Question about patients with high myopia and glaucoma

[Kenan2000]

I've read that not only severely myopic patients have a higher chance of developing glaucoma but also that :1) it is much harder to diagnose at earlier stages, 2) in myopic eyes the very same glaucoma will be more aggressive.

This, of course, raises great concerns in my mind considering that i am high myopic (-4.75 LE, -5.75 RE) and only 18 - my myopia might continue increasing until 21-24 (may God forbid).

I'm sort of addressing to Dr. Hagan, have you had severely myopic glaucoma patients?How did the medications work on them?Did they go blind eventually?

I've read that patients with medications and laser/surgeon that developed open-angle glaucoma can go on without going blind pretty much for the rest of their lives (35+ years