Glaucoma drops-just curious

[frwbeach]

  In the past I was on Travatan PF and Kosopt for high pressures. My vision deteriated  and didn't improve until a new Glaucoma specialist took me off the drops and changed treatment ( pressures  in the past 8 months have  been better than the past 2 years and as good as they have been in 12 years )  . He  said some people do experience deminished visual acuity as a side effect. I contacted the one drug company and they were very upfront with me and said others have reported substantial acuity loss .  I am doing fine with Glaucoma and pressures for 8 months now and vision is much better--What I am curious about is what part of the eye is effected that would cause this side effect?

I understand its not obvious and even the doctor that flushed my eyes and changed treatment said he wasn't sure it would help but wanted to start from scratch .  The almost sad part was that my previous doctor was going to do surgery because even with the drops my pressures were always over 27 min. ( Now  around 15 ).  Happy, just curious --my current doctor said he uses both drops  and has good results- he has been practicing for many years and only had a few that effected vision like myself. Went from 20-80 / 20-120  to 20-50  20-60  doesn't sound like much but believe me its huge to me.
Just curious as to what causes this side effect / why ?  

[John C Hagan III, MD, FACS]

What glaucoma medciations are you on now?

JCH III MD

[frwbeach]

  No drops. I have been on the Rosecea ( oral meds ) meds .  Celluvisc for dry eye and changed my diet- taking omega 1000 fish oil
3 times a day--vitamins , and also washing flushing my eyes and warm compresses for Conjunctivitis -
In the past 8 months my pressures have been checked often ( slit lamp )  and average around 15-17   In the previous 13 years I have taken many drops and seen several specialists and no matter what drops they used, my pressures were 20-24 at best. The new doc actually said he thought I was having a toxic reaction to drops and just wanted to flush the eyes and start new drops, however the pressures have remained low and no more field loss or optic nerve change and he
tells me at some point we will have to restart drop treatmen its just with no optic nerve changes and low pressures , not yet . We  call it a miracle, however the doc says that there are cases were the pressures drop for periods of time and wants to keep a close check on things. He doesn't seem to think that treating the Dry eye (Celluvisc ) , Rosecea , Conjuntivitis  has anything to do with the lower pressures but my vision was improving the first week off the drops and continued imprving to 20-50 which he feels may be the best we will get. The Rosecea ( you should see the before and after pics ) treatment and others were never tryed before , and he feels this has helped also.  Back to reaction to some drops--The manufacturer admits that they do get complaints of significant vision loss from a few patients but they could not tell me what or why-Thats what I am curious about ???    Am a bit dissapointed that nearly a dozen doctors tested and looked for reasons for the 20-80 to 20-120 vision but never thought about the drops
PS- since on vitamins and fish oil my Blood Pressure has been much improved also-
Sorta still feel  going from - potential surgery to pressure of 15-17 is a miracle .

[John C Hagan III, MD, FACS]

I do not feel that the eye drops you took caused your vision to decrease nor do I think that the drops increased your pressure. I believe that the improvement in your vision is likely due to the aggressive treatment of your dry eye and acne roseacea.

Also it is well known that glaucoma can "burn out". Just like someone that has asthma and it goes away, has stomach ulcers and they go away. It is also possible that it is remission and could come back.

In addition there is a type of glaucoma called normal tension or low tension glaucoma in which damage can continue to develop in spite of pressures that are normal.

You sound like you have an excellent Eye MD ophthalmologist now. There are several tests that are extremely important to do in your case.

The first is central cornea thickness CCT. If your corneal is normal thickness about 550-550 microns then the pressure obtained with a standard Goldman tonometer will be exactly what the machine records. However if you have a thin cornea <500 microns then the pressure in your eye could be as much as 4-6 points higher than the reading (in your case if you have a very thin cornea your presure could be 21-23 INSIDE the eye).

Finally in my opinion you need a optic nerve OCT test and that should be repeated every 6 months for the next couple of years to look for progression.

I'm glad your better but I don't think this is a miracle, unusual, due to the drugs nor are you out of the woods.

JCH III MD