How to help the ophtalmologist find the right medication.

Hi,

I was diagnosed with Glaucoma around 1991, after I got a laser treatment for retinal detachment to both eyes.  That was two years after I was treated for retinal detachment to the right eye in 1989; the surgeon then injected a bubble of gas in my right eye to press the retina on the back of the eye and a week later he cauterized using liquid nitrogen.

After that, I had the pressure in my eyes checked once a year and the ophtalmologist(s) gave me Xalatan.  As the pressure of my right was over 20, one ophtalmologist replaced the Xalatan with Cosopt, but he still wouldn't see me more often than once a year.

As I started loosing the fovea of my right eye (I couldn't read any more with the right eye) the ophtalmologist didn't look enough concerned to my taste and I looked around for other opinions.

Another ophtalmologist was concerned with the pressure level and he added Combigan to Azopt and he would see me every 6 months but the pressure remained high. He was a retina specialist but I needed a glaucoma specialist.

 Six months ago, I found a glaucoma specialist working in a hospital and he started with the combination (Cosopt, Alphagan) but my pressure is still (16,20), so he wants me to add a Pilopine gel on top of that; all add up to four chemicals.  He took two pressure measurements already and the next one is scheduled in two months from now.

Although this last doctor is taking more measurements, I don't like the idea of adding chemicals to the soup.  The whole process looks to me closer to alchemy than to the scientific method medical doctors claim to use.  One can make 16 mixtures out of those four chemicals.  Then, one needs some differential procedure lasting at most a couple of months to sort out which one of those mixtures is effective if any.

So I am planning to make an experimentation plan myself.  The optometrist I see uses an air tonometer  and I was thinking  to ask him for a technician to take a series of weekly  pressure measurements as part of the plan.

My question is :  Has anyone tried that route before and has anyone some recommendations to make.  Is there any model of tonometer used by optometrists that would provide good enough data?


Thank you and sorry for the long post.

Richard

Richard Lemieux:

My question is :  Has anyone tried that route before and has anyone some recommendations to make.  Is there any model of tonometer used by optometrists that would provide good enough data?

Hi Richard. That's an excellent question! This is nearly the same route I took when I started. The first thing I did was work closely with an optometrist who allowed me to come in for eye pressure checks very frequently. I started by going once every two weeks. Eventually, with a different doctor of optometry, I worked up to several occasions of multiple intraocular pressure measurements in a single day. That proved so worthwhile that I started a research project that focuses on high-frequency self-tonometry. (One recent example of how I continue to work with my doctor of optometry is given in this blog post about white coat ocular hypertension.)

In this research project I and the other subjects use professional quality tonometers to monitor our intraocular pressure up to 100 times per day (but not everyone does it that frequently). In my experience, weekly measurements had value - but the primary value I saw was in learning that intraocular pressure responds to our mental and emotional state and our daily activities (lifestyle and diet). This led immediately to the need to monitor intraocular pressure more frequently. However, if you start with the weekly monitoring plan, as you have described it, I expect that you will learn a lot.

I personally have a database of well over 30,000 intraocular pressure measurements on my own eyes. I have data from many different tonometers, including Goldmann, various models of air puff tonometers, the Pascal Dynamic Contour tonometer, the Reichert Ocular Response Analyzer, and more. I have intraocular pressure data under all kinds of different conditions and all all times of the day (and night).

Based on my experience, I think your plan is a good starting point. Simply note the make and model of tonometer used by your optometrist. (From my perspective, it would be ideal if it is a Reichert AT550, AT555, or even an Xpert Plus because I understand that model the best. However, other models have also been researched and compared to Goldmann Applanation Tonometry - GAT.) None of the air puff tonometers agree exactly with GAT, but generally they agree well enough -- better than the TonoPen does, for example. And if you take enough measurements and watch for artifacts, you will end up with good data. Make sure you always take at least 3 measurements on each eye during each exam. Learn about the things that can lead to inaccurate measurements - I can send you (or post here) some documents.

