Aa
Question about Father's Glaucoma Treatment
Hello Dr. Hagan,
I hope you are doing well!
I had asked you several questions about my CSR and Wet MD conditions over the last five months. I wanted to thank you again for your generous answers! I am currently on my fourth Avastin injection and OCT is showing significant fluid clearing in the right eye, but the vision is still blurry and wavy when the lighting is not good. If you don't mind, I have a question about my father's Glaucoma Treatment.
Details:
1) Father is 85, lives alone in India and has help when needed.
2) He was diagnosed with Glaucoma in 2001 and was in the care of an Ophthalmologist until 2011 and since then has been seeing a Glaucoma Specialist (GS).
3) His eye pressures are well controlled and is currently (measured yesterday during a visit) at 11 and 11 (cornea is thin, but the GS told me he has applied the corrections for the eye pressure).
4) He is currently on a single eye drop : Timolol (5mg) + Travoprost (40mcg) and an eye drop for dry eyes and takes an antioxidant soft gel capsule.
5) He sees the GS once every five months.
I talk to the GS after every visit. The GS has always maintained that since my father’s Glaucoma is advanced, the OCT does not have much utility. A visual field test was done yesterday after a year and the results were not reliable. Therefore, the GS told me he will use eye pressure to gauge progression and increase the number of drops if the eye pressure increases or father has any vision issues. So far, father has not had any vision problems. He does not drive and is always with a caretaker when he leaves home.
Questions:
1) With the current treatment, it seems like we are checking eye pressure every 5 months and/or waiting for father to detect vision changes. It is not pro-active. Your thoughts?
2) I have read about Macular OCT and OCT Angiography for advanced Glaucoma. Can these tests detect progression before they show up in increased eye pressure or vision changes?
3) Can Macular OCT be done in the same machine that does regular OCT?
4) Would you happen to know if OCT Angiography would be available in countries like India?
Sorry for the long message. Thank you for your time!
I hope you are doing well!
I had asked you several questions about my CSR and Wet MD conditions over the last five months. I wanted to thank you again for your generous answers! I am currently on my fourth Avastin injection and OCT is showing significant fluid clearing in the right eye, but the vision is still blurry and wavy when the lighting is not good. If you don't mind, I have a question about my father's Glaucoma Treatment.
Details:
1) Father is 85, lives alone in India and has help when needed.
2) He was diagnosed with Glaucoma in 2001 and was in the care of an Ophthalmologist until 2011 and since then has been seeing a Glaucoma Specialist (GS).
3) His eye pressures are well controlled and is currently (measured yesterday during a visit) at 11 and 11 (cornea is thin, but the GS told me he has applied the corrections for the eye pressure).
4) He is currently on a single eye drop : Timolol (5mg) + Travoprost (40mcg) and an eye drop for dry eyes and takes an antioxidant soft gel capsule.
5) He sees the GS once every five months.
I talk to the GS after every visit. The GS has always maintained that since my father’s Glaucoma is advanced, the OCT does not have much utility. A visual field test was done yesterday after a year and the results were not reliable. Therefore, the GS told me he will use eye pressure to gauge progression and increase the number of drops if the eye pressure increases or father has any vision issues. So far, father has not had any vision problems. He does not drive and is always with a caretaker when he leaves home.
Questions:
1) With the current treatment, it seems like we are checking eye pressure every 5 months and/or waiting for father to detect vision changes. It is not pro-active. Your thoughts?
2) I have read about Macular OCT and OCT Angiography for advanced Glaucoma. Can these tests detect progression before they show up in increased eye pressure or vision changes?
3) Can Macular OCT be done in the same machine that does regular OCT?
4) Would you happen to know if OCT Angiography would be available in countries like India?
Sorry for the long message. Thank you for your time!
MEDICAL PROFESSIONAL
It is true that if the nerve fiber layer is thin it is not a reliable indication of progression. Visual fields are a sensitive indicator but many people have trouble maintaining fixation and the tests are not reliable (this is called fixation loss). Visual fields also sometimes become very painful and uncomfortable for older patients that have arthritis problems. Even with a thin cornea an IOP of 11 should prevent progression (except in a rare type of glaucoma called low tension or normotension glaucoma). OCT machines are like automobiles, some have more accessories than others. So some OCT can do OCT FA and some cannot. I do not do OCT FA on my patients and our retina specialist prefers the classis fluoriscene angiography. Your fathers glaucoma specialist seems vey competent. the GS can also monitor the glaucoma by careful study of the optic nerve morphology (cupping). One thing that is very important is that some older people as some point due to physicial or mental health are unable to instill or forgetful of their glaucoma drops and that can be a disaster. So can being hospitalized for a serious problem like heart attack or stroke or fall and have the hospital overlook putting the drops in. You and your family will have to advocate for him to get the drops. I have seeen this happen a distressing number of times. Best of luck.
5 Comments
Thank you so much for your answer, Dr Hagan! If you don't mind, I may ask you more questions about father's eye treatments in the future. I hope that is fine with you.
I am always very grateful for your answers!
I am always very grateful for your answers!
Happy to answer and grateful you are grateful. I don't get paid to do this. Perhaps 3-5% take the time to say thank you.
And I've answered over 10,000 questions.
Hello Dr Hagan,
Wow! Thank you, Sir!
Regards
Wow! Thank you, Sir!
Regards
Have an Answer?
You are reading content posted in the Eye Care Community
Top General Health Answerers
Kansas City, MO
Grand Prairie, TX
San Diego, CA
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.
