Glaucoma and Cataract surgery

I am now 6 weeks out from cataract removal on left eye with ecp laser. Best corrected vision now requires -0.75 to get me to 20/50. Eye surgeon says that I have some central vision loss from glauoma according to visual field test.  Two questons: how much better can he tweak the IOL lens choice for the right eye to get me closer to distance vision, and two, since I have been under their care since before I had glaucoma, how is it that the glaucoma could progress that far that fast, with loss of vision over the last 18 months affecting my night and daytime driving. I thought he had pressure under control with Lumigan, and he even stopped that in the left eye months ago, then restarted after the visual field test showed deteriration.

[Houman Vosoghi, MD]

Make sure you are under the care of a fellowship trained glaucoma specialist/ophthalmologist as it seems the glaucoma is the worse of your problems.  If not, go see one.  The doctor should have also performed an OCT exam of the macula to make sure you do not have any swelling or other abnormalities of the macula as the cause of the central vision loss.  As far as the progression of the glaucoma, I can not comment without seeing your eyes and your records.  There is a form of glaucoma (normal tension glaucoma) that sometimes fools doctors into thinking the glaucoma is under control or not present as the eye pressure seems OK but the vision might still deteriorate.  If ever in doubt, you could always get a second opinion with another glaucoma specialist to make sure everything is being done correctly.

HV

[cpax]

Thank you for the advice. I have had 2 OCT and visual field exams, after the last ws when my Dr. had me restart Lumigan for left eye.My complaints of poor vision, night driving, contrast vision led to first catatact surgery, am awaiting the second. Some central vision loss was attributable to glaucoma, which I thought had been managed well. I have been considering a second opinion (possibly at Wilmer eye); not sure who closer to home, ichmond/Williamsburg Virginia area would be good to see.

[Houman Vosoghi, MD]

Wilmer is ranked #1 in the country so if you have access to their glaucoma specialists it would not be a bad idea.  you want to make sure you are doing everything possilbe.

HV

[cpax]

I did gio to Wilmer. Confirmed the bad news, there is some permanent loss of vision from Glaucoma in one eye. Over time, my vision complaints were attributed to myopia and cataracts not yet ripe, all while I thought glaucoma was well controlled. Pressure apparently not as well contolled as I was led to believe. I think my ophthamologist just missed it, and now I must suffer.

[Houman Vosoghi, MD]

I'm sorry to hear that.  I hope they are able to get it under control now to stop any further loss of vision.

HV

[cpax]

As follow up to earlier posts, JHH recommended a retina evaluation to rule out any problem there, this turned out normal (a good news bad news scenario) since there was nothing correctable there. So on their recommendation am going ahead with right eye cataract and ecp. Last week I was at 13 Left and 16 right, a month ago 16 left and 23 right. My pressures over the last 12-18 months has ranged 17-22, which for me may have been too high. My Opthalmologist here told me that the central vision loss that I presented is extremely rare, less than 1/2 of 1 percent. I still wonder if this could have been caught sooner, Being that I thought it was a cataract problem, I toughed it out, to my detriment I'm afraid.