keeps the IOP down and forestalls the possibility of further optic nerve damage.

Liberty,not the Daughter, but the Mother of Order-PROUDHON See Champions ofLiberty

Response:

I was on Xalatan monotherapy and then put on Cosopt (a combination CAI and Beta Blocker) along with the Xalatan. There was possibly a slight decrease in IOP when measured from 22 to 21 or 20 with the combination. However, I believe there are severe side effects with the Cosopt and have discontinued it for the past week or so.

Liberty,not the Daughter, but the Mother of Order-PROUDHON See Champions ofLiberty

Response:

I think it important you advise the group what these severe side effects may have been. – Hide quoted text — Show quoted text -Roy Davidson wrote: > I was on Xalatan monotherapy and then put on Cosopt (a combination CAI > and Beta Blocker) along with the Xalatan. There was possibly a slight > decrease in IOP when measured from 22 to 21 or 20 with the combination. > However, I believe there are severe side effects with the Cosopt and > have discontinued it for the past week or so. > —————————————————————- > Liberty, not the Daughter, but the Mother of Order-PROUDHON See > Champions of Liberty > [Click for Green Valley, Arizona Forecast]

Response:

Everybody good luck! Nowadays It is prescribing combination therapy of topical CAI solutions or prostglandin drugs and beta blocker solutions. Could you tell me carteolol ophtalmic solution and Xalatan combination therapy have been exprienced. I know that combination therapy data have the effect of IOP reduction than Xalatan monotherapy. I’m thinking of carteolol ophtalmic solution still effective for glaucoma and ocular hypertension patients because of no undesirable effect on the cardiovascular system and little ocular irritation.

Response:

Measuring units for Glaucoma???

admin — Sat, 06 Jan 2001 00:00:00 +0000

Question:

Hi Ian, Thank you for your answer. And yes, my ophtalmologist says it is congenital glaucoma with no doubt. I still don’t understand something and I hope that you can clarify it. The IOP in right eye is measured to be 2 units, while the IOP on left eye is equal 1 unit. And you say that this means pressures of 34mmHg on each eye. Was this your mistake? Is (34mmHg = 1Schioetz unit) or (34mmHg = 2 Schioetz units) ? Besides, for which weight is this translation valid (5.5gr or maybe 7.5gr)? My ophtalmologist says that operations have to be done to reduce the pressure. But as the kid is too small (only 9 days old), the operations must be postponed for at least one month. I am afraid that this pressure might produce some irepairable damage during this month of waiting. Is it usual to wait so long before anything is done? How high is this risk? Lav – Hide quoted text — Show quoted text -"Ian Hodgson" wrote in message news:PIY56.5$hE2.3747@news.enterprise.net… > Lav Kovacic wrote in message > news:937ga3$vr1$1@sunce.iskon.hr… > > Hi all, > > I am just looking into ophtalmologist findings of my 8 days old child. > > Unfortunately, a glaucoma was diagnosed. Does anyone understand > > the following abbreviations and numbers: > > TOD(5.5 gr): 2.0 jed TOS(5.5 gr): 1.0 jed > > ("jed" could maybe be an abbreviation of Croatian word "jedinica" which > means unit) > > I suppose that these are results of measuring of intraocular pressure, but > I don’t > > know the meaning of these units. How many units would be measured on > > healthy eyes? Can these units be translated into mmHg units? > > How alarming are these findings? > > Thanks in advance > > Lav > Hello Lav, > Some of this is guessing but it if the ophthalmologist was using a Schioetz > tonometer, > not an instrument used these days in the UK, then the pressures were about > 34mmHg in > each eye. I have an old one which is kept as a reminder of the old days!! > I assume T=pressure . > OD= ocular dexter OS= ocular sinister (latin for Right Eye and Left Eye > respectively). > Normal IntraOcular Pressure is usually given as 16mmHg (by Goldmann > Applanation Tonometer) > Schioetz used to be higher about 18 to 20mmHg (I think). Different methods > of measurement > slightly different values. > 34mmHg is high and in a child be treated with some alarm. It is possible > that your 8 day old may > have congenital glaucoma. However the only person who can say this with > confidence is your > ophthalmologist. > Hope this helps > Ian Hodgson BSc FCOptom

Response:

