Does my treatment is on Right path? Does eye drops will work for me?

Hi

I visited Opthalmologist for Monitoring progress in my Gluacoma yesterday and this visit get me very worried. I am currently 41 yrs of age.

I was diagnoised with Glaucoma in June 2007 in both eyes. My glucoma is in very advance stage. In my right eye has considerable damage even in central vision as per Perymetry field test. Though as of now I dont feel any loss of vision in eyes. But all of the eye doctors (opthalmologist) that I have visited indicate advance stage of Glaucoma.

My IOP readings are as follows

Date     Right      Left     Treatment
6/12/07   24         26     Timolet and Xelatan started
7/7/07    17         17     Timolol continued
                            Lumigan started to replace             Xelatan(for non medical reasons)
7/19/07  17          17       Lumigan and Timolol continued
8/16/07  18          22     XELATAN restarted and Cospost to replace
                            Timolet
I was very worried to know that my IOP was increasing again
I have visited three different doctors during course of this two month treatment. All Opthalmologist (two in India and one in US just yesterday)

I have perimetry done once on 12/6/06 but still no any type of immaging is done yet. Yesterday's visit (8/16/07) doctor said that my cup sizes are quite big as of now, so we should first wait for IOP to normalize before we go for immaging so that we can better monitor progress of nerve damage later on (if any) after immaging test.

My questions are
(1) Does my treatment is on right path?

(2) For frequent measurment of IOP nearby where we should go? Opetimetrist is OK? If some one know good chain of Optimerist who can measure IOP regualrly with VERY GOOD INSTRUMENTS, I would like to know.

My doctor that I visited yesterday told that some of them just throw air in the eyes and measure which is not good way. He told those who have and instrument with SOme type of blue light is better. (he was having that instrument)

(2) Does Cospot is better that TIMOLET

(3) Can some one suggest link where more details about all glaucoma drops and what they do to prevent damage.

(4) IF Dr. Ritch can suggest good GLaucoma specialist for me around Anderson South Carolina ( zip 29621) that will be of great help.

Non control of my IOP with advance state of Galucoma really is making me lot worried about all this.

thanks for your advise and inputs.

Paresh

My question is

pmpvip:

I was very worried to know that my IOP was increasing again. Non control of my IOP with advance state of Galucoma really is making me lot worried about all this.

You are correct that it is important to take all the steps you can to get your intraocular pressure under control. I think you are off to a good start by seeing professionals, seeking the best experts, and using the Internet.

Set yourself up for success as you start this important process of learning how to care for your vision by being aware of the importance of your mental state too. Being "very worried" is neither productive nor good for your eye pressure. Any high-achiever will tell you the importance of attitude in achieving a successful outcome.

Consider that you are at the beginning stages of a project where you want to ensure a successful outcome. The right attitude is an important key to a good start and good outcome on this project (your vision).

Worry is closely related to the emotion of fear. I am quite sure that fear and worry increase intraocular pressure for at least some subset of glaucoma patients. I suspect those negative emotions are damaging to the vision for most, if not all, glaucoma patients. That is not an accepted medical position yet, but in my own case I have no doubt that worry and fear increase my intraocular pressure. Therefore, my advice is to address any negative emotions using proven effective techniques.

Since you are from India, why don't you check out some of the teachings of the masters from your country? "The Law of Success" by Paramahansa Yogananda comes to mind. Here's a link to my perspective on the mental aspects of dealing with glaucoma: http://fiteyes.com/blogs/dave/2007/02/02/Embrace-Evolve-Exceed.

pmpvip:

I have visited three different doctors during course of this two month treatment. All Opthalmologist (two in India and one in US just yesterday).My questions are, Is my treatment is on right path?

I personally think you are wise to seek out the advice and care of the best experts you can find. Keep doing that. But don't limit yourself to experts in your own zip code. Do try to find the best professionals you can find in your area, but don't limit yourself to that either. I gave more of my opinion on this question in my blog article, What Can We Do To Prevent Further Glaucomatous Damage To Our Eyes?

pmpvip:

For frequent measurment of IOP nearby where we should go? Optometrist is OK? If some one know good chain of Optometrist who can measure IOP regualrly with VERY GOOD INSTRUMENTS, I would like to know.

