I should wait little more for drops to work or go for Trablculectomy immidiately?

Hi

I am under confusion and stress after my last visit to the Glaucoma Specialist So need advise from experienced members like you.

Here is my Case history:

I am diagnosed with Advance Glaucoma (open angle) in both of my eyes. My right eye has also lost some of the central vision as shown in the visual field test. I also experience some vision loss at one corner of my right eye. I was unaware of this until this June when this diagnosis was done.

I am on the drops since start of the June-07. When it was diagnosed in June my IOP was 24 and 26. Doctors have tried different combinations with following results ( Results are only  one time measurements during doctors visit) I have only visited specialist in this important area each time.

Date        Right      Left       Treatment started after these readings
6/12/07     24         26          Timolol and Xelatan started
7/7/07       17         17          Timolol continue and Lumigan replaced Xelatan                                                                                   
8/16/07     18          22          Xelatan and Cosopt  (replace Lumigan and Timolol)

10/18/07     19        20         Alphagan added ( to Xelatan and Cosopt ) ( last visit)

I visited Glaucoma specialist last week. He mainly did dilated eye exam and relied on previous visual filed test that was done in India. He did measure cornea thickness but did not do any other test. After his exam he told me following things

(1) I have very advanced glaucoma in both my eyes. Right eye has more advanced

(2) He added  Alphagan ( 3 times a day) in addition to current eye drops, but he was very quick to say that it will most probably will not affect much in terms of IOP reduction. He told me my target IOP should be around 12 in both eyes.

(3) He asked me to schedule  incisional TRABECULECTOMY some time after a month or so.

(4) When I asked for details on my cornea thickness as well as cup sizes, he was telling that it was bad But was not ready to discuss further. He was not ready to discuss much or give more information about his observations. I also found him very quick to arrive at his conclusions.

In short he suggested me to go for TRABECULECTOMY , he told me that I was not good candidate for Laser. Why I don’t know.

 

My Age is only 41 year and I understand Trablculectomy is a last resort to reduce IOP or control glaucoma.

My questions are

(1)   Since my drops are started just few month back should I give drops chance to work and wait before going for Any type of surgery.

 

(2)   In my case Xalatan and Timolol combination was found to lower IOP to 17 in only one month of taking it. I think that it was mistake to change to Lumigan. I asked last two doctors to Change my drops back to Xalatan and Timolol but they were not even ready to listen that idea and they immediately dismissed that. Based on my eye experiences I personally feel that it was best combination as far as feeling in my eyes are concerned and also IOP reading are concerned.  I don’t understand why they are not ready to try that one more time and see its results?

 

(3)   None of the doctor I visited except the last Glaucoma Specialist ( all other were Ophthalmologist experienced in Glaucoma area) suggested to go for immediate surgery. Should I seek second Opinion or go for surgery immediately?

 

(4)   If I absolutely has to go for surgery which may be best alternative to Trablculectomy. ? if Laser is not good for me are there any good options left for me before going for Trablculectomy?

 

(5)   If I go for Trablculectomy.,.should I go for only one eye which is currently badly affected ( right) and see result before having  Trablculectomy in other eye which has very good vision right now? What is normal success rate in Trablculectomy? Are there any chance to save vision if Trablculectomy is not successful and go wrong?

I know these are lot questions but I think apart from expert’s opinion from Ophthalmologist and Glaucoma specialist I also want to know your suggestions which comes from very personnel experiences of the similar situation with self or from family members.

Please take your time to reply it but make your reply detailed one so that it can help me a lot.

 

Hi Paresh - previously I recommended that you go see Robert Ritch, MD in New York. What glaucoma specialist have you decided to work with? Can you discuss these alternatives with him or her?

 Dave thanks for your repsonse and email

Last doctor I visited was Glaucoma specialist in  SC and he or his staff does not seem to be ready to discuss much. 

Unfortunately for one or another reason I have to change specialist I visit every time ( though I dont wan to do so !!)

thanks  

 

 

Paresh - given that you have advanced glaucoma, why don't you pick one of the very best glaucoma specialists you can find and travel to visit that person? I personally like Dr. Ritch because I can communicate well with him. I think communication is one of the most important factors. I would recommend for you the same thing I do for myself. I have a local doctor and I travel to see Dr. Ritch. I am able to communicate very well with both doctors. Finding a situation like that should be your top priority.

About three months ago I wrote a detailed blog post about what we can do to stop glaucoma progression in response to a question you asked. My first recommendation in that post was the same recommendation I just made above. You need to start by putting together a medical team that you can work closely with. Build the best team for you.

Please review that blog post I wrote for you and let me know if you have questions. 

If you think you will find a "specialized glaucoma supplement" (whether from Ayurveda, TCM, or alternative western medicine) that you can simply walk into a drug store and purchase, you need to get real. Not being real with yourself is unhealthy and will not help you heal your glaucoma.

As I recommended in my blog post for you, you need a top quality Ayurvedic physician (or other alternative medicine specialist) to make dietary and supplement recommendations for your unique physiology. Getting your recommendations for vitamins from other patients via the Internet isn't what you need. You are wasting your time and you are misleading yourself with false hopes.

Chris Carr is an example of someone who took the right approach. I give a link to her blog and her website in my post titled Glorious Illuminating Glaucoma. Watch her film and follow her example. She worked with medical experts and considered the data when she made her decisions (and she wasn't biased in regard to any particular medical approaches).

You can also learn my the examples here on my blog. We have many discussions about the value of having your intraocular pressure monitored frequently. The approach I recommend is a data-driven approach where you work with the best team of experts you can assemble and consider all approaches (western, alternative, Ayurvedic, etc.) without bias. And most importantly, you must be willing to change.

The old you ended up with glaucoma. If you want to have any chance of managing (or maybe curing) your glaucoma without surgery, you certainly will have to become a completely new version of you. You will have to change many things about yourself and your lifestyle.

Please remember that many treatments from Ayurveda and TCM were designed to be preventative. When an individual lets a disease go too far, even Ayurvedic physicians must resort to surgery at times. Even early stage glaucoma is actually a late stage result of a chronic imbalance in one's system. In your case this has been progressing for a very long time. Stop fooling around asking about vitamins you can buy at a drug store. Get real now!