Lav Kovacic wrote in message

news:937ga3$vr1$1@sunce.iskon.hr… – Hide quoted text — Show quoted text -> Hi all, > I am just looking into ophtalmologist findings of my 8 days old child. > Unfortunately, a glaucoma was diagnosed. Does anyone understand > the following abbreviations and numbers: > TOD(5.5 gr): 2.0 jed TOS(5.5 gr): 1.0 jed > ("jed" could maybe be an abbreviation of Croatian word "jedinica" which means unit) > I suppose that these are results of measuring of intraocular pressure, but I don’t > know the meaning of these units. How many units would be measured on > healthy eyes? Can these units be translated into mmHg units? > How alarming are these findings? > Thanks in advance > Lav

Hello Lav, Some of this is guessing but it if the ophthalmologist was using a Schioetz tonometer, not an instrument used these days in the UK, then the pressures were about 34mmHg in each eye. I have an old one which is kept as a reminder of the old days!! I assume T=pressure . OD= ocular dexter OS= ocular sinister (latin for Right Eye and Left Eye respectively). Normal IntraOcular Pressure is usually given as 16mmHg (by Goldmann Applanation Tonometer) Schioetz used to be higher about 18 to 20mmHg (I think). Different methods of measurement slightly different values. 34mmHg is high and in a child be treated with some alarm. It is possible that your 8 day old may have congenital glaucoma. However the only person who can say this with confidence is your ophthalmologist. Hope this helps Ian Hodgson BSc FCOptom

Response:

Hi all, I am just looking into ophtalmologist findings of my 8 days old child. Unfortunately, a glaucoma was diagnosed. Does anyone understand the following abbreviations and numbers: TOD(5.5 gr): 2.0 jed TOS(5.5 gr): 1.0 jed ("jed" could maybe be an abbreviation of Croatian word "jedinica" which means unit) I suppose that these are results of measuring of intraocular pressure, but I don’t know the meaning of these units. How many units would be measured on healthy eyes? Can these units be translated into mmHg units? How alarming are these findings? Thanks in advance Lav

Response:

Vaying eye pressure

admin — Fri, 11 Jun 1999 00:00:00 +0000

Question:

Hi AnAires, What you say is wholley consistent with what the optician suggested and what the Eye Hospital doctor seemed to discard. The optician said her father has glaucoma so I imagine her attention is well focussed (pun accidental) on the possibility that a sporadic high measurement could be a precursor to glaucoma. Luckily I think hypertension is a lifetime away. Things seem fine in that department. It is the left eye that has the higher pressure. This eye has been a source of much bemusement and squirming. For an inexplicable reason this eye makes a squelching noise when I rub it, almost as it there are bubbles of air beneath the eyelid that are racing for unpressed regions. With concentration I can make the squelching sound with a circular screwing action of my hand so that it seems that I am unscrewing my eyeball. I am amazed how my friends concoct horror scenarios and lapse into the belief that it is more sinister that a chap with a squelchy eye. Still, we all have our party tricks, don’t we? Please tell me I am not the only one. CJ

– Hide quoted text — Show quoted text – Hello Read your post and you are talking about Glaucoma? I have suffered with Glaucoma for about 10 years now and I can tell you that the eye pressure varies constantly and so will your vision. If you have Hypertension, Glaucoma will also be effected by your Hypertension levels. I strongly suggest you don’t stop investigating the high eye pressure in your eyes. Do go see another eye doctor but try a specialist. If your eyes at any time have a high pressure, there is something wrong. Make an appointment with an eye specialist asap if you can. Good luck to you and stay happy and healthy.

Response:

sinister that a chap with a squelchy eye. Still, we all have our party tricks, don’t we? Please tell me I am not the only one.

Nope.. it’s just you. -MT

Response:

Chris, hate to burst your (eye-air?) bubble, but my left eye does that too–squelches, I mean, when I rub it. In fact, my party trick growing up was to get someone to put a finger near the inside corner of my eye while I held my nose and blew as hard as I could. The lucky volunteer could feel a stream of air coming out of the corner of my eye. Cool, huh. And I don’t have varying pressure or any other eye problems but a little macular degeneration (normal for my age they say) and nearsightedness, oh yeah, a minor cyst in the macula that developed after I was diagnosed. It has shrunk to near invisibility. In any case the air trick was mine long before I developed diabetes. — Nanuq of the North, T2, 6 years, glucophage, diet & (not enough) exercise Remove grzl to send email: I’m only a grizzly when my bgs are low! – Hide quoted text — Show quoted text – It is the left eye that has the higher pressure. This eye has been a source of much bemusement and squirming. For an inexplicable reason this eye makes a squelching noise when I rub it, almost as it there are bubbles of air beneath the eyelid that are racing for unpressed regions. With concentration I can make the squelching sound with a circular screwing action of my hand so that it seems that I am unscrewing my eyeball. I am amazed how my friends concoct horror scenarios and lapse into the belief that it is more sinister that a chap with a squelchy eye. Still, we all have our party tricks, don’t we? Please tell me I am not the only one.

