Hi Dr. O and Dr. Hagan!

[toughilou]

Both of you wonderful doctors have helped answer questions for me in times past, and I have one more. I went to my eye Dr. today, and he seems put off by my asking to understand my diagnosis or even know my test results. He said I have the chronic open angle glaucoma 2 months ago. My pressure was 26 in both eyes. Today it was down to 21, thanks to the ketorolac drops. I really had to press for that tidbit. Anyway, I tried to impress him a bit today by letting him know I'd done a bit of homework and used big words like aqueous humor (he he he) and let him know I knew what signs to be wary of if one should develop the closed angle type of glaucoma. I'm so goofy. I rattled off the red eyes, the fixed, mid-sized pupil which doesn't respond to light, etc. He seemed impressed that I had at least tried, and even shook my hand. Jaw Drop! :) Anyway, he gave me a bit of disturbing news just as I was walking out the door. "Be very faithful about taking your eye drops twice a day because your right eye is borderline closed angle." HUH? That's what I get for being over confident. I thought I was totally safe from sudden attacks of Glaucoma. My question is this. What in the world does that mean? Borderline for closed angle? It's really got me kind of scared.

[toughilou]

Thank you so much, Dr. Hagan! I hope a world of blessings bestow themselves upon you. You are my second opinion, as far as I am concerned. So, if my Dr. still thinks I should undergo iridotomy, I will do it. You have really set my mind at ease, and I am glad you mentioned all the variables for how a sudden attack could occur. So, I won't be too hard on my Dr. It's like diagnosing abdominal problems, I suppose. One thing mimics another and always so many things to consider. Thank you, and have a great Holiday season! :)

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

Don't be too hard on your MD. It is often every difficult to tell if an angle is occludable and thus suseptable to angle closure (which can occur as acute, subacute, chronic, and reoccuring).

If he offered to do a LPI (laser peripheral iridectomy) they he must think its a problem. Cases must be individualized but in many cases it is safe to wait weeks to months if the angle is not closed and the IOP up.

It is true that medications like cold, sinus, diarrhea, allergy can theoretically induce an attack of angle closure however it must be very rare as in 35 years in practice with a couple of thousand glaucoma patients at all times I've never seen it.


LPIs are not expensive and are covered by insurance with standard disclaimer of deductibles and copayments.

If I'm sitting on the fence about an angle I have a couple of glaucoma specialists that I respect highly and I will usually get a second opinion.  Good luck with your surgery.

JCH MD

[toughilou]

Oh, I forgot. Do you still think I may need to get the laser iridotomy? He did offer to do it last time, but I told him no because I had gallbladder surgery this year and am getting another surgery this Friday for something else. Also, I read a tidbit online today about how a Dr. should warn his patient if they refuse surgery about stress and otc cold meds. Is there anything else I should know that could cause a sudden attack? It seems horrible my Dr. didn't warn me of these things if they are true. I feel I deserve to know, even if he thinks I'm too duh, duh, duh to understand because I will research a subject tirelessly until I do understand when it is of interest to me. I will get the surgery, if necessary. It's just that, at income tax time, I have to get my last 4 teeth pulled and get new dentures, too. Fallin apart. Does insurance usually cover laser iridotomy? We have a wonderful insurance company. They paid 100% of my gallbladder surgery.

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

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[toughilou]

I am so sorry! I actually meant to say Timolol Maleate. I get them mixed up. He had me on Ketorolac along with Timolol because I have the recurrent erosions, too, but you said Ketorolac was not a great choice, before, so I abandoned it in favor of generic Muro128 and he said I should switch to just plain artificial tears. The pain I was experiencing in my orbits when I coughed was unbearable. I had to push on my eyes because it honestly felt like they would pop out if I didn't It has resolved itself through 2 courses of strong and stronger antibiotics, so I guess that part was just a serious sinus infection. Phew! I love this forum. I learn something here every time I check in. You all are the greatest! :)

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

treating glaucoma with ketorolac is an off lable use of the medication. No sure why you're on that and not a standard medication.   I may mean that your angle is borderline, as we grow older the lens pushes the iris forward and a "mixed mechanism" glaucoma may develop. That requires a laser iridotomy.

Either discuss it at length more with your Eye MD or get a consult from a glaucoma Eye MD second opinion.
JCH MD