How is normal presure glaucoma treated?

[villandra]

What ways are there to treat normal pressure glaucoma?   I actually understand that normal pressure glaucoma is treated the same way as high pressure glaucoma, but if another medical condition is likely to have caused the problem, is lowering the intraocular pressure likely to help, or are there other approaches?    I have migraines, optic migraines, and prediabetes, and take GERD medication which seriously aggravates the migraines.

Also, I have alot of retinal specks floating around in my eyes - I'm 50 years old.   Called I think K-Spindle.   If my intraocular pressure is borderline normal, is there any real treatment short of laser surgery for them blocking the ductwork or whatever?  

I'm actually trying to avoid glaucoma medication - seems like all kinds have nasty side effects, and I have medical contraindications to taking a number of them, and if my intraocular pressure is normal I have serious doubts about what good they're likely to do.  It doesn't seem like a reasonable strategy.   I really want a treatment that is likely to work.  

[John C Hagan III, MD, FACS]

You need to further educate yourself on glaucoma and its treatment, you have some misconceptions.

First K-spindles (krukenberg spindles are collections of pigment on the back of the cornea) are a risk factor for "Pigmentary Glaucoma" not normal tension glaucoma. Second your pressure might be normal (20 mm of mercury or less) by applanation tonometry but really higher than that if you have thin corneas (which are also risks for getting glaucoma). Your Eye MD has probably measured that with a pachymeter.  Third the pressure in the eye varies from hour to hour being sometimes higher and sometimes lower. This is called the diurnal curve. For most people the difference between the high and low pressure is 4-8 mm Hg, for others it can be 20 mm Hg or more).   If your diurnal curve is shifted such that your high pressures occur in the evening or during the night, you may appear to "always" have normal pressures during normal office hours at your ophthalmologist but may in fact be runnning  quite high during the 16 hours of each day that are not "office hours". If your pressures are "borderline normal" it's likely their high sometime in each 24 hour cycle.      There is such a thing as normal tension glaucoma but I don't think you fit the profile.

Modern glaucoma treatment is often as simple as using one drop once per day. Most ophthalmologists, including me, start treatment with prostaglandin analogs (In the US Lumigan, Xalatan or Travatan). These medications are very effective, very safe and have very few contraindications. There are three other kinds of glaucoma medications (drops) that are often used. Only one of the four, (beta blockers) have major side effects and frequent contraindications.

It would help to know what a test called gonioscopy has shown your eye. If you are a pigmentary glaucoma suspect or if you have pigmentary glaucoma the angle of your eye will be very heavily colored brown with pigment granules dropping out of your iris.  This type of angle often responds very nicely to either of the two types of laser trabeculoplsty (Argon or nanosecond, frequency doubled Yag selective laser trabeculoplasty)

Pigmentary glaucoma also occurs in younger individuals (50 is young for glaucoma), often runs in families, is more common in males and myopes.

So now you know. Drops or ALT or SLT would both be good options for you.

JCH III MD Ophthalmology, Diease and Surgery of the Eyes

[Wyomingman]

A related discussion, Avoiding glaucoma was started.