My doctor that I visited yesterday told that some of them just throw air in the eyes and measure which is not good way. He told those who have and instrument with some type of blue light is better. (he was having that instrument).

Now you have asked a question in an area that I know something about - tonometry. If you want to have your intraocular pressure measured with the best tonometers available today, find a glaucoma specialist who will measure you with all the following tonometers:

1. Pascal Dynamic Contour tonometer
2. Reichert Ocular Response Analyzer
3. Goldmann applanation tonometry (this is the "instrument with some type of blue light")

I can recommend a doctor within about a 6 hour drive from you, but maybe you can find someone closer who has all those tonometers. (Almost everyone will have the 3rd one -- it's finding the first two at one physician's office that might be a challenge.) I suspect you'll have to file this option away for future reference because (unless you want to travel about 400 miles, you probably won't find a place to get all those measurements performed.

However, the more immediate question you asked was about finding a professional for frequent eye pressure exams. As you know, I think this is a good idea. I give a detailed description of my observations about the kind of changes in eye pressure you describe in this blog post: How Much Does Eye Pressure Fluctuate? That article is part of my justification for frequent eye pressure measurements. Your own situation sounds very similar to mine - here's my story in this blog post: http://fiteyes.com/blogs/dave/2006/07/07/Prior-Two-Year-IOP-Trend-Meaningless. I also discussed this in What Can We Do To Prevent Further Glaucomatous Damage To Our Eyes? and other articles on this website. (You can use the search box at the top of the page, or use the tags feature to find more articles.)

Here is some more specific information about your question:

I would not go seeking out a chain of eye glass stores. Look for a competent Doctor of Optometry or an ophthalmologist. I have personally had good luck finding several Doctors of Optometry that would work with me for frequent intraocular pressure exams. A Doctor of Optometry can use both a Goldmann applanation tonometer (this is the "instrument with some type of blue light") and the air-puff type of tonometer.

In my opinion, the air puff tonometers can serve a very useful role in intraocular pressure management. They are commonly misused. However, when used correctly, they can lead to knowledge about your intraocular pressure that you cannot obtain via any other tonometer in existence today. If you dismiss air puff tonometers (also called non-contact tonometers) as not being valuable, you will do yourself a disservice. My favorite tonometer for high-frequency self-tonometry is the Reichert AT555, which is an air puff tonometer. Here is an article where I describe how the air puff tonometer can provide knowledge about intraocular pressure that a Goldmann tonometer cannot. So the bottom line is that you should consider the use of an air puff tonometer for frequent intraocular pressure measurements.

If you would like to have a more indepth discussion on tonometers, I would enjoy that. You might also refer to the "IOP Consensus Meeting" book from ARVO 2007. You may have to ask your ophthalmologist to get a copy for you.

Call or visit with several of the independent Doctors of Optometry in your area and find one that will work with you for tonometry exams. I think it helps if you explain that you are under the care of an ophthalmologist and that you simply want intraocular pressure exams on a more frequent basis. Explain your situation just as you have explained it here. When you find one, note the models of tonometers used, and ask about the calibration procedures for the Goldmann. If you have read my "diabetes management analogy" (see below), you may want to discuss that too.

I can imagine that in the future glaucoma patients will monitor their eye pressure the way diabetics monitor their blood sugar today. I think most physicians treating diabetes would not dream of caring for a patient without knowing details of how that patient's blood sugar responds to his or her diet and activities throughout the normal course of the patient's life. I believe the same should be done for glaucoma patients.

P.S. For a link about the glaucoma drops, try PubMed. 

pmpvip:

If some one know good chain of Optimerist who can measure IOP regualrly with VERY GOOD INSTRUMENTS, I would like to know.

Anderson South Carolina ( zip 29621)

This was passed on to me from a colleague.

From Dr. Ken Nash in Greenwood, SC:

I will see the patient if no one closer to them is interested. I am 45 miles south east of  Anderson  in Greenwood.  Vaughn Parfitt, a past president of the SC Board of Optometry, is in Anderson.