doctors

Here's what one well-respected ophthalmologist told his patient in response to her inquiry about starting home eye pressure monitoring.

Eleanor E. Faye serves as the Medical Director for Lighthouse International as well as the Ophthalmological Advisor to the Lighthouse Center for Education. She was born and raised in Hawaii. She was awarded her BA degree from Stanford University and her MD degree in 1950 from Stanford University School of Medicine.

From 1965-1993 Eleanor Faye served as the Director of the Lighthouse Low Vision Services. A founder and lead instructor with the Lighthouse Continuing Education Program in low vision care, Eleanor Faye also lectures at universities, hospitals and agencies for the blind and visually impaired. She is an emeritus ophthalmic surgeon with the Manhattan Eye, Ear and Throat Hospital and with the New York Hospital-Cornell Medical Center.

 I thought it might be interesting to do a series of profiles on top glaucoma specialists around the world. I was inspired to start this because of my recent visit with Dr. Robert Ritch. He is certainly one of the top glaucoma specialists in the world from a variety of points of view. He is highly respected by his peers and he has been voted "Best Doctor" many times by his patients.

White coat hypertension (or white coat syndrome) is a widely recognized blood pressure phenomenon. However, white coat ocular hypertension is not yet recognized by the medical community. One of the first reports of white coat ocular hypertension was published Tuesday, April 24, 2007 here on my blog in an article titled White Coat Syndrome for Eye Pressure.

Today's article represents a follow up to that first report. The purpose of this experiment was to determine if my intraocular pressure is again different when measured in the doctors office compared to when measured at home.

I define white coat ocular hypertension as a situation where patients exhibit elevated eye pressure (intraocular pressure) in the doctor's office but lower eye pressure at home (or in similar situations where they are comfortable). Patients with white coat ocular hypertension will often experience elevated eye pressure under stressful situations other than the physician's office. My data reported below and in the first report of white coat ocular hypertension fit this definition well.

I have strong evidence that I exhibit a white coat syndrome for intraocular pressure (eye pressure). First, let me provide some background on white coat syndrome.

My pick for the best glaucoma clinic in the US (and maybe in the world) is Glaucoma Associates of New York at the New York Eye and Ear Infirmary. This is where Dr. Robert Ritch practices and it is the home of The New York Glaucoma Research Institute. Dr. Robert Ritch is my pick for best glaucoma doctor.

The New York Eye and Ear Infirmary
310 East 14th Street
New York, NY 10003
Patient Appointments - Tel: 212-477-7540
Fax: 212-420-8743
http://www.glaucoma.net
http://www.nyee.edu

 A friend referred me to a new ophthalmologist who lives in another city. I corresponded with this new ophthalmologist via email. I am not replacing my current ophthalmologists, merely seeking additional input on specific issues where experts are few and far between.

However, I guess many facts did not get communicated clearly in my various emails to the doctor. The doctor sent me this email reply today (and I edited what is posted here):

Here are today's IOP values. For a period of time, I will simply work with the experts to understand the process and the instruments. The more interesting things will begin once we have the procedures down pat.

Today is the beginning of my effort to really understand my IOP. You will begin to see daily reports of my IOP values now. I may have to miss some days due to special circumstances, but my plan is to have my IOP measured every day -- usually multiple times per day.

I went to my ophthalmologist today convinced that my IOP would be lower than it was on my last visit. After all, my IOP has been trending downward since my first visit to the ophthalmologist. I assumed all the good nutrition and health practices I have been doing are responsible for this positive trend and I'm still doing all those good things. Furthermore, I have engaged in a much more ambitious program for improving my vision and the health of my eyes these last few months.

As I mentioned in a prior post, my IOP seems to have been trending downward consistently. The only question in regard to that trend was the last IOP check at an altitude of 8000 feet above sea level. Most of my IOP measurements were done at sea level.

I returned to my ophthalmologist just after the holidays. He prescribed homeopathic phosphorus and some energized water.

This eye exam was performed at an elevation of about 8000 feet using Goldman tonometry. At 8000 feet elevation, normal intraocular pressures are about 21, I'm told.

My IOP values are:

Left 19; Right 17

I'm not completely sure, but it seems like the downward trend in my IOP is continuing. This is also the first time my right IOP has been lower than the left. I'm also on vacation, and that might have something to do with the IOP values.

Upon today's visit to my ophthalmologist, my IOP values were:

Left 18; Right 18

Wow! My IOP has decreased each and every visit to my ophthalmologist. This is a good trend.

 My ophthalmologist checked my IOP today with his Goldman tonometer. The results were:

Left 20; Right 20

I have been using Xalatan for two weeks. Today I returned for a follow-up visit with my primary ophthalmologist. At the last visit, my IOP values were:

Left 34; Right 48

Today's IOP values (using Goldman Tonometry) were:

Left 21; Right 22

I also received a diagnosis:

Pigmentary glaucoma (noted Krukenberg's spindle); scotoma (an area of decreased or loss of vision).

It is still very hot where I live, and the doctor still doesn't use the air conditioning in her office. In spite of the discomfort, I returned for another visit.

We reviewed  all my lab tests, but she mostly focused on lifestyle factors. I have a lot of respect for that approach.

Today I had a telephone consultation with another member of my medical team, an ophthalmologist who is the current President of the Alternative Medicine association (since 1996) for his country. He has been in private practice since 1978. 

Today was my first visit with a physician in my area who practices conventional and holistic medicine. My main reason for seeing her was to see if she had any advice regarding alternative treatments for glaucoma. She gave me a complete physical and sent me to the lab for blood and urine profiles. She wanted to check my kidney function because, in her view, the health of the kidneys influences the health of the eyes.

Today I went to my newly selected ophthalmologist. He used his Goldman applanation tonometer to measure my IOP. Here is what he found:

Left 34; Right 48

Just to be clear what I mean by that, my left eye IOP is 34mm Hg and right eye IOP is 48 mm Hg.