Treatment options

[Jesse1188]

I used to be a very active, healthy person, occasionally inconvenienced by migraines. Since I turned 45, I have been overwhelmed with hereditary health problems: high BP, high cholesterol, mild arthritis, borderline hypothyroidism  (TSH 4.5),  Raynauds, factor V Leiden (heterozygous) . I have been thoroughly worked up, because my family doctor was surprised by all the problems that started cropping up. The latest - suspected glaucoma, is quite a shock. I don't have any family history of glaucoma - only of heart disease and stroke. My grandmother lost all vision in her left eye as a result of a "blood clot". I have no visual field defects and the RNFL in both eyes are "borderline", so I see the ophthalmologist again in a few months to see if there is progressive damage. I have a few questions after doing some reading on the topic:
1.  How are decisions regarding NTG treatment made? Is wait and see an option?
2.  As I have normal IOP, are there other mechanisms that can cause the optic nerve damage, e.g. insufficient blood flow, etc.?  Will treatment of an underlying condition halt the progression of glaucoma?
3. I read that extreme fluctuations in IOP over day and night can cause optic nerve damage. Can eye pressure be stabilised?
4.  My IOP, on Aceon 4mg for high BP,  was 16 in both eyes. After stopping Aceon, the reading was 18 in both eyes. Is this change significant? Should I start BP meds again?
5. My eyes are light sensitive and the left eye occasionally has blurry vision. At night, street and car lights have "rays" radiating from the centre, but no halo's. Are these signs of glaucoma?
6. Can an MRI help to identify the cause of glaucoma, e.g. abnormal blood vessels, etc?

I am a hands-on person.  I normalized my cholesterol and BP levels within 8 months with diet and exercise and was able to go off Aceon. (I quit under medical supervision and subsequent 24hr ABPM showed  borderline to normal BP, normal dipping at night, etc.) I know I cannot do anything about glaucoma if I do in fact have it. I just want to be 100% sure that any treatment that may be prescribed addresses the problem and won't make it worse, as I have read it is possible when NTG is treated. Is it true that NTG also has a worse prognosis because IOP is not the only cause?  Sometimes research is confusing and scary. I guess ignorance is bliss. My husband is an MD, but cannot answer my glaucoma questions. I am just gathering information. The Medhelp Foums helped me to overcome high BP and cholesterol, but my eyes are even more important. Thank you!

[John C Hagan III, MD, FACS, FAAO]

Thanks and good luck to you.

JCH MD

[Jesse1188]

Thank you, Dr. Hagan.  I will definitely keep on seeing my ophthalmologist.  I am sure he will tell me about the developments in neuroprotective meds for glaucoma caused by pressure independent mechanisms.  Maybe they will be available by the time I need drugs.  As a result of lifestyle changes, I am beginning to look and feel great; maybe that will benefit my eyes too. Thank you for your straightforward answers.  I started seeing double from all the big words in the ophthalmology articles! That is Latin not intended for the laity.

[John C Hagan III, MD, FACS, FAAO]

1. NTG (normal tension glaucoma): treatment is begun if damage is detected to optic nerve, optic nerve fiber layer, or visual field.  You will need to see an eye MD at least twice a year the rest of your life.
2. The mechanism of NTG causing damage is unknow, treatment is problematic. Progression is common. New glaucoma medications to stop this pressure independent mechanism (neuroprotection) are in the pipeline.
3.If damage occurs because of high fluctuation of IOP that is NOT NTG.
4.NO  HPB medications don't generally affect IOP. Exception is beta blockers which lower IOP.
5. If high IOP has been excluded then no they are not symptoms of glaucoma.
6. NO

NTG does seem to benefit or at least slow progression by lowering IOP as low as possible with drugs. There is some question at Alphagan-P might have some neuroprotective benefit.

JCH MD