If you begin this project and you want access to the private forum on FitEyes.com for our research project, let me know. This forum might have tips you find useful. The people I'm working with right now are all using the Reichert AT555 tonometer, so the discussion focus has been on that tonometer.

Dave, Thank you for the answer and the support.

I have been exploring the blogs and found "A Surprising Look At Stress and My Eye Pressure Over Four Days" very much in line with what I am looking for.  That tells me that depending on when I see him, my ophthalmologist, he will either be happy my IOP or he will be alarmed and he will add to the existing medication. At first sight, the graph shows at least as much fluctuation as the blood pressure data I collected for a while.  I wonder if anyone has yet researched the correlation between IOP and blood pressure fluctuations.

The discussion in the blog addresses important issues related to experiment design. I like David Baer's question and I like your answer.  My own answer to one of David's question is that I  can't really measure my current level of stress myself, but I can to meditation and exercises that let me in a more or less 'neutral' state.  I find that my blood pressure typically becomes lower following such exercises and I typically do them before a medical exam.  In the future I will also do some meditation before the ophthalmologist takes an IOP measurement!  For the time being I know nothing of the effect of such exercises on my IOP.  I wish I had the AT555 for a while.
 

Richard - it's good to have your participation on FitEyes.com.

I have done some work to correlate intraocular pressure and blood pressure, although I have not done anything extensive. My intraocular pressure seems to fluctuate more than my blood pressure. You can probably find some interesting articles on this subject on PubMed.

Did you see any of my blog articles on meditation and intraocular pressure? The results are very mixed. I would suggest that meditating prior to an intraocular pressure measurement is not a good idea unless you are able to collect IOP measurements both before and after meditating. If you get a high eye pressure reading after meditating it could be very alarming unless you have more data (especially your eye pressure before meditating).

I do have a simple mental techique I can use that seems to instantly lower my intraocular pressure by 2-3 mmHg, but it is not what I call a meditation technique. It is simply a technique to quiet my mind. (In my opinion, there is a difference.) Formal meditation techniques have never lowered my eye pressure - at least not yet. I continue to conduct research in this area. Often techniques like Transcendental Meditation raise my intraocular pressure, and sometimes they leave it unchanged.

You may find this interesting. On one recent day my eye pressure was a bit elevated when I woke up. It was around 20 mm Hg. My IOP was staying higher than normal throughout the day (near 20). I decided to take this as another opportunity to test some of the techniques I'm using to manage my intraocular pressure. I used the "quiet mind" technique mentioned above more extensively, including while I was out walking my dog. I altered my attitude and activities in ways that I have found lower my eye pressure. After doing that my intraocular pressure was under 10 mm Hg! In my experience, these procedures work every time - provided I can actually get into the mental state where I can apply them. My ability to do so is increasing every day.

Dave:

If you begin this project and you want access to the private forum on FitEyes.com for our research project, let me know. This forum might have tips you find useful. The people I'm working with right now are all using the Reichert AT555 tonometer, so the discussion focus has been on that tonometer.

 Is the information from this forum going to be accessible only to those who've been able to purchase the Reichert tonometer?

Nancy:

 Is the information from this forum going to be accessible only to those who've been able to purchase the Reichert tonometer?

Nancy, I don't think that info would be of interest to anyone without the tonometer. The discussions are all about how to hook the tonometer up to your computer or how to record the data properly for research purposes. However, if you still want access to the forum, I'll give it to you. Just ask.

Thanks for elaborating on the forum's status quo, Dave. It doesn't sound as if I would have much to offer at this stage. However, although I don't currently have a reliable home tonometer, I've documented much of my 30 years of ocular hypertension. It may be considered too subjective for this study. If so, a blog might be more appropriate for sharing my insights and findings.

Richard Lemieux:

At first sight, the graph shows at least as much fluctuation as the blood pressure data I collected for a while.  I wonder if anyone has yet researched the correlation between IOP and blood pressure fluctuations.

In my own case I think pulse pressure is more related to IOP than actual blood pressure.  Stress is very much a factor too and as David points out a quiet mind is something to be practised!