Response:

Some people can swallow liquids just right and make them squirt out of their eye. There was a guy on TV recently squirting milk a few feet. -MT

Response:

Thanks nanuq, I feel a little more normal now.

Response:

Hi Mike, Many thanks, I shall mention that when I see the optician next. She said more frequent monitoring would be a good precaution so I am going in 3 months time.

and take his advice. Most likely he will recommend monitoring only, but a good test of your visual field would reassure you. Visual field studies usually show up glaucoma loss first, but a diagnostic laser evaluation (GDx) of your retina can reveal problems a little earlier. If either of those are normal, most doctors would reassure you and check it again in six months or a year.

Response:

In my annual eye test the optician found one eye to have a higher than average pressure reading and after dilation eyedrops the pressure increased significantly. I was referred to the casualty dept of the local eye hospital who measured the pressure a few hours later and found the levels to be normal. They suggested the opticians equipment was "sensitive". There is a flaw in that comment since the optician took several measurements and besides, the equipment was unaware of which of my eyes it was measuring and they were consistently different. Does anybody have experience of such things? Does ocular hypertension vary throughout the day as the optician suggested and why didn’t the doctor at the hospital mention this? CJ

Response:

Hello Read your post and you are talking about Glaucoma? I have suffered with Glaucoma for about 10 years now and I can tell you that the eye pressure varies constantly and so will your vision. If you have Hypertension, Glaucoma will also be effected by your Hypertension levels. I strongly suggest you don’t stop investigating the high eye pressure in your eyes. Do go see another eye doctor but try a specialist. If your eyes at any time have a high pressure, there is something wrong. Make an appointment with an eye specialist asap if you can. Good luck to you and stay happy and healthy.

Response:

– Hide quoted text — Show quoted text – In my annual eye test the optician found one eye to have a higher than average pressure reading and after dilation eyedrops the pressure increased significantly. I was referred to the casualty dept of the local eye hospital who measured the pressure a few hours later and found the levels to be normal. They suggested the opticians equipment was "sensitive". There is a flaw in that comment since the optician took several measurements and besides, the equipment was unaware of which of my eyes it was measuring and they were consistently different. Does anybody have experience of such things? Does ocular hypertension vary throughout the day as the optician suggested and why didn’t the doctor at the hospital mention this? CJ

It suggests rather that one eye is prone to "angle closure", an unusual anatomical condition where dilation may raise the pressure temporarily. Glaucoma is not high pressure. Glaucoma is damage from high pressure and there is no single definition for what pressure is "normal" for you. Glaucoma (_generally_) develops very slowly from chronic sustained high pressure, and momentary spikes aren’t usually alarming if they aren’t too high or too long. Pressures should be tested at several different times of day before starting someone like you on medicine. See an eye surgeon who has treated "Angle-closure glaucoma" and take his advice. Most likely he will recommend monitoring only, but a good test of your visual field would reassure you. Visual field studies usually show up glaucoma loss first, but a diagnostic laser evaluation (GDx) of your retina can reveal problems a little earlier. If either of those are normal, most doctors would reassure you and check it again in six months or a year. -MT

Response:

Information Request

admin — Sun, 15 Mar 1998 00:00:00 +0000

Question:

with reference how many optometrists use anaesthetic in testing IOP I attended a recent optometry conference and the answer to your question seemed to be approx 50% of British optometrists in the room were using applanation tonometry most instilling either 4% benoxinate or proxymetacaine with fluorescein. regarding question is it possible to have higher IOP (>22mmHg) and not have glaucoma – the condition is called ocular hypertension. hope this helps. Karen

Response:

On Sun, 15 Mar 1998 21:46:01 -0800, "Dr.Trevor Salloum" wrote: >I’m doing some research on glaucoma and would like your help. >1.What percentage of people with slightly high IOP (22-3O) develop >glaucoma?

The epidemiological literature has some numbers for this and for those with readings averaging below 22, but I forget them. The percentage in Japan, however, I’m told, is much higher than in other places. >Since it is possible to have glaucoma without an elevated >IOP, I would guess that it is possible to have an elevated IOP >without having glaucoma.

Well, that’s certainly well recorded in the clinical literature — at pressures up to the neighborhood of 40. >2. Has anyone heard of "white coat syndrome" with IOP similar to the >condition in HBP which occurs only when the person is in the doctors >office?

I haven’t heard of it to any significan extent. Some attempts are made in medical environments to avoid such distortions in IOP readings to prevent uncharacteristically high readings. >3. Do most optometrists/opthamologists use topical anesthetic when >testing IOP?

I believe almost all who use applanation tonometry do, and I believe the majority of optometrists and almost all ophthalmologists (Hey, Doc (are you really), you gotta spell your colleagues’ specialty right!) use Goldmann or similar tonometry. No anesthetic is used with air-burst tonometry. >4.Have any of you tried topical or oral use of the botanical medicine >Coleus Forskoli? It has been used topically to reduce IOP.

Not I. >thank-you in advance >Trevor

Doctor of what? Phytoceutics? Ray (not an eye-poker)

Response:

Dr. Trevor Salloum writes: >I’m doing some research on glaucoma and would like your help. >1.What percentage of people with slightly high IOP (22-3O) develop >glaucoma? Since it is possible to have glaucoma without an elevated >IOP, I would guess that it is possible to have an elevated IOP >without having glaucoma.<

I don’t know. It would be interesting, I suppose. My pressure sat at quite high levels (28 to 46) for years without causing any damage. >2. Has anyone heard of "white coat syndrome" with IOP similar to the >condition in HBP which occurs only when the person is in the doctors >office?<

I haven’t. However, I suspect blood pressure rises in the office of an eye doc as well as an internist, and with it, IOP. The pressure of a finger holding open eyelids while checking pressure, neck position, holding breath, forcibly contracting the eyelid muscles, etc. may well create conditions in which pressure is distorted from what it otherwise might be. >3. Do most optometrists/opthamologists use topical anesthetic when >testing IOP? <

I hope so. >4.Have any of you tried topical or oral use of the botanical medicine >Coleus Forskoli? It has been used topically to reduce IOP. <

This was once considered a promising drug when packaged as Forskolin 10 years ago or so, but to my knowledge, didn’t go very far. (Not a professional response)

Response:

On Sun, 15 Mar 1998 21:46:01 -0800, "Dr.Trevor Salloum" wrote: ………… >4.Have any of you tried topical or oral use of the botanical medicine >Coleus Forskoli? It has been used topically to reduce IOP.

Aha, the crystal Web ball says we’re dealing with a naturopath! He should check out a few previous posts around here. Ray

Response:

I’m doing some research on glaucoma and would like your help. 1.What percentage of people with slightly high IOP (22-3O) develop glaucoma? Since it is possible to have glaucoma without an elevated IOP, I would guess that it is possible to have an elevated IOP without having glaucoma. 2. Has anyone heard of "white coat syndrome" with IOP similar to the condition in HBP which occurs only when the person is in the doctors office? 3. Do most optometrists/opthamologists use topical anesthetic when testing IOP? 4.Have any of you tried topical or oral use of the botanical medicine Coleus Forskoli? It has been used topically to reduce IOP. thank-you in advance Trevor

Response:

Eyeworld Week

admin — Sun, 16 Mar 1997 00:00:00 +0000

Question:

the second subject in the eyeworld post "pneumatic Trab" is quite intersting in that Dr Ann Chan at Willis has used(what appears)a simalar method which has its orgins in a nearly 40 year old device for years (prehaps 20) sometimes at the deristion of her fellow Practioners, she uses this post op as the drugs 5 fv and mitomycin are fairly strong and are assocated with some side effects- maybe she"s onto something- aye Doug Meckel ps what’s next the return of eye massage as a treatment

Response:

This was posted in the sci.med.vision newsgroup. It should be of interest to this group. EYEWORLD WEEK MARCH 10, 1997, Vol. 2, No. 10 High-dose asthma inhalants found to increase glaucoma risk MONTREAL — McGill University researchers have linked the use of steroid-containing asthma inhalants to an increased risk of glaucoma in people using high doses for several months at a time, according to a report in the Journal of the American Medical Association. People using high doses — defined as two puffs from a typical inhaler four times daily — for three months or more had a 44% higher risk of glaucoma or ocular hypertension than those who did not use steroid-containing inhalants. The researchers warned people not to stop using the inhalers, but to have regular checks for glaucoma. Critics of the study noted that the researchers used insurance records rather than actual medical charts. Glaxo Wellcome, a major supplier of inhaled steroids, downplayed the findings, noting that steroid inhalation has long been associated with a slight increased risk of glaucoma. ________________ Alcon enters pact to discuss pneumatic trabeculoplasty PHOENIX, Ariz. — Ophthalmic International Inc., a subsidiary of Coronado Industries Inc., and Alcon will discuss Ophthalmic’s pneumatic trabeculoplasty device under a confidentiality agreement, Coronado announced last week. Ophthalmic holds a method patent for pneumatic trabeculoplasty, as well as a patent on a device for performing the procedure. The device consists of a vacuum ring applied outside the eye over the trabecular meshwork. The procedure appears to work by restoring outflow through the meshwork. Though the effect usually fades, the procedure reportedly can be safely repeated. ________________ Copyright 1997 ASCRS Ophthalmic Services Corp. All rights reserved.

Response:

HMOs and glaucoma, defering Rx, awaiting optic nerve damage?

admin — Thu, 16 Jan 1997 00:00:00 +0000

Question:

i have now been to my local HMO where I have been told that my IOP is elevated. I cant remember the exact number, but it was 2x normal pressure. BUT — "no Optic Nerve Damage, Mr Boatright," they took pictures, and sent me along my way for another check in 6 months…… Is this Ok, I am frankly not very trusting of this HMO, they are reputed to be willing to do alot to save money, and the physicians do definately get a Christmas bonus tied to the amount of non-Rx they can accomplish. what are your thoughts folks is this standard of practice? John Boatright (jnlz0…@aol.com)

Response:

- Hide quoted text — Show quoted text -Mark Friedman wrote: > Jnlz0000 wrote: > > i have now been to my local HMO where I have been told that my IOP is > > elevated. I cant remember the exact number, but it was 2x normal pressure. > > BUT — "no Optic Nerve Damage, Mr Boatright," they took pictures, and sent > > me along my way for another check in 6 months…… > > Is this Ok, I am frankly not very trusting of this HMO, they are reputed > > to be willing to do alot to save money, and the physicians do definately > > get a Christmas bonus tied to the amount of non-Rx they can accomplish. > > what are your thoughts folks is this standard of practice? > > John Boatright (jnlz0…@aol.com) > Just my opinion and I’m not a doctor…but if your pressure is 2x > normal (which could be 30-40) you might want to be checked in less then > 6 months. This could be normal for you and there may not be damage to > the nerve at this point…but 6 months seems like a long time to me > between checks with a pressure over 30. > Mark

I would be greatly concerned, having high pressure in one eye ( 24 to 27) for three years now, but no nerve damage. I am on eye drops and just changed to a new medication to see if it will drop the pressure. The problem I have heard from three different medical eye specialist is that you should not, repeat, not wait until there is nerve damage to start treatment. I understand that with HMO’s that is the procedure, until there is nerve damage they will provide no treatment. That is a little like closing the barn door after the cow escapes, or is it the horse. Please see an independent or ask why you have to wait until there is damage, is not preventative a good approach. Fred — Please change my email address to ‘fr…@ionet.net’. Email sent to ‘fr…@paloverde.com’ will be forwarded temporarily, my server has changed. Maximum frustration is encountered immediately before the solution is found.

Response:

Jnlz0000 wrote: > i have now been to my local HMO where I have been told that my IOP is > elevated. I cant remember the exact number, but it was 2x normal pressure. > BUT — "no Optic Nerve Damage, Mr Boatright," they took pictures, and sent > me along my way for another check in 6 months…… > Is this Ok, I am frankly not very trusting of this HMO, they are reputed > to be willing to do alot to save money, and the physicians do definately > get a Christmas bonus tied to the amount of non-Rx they can accomplish. > what are your thoughts folks is this standard of practice? > John Boatright (jnlz0…@aol.com)

Just my opinion and I’m not a doctor…but if your pressure is 2x normal (which could be 30-40) you might want to be checked in less then 6 months. This could be normal for you and there may not be damage to the nerve at this point…but 6 months seems like a long time to me between checks with a pressure over 30. Mark

Response:

"Kim M. Clark, O.D." wrote (only in alt.support.glaucoma): – Hide quoted text — Show quoted text -……………… > Glaucoma is not a disease of elevated pressure. Glaucoma is an optic >neuropathy. Elevated pressure is a significant risk factor and should >not be taken lightly. I would estimate that at least 25% of the >patients I treat for this disease had normal intraocular pressure (IOP) >at the time of the diagnosis. There are three fundamental factors I >look at in determining whether or not the patient has the disease: >1) IOP, 2) Optic Nerve morphology (appearance and configuration), 3) >Visual Field (VF). > If the IOP is elevated but there is no "cupping" to the optic nerve, >and the VF is normal, the patient has ocular hypertension and not >glaucoma. This patient should be followed at least every six months. >If there is cupping (especially if it is assymetrical … ie, there is >more cuping in one eye than in the other), and if the VF evidences >damage to the nerve, the patient has glaucoma and should be treated >accordingly. It matters not if the pressure was normal–a damaged nerve >is a damaged nerve and requires medical attention.

I like this straightforward view, and it jibes with current apolitical writings. There’s still a ton of the past OMD garbage all over the Net. The only thing is, when you come to the bottom line of your post, what do you figure is *effective* "medical attention"? I’ve certainly seen enough indication of the other kind, the vast majority of it dealing with lowering the IOP, whether high or low and whether there is any indication of its slowing or stopping progression of nerve damage. Do you see much of this "medical attention" coming from ODs? (I live in a state where they can legally only diagnose glaucoma.) I would like to also add that *other* assymmetries in the orbital areas should be monitored to see if they indicate possible development of glaucomatous or other nerve damage. I developed considerable assymmetry in astigmatism prior to manifestation of glaucoma, the more cylindrical eye becoming the only one to develop glaucomatous damage. Both IOPs rose, from perhaps too-low values, to only the high teens and low 20s, the higher one being on the damaged side, but I don’t think the pressures rose *prior* to detectable nerve damage, but I don’t know, since nobody runs around detecting such things, and only *I* first detected the VF symptom by looking at the sky. (But why detect it earlier when, mostly likely, if you’re only going to try to drop the after-the-fact pressure, and not chase after the actual cause (most often some, maybe a bit remote, blood-supply problem), you aren’t going to be able to do anything about stopping or slowing increase in the damage.) (All you gain (?) is conversation with practitioners you’d just as well never meet.) There usually isn’t any reason to get your eyes checked by an OD for refraction (what you traditionally think of going to one for) during later midlife. I think it’s pretty clear that my eyes’ pressures (both) only rose a little as a *result* of either the nerve damage to only one, or of the cause of same. If ODs successfully crash this area of medicine (inter)nationally, let them bring clean, up-to-date views of the subject matter, such as yours — and maybe help in redirecting research money away from pressure-biased work and into areas of neurochemistry and -pharmacology and into small-vessel blood-flow monitoring and angiology. Ray (nonmedical, non-eyecare)

Response:

Thanks Dr. Kim! thats very helpful. I put in a call (before I saw your posting) to my HMOs member reps, they were going to check into it, that was several days ago, i got a call saying that the head OD was going to call me. still waiting for that, but i appreciate your info, its nice to hear from someone who Cabt have a vested interest in undertreatment. thanks again johnb

Response:

John & Mark, Glaucoma is not a disease of elevated pressure. Glaucoma is an optic neuropathy. Elevated pressure is a significant risk factor and should not be taken lightly. I would estimate that at least 25% of the patients I treat for this disease had normal intraocular pressure (IOP) at the time of the diagnosis. There are three fundamental factors I look at in determining whether or not the patient has the disease: 1) IOP, 2) Optic Nerve morphology (appearance and configuration), 3) Visual Field (VF). If the IOP is elevated but there is no "cupping" to the optic nerve, and the VF is normal, the patient has ocular hypertension and not glaucoma. This patient should be followed at least every six months. If there is cupping (especially if it is assymetrical … ie, there is more cuping in one eye than in the other), and if the VF evidences damage to the nerve, the patient has glaucoma and should be treated accordingly. It matters not if the pressure was normal–a damaged nerve is a damaged nerve and requires medical attention. There is much more that could be said about this insidious disease. If you have specific questions email me and I’m only too happy to assist you. Best of luck. Kim Martin Clark, O.D.