Glaucoma

[frances318]

I currently suffered from glaucoma, with high myopia since young age.
I had a history of right eye retinal hemorrhage in March 2008 and left eye retinal hemorrhage in September 2009.  In June 2010, I had cataract surgery on both eyes because of kink vision, my IOP was 19 for both eyes. Considering I have significant thinning of the retinal nerve, my doctor said it is necessary to achieve a low IOP as far as possible. I have regular monitoring by Optical coherence tomography and visual field of central 30-2 by threshold program. I was put on Xalacom Eye Drops Solution (Xalacom) after the cataract surgery. The IOP drop a bit but linger around 16 to 18. AZOPT® was then added to my daily eye drop treatment in addition to Xalacom since August 2012. IOP remained 17 to 18 after then. I then undergo a selective laser trabeculoplasty (SLT) surgery in April 2014 with a hope to drop the IOP, my IOP improved marginally with 15 to 17 in 2014, and 14 to 17 in 2015. But lately it has come up to 19 to 20 in 2016.
The following are the most updated information on my eye condition:

Retinal nerve fiber thickness: 71.19 um (right eye) and 68.75 um (left eye)
Visual fields:
(a) Mean deviation: -1.74 dB (right) and -3.82 dB (left)
(b) Visual filed index: 99% (right) and 96% (left)

I am very concerned about the glaucoma condition is deteriorating and not responding to medical and SLT. My ophthalmologist advised me that that the next option is to add the last powerful eye drop, if it fails or losing its effectiveness, I will have to go for traditional surgery, but I can only attempt it once. Then there is no more option or treatment possible for me. So I will be blind totally. I become so worried about the likelihood of losing my eyesight and its grave consequences. I am desperately looking for treatment options that could possibly preserve my eyesight, no matter how slight. I would like to know what is the best treatment options for me now. I hope there is still hope

Thank you, in advance, for your help. I sincerely look forward to hearing from you.

[JohnHaganMD]

Yes best of luck. I believe you will be much relieved after a consultation.

[frances318]

Thank you so much for your advice, I will get a second opinion from a glucoma specialist and see what he says, thanks heaps again.

[JohnHaganMD]

Your despair is not warranted and your options plentiful. Moreover its not possible to quantitate  the severity of your glaucoma.  Your IOP is not out of control. Normal IOP is less than 20. I had two patients in my office this week so far with IOP over 30. So there are two types (beta blockers) and alpha adenergic agents like Alphagan-P (generic bromonidine) that you haven't tried.

If you do indeed have glaucoma you either have low pressure glaucoma (also known as normal tension glaucoma) or you have very thin corneas. There are 4 times of glaucoma medications available.  In the Xalacom family there are two stronger medications lumigan and Travatan-Z. If you do need glaucoma surgery there are many options and more becoming available all the time they use MIGS (minimally invasive glaucoma surgery) THEY CAN BE REPEATED IF NECESSARY.  There are also several new glaucoma drops in the testing pipeline.

My suggestion would be to gather all your test and records and get a second opinion from a ophthalmologist that specializes JUST IN GLAUCOMA.   You live in Hong Kong that won't be difficult to do.  You need at least one other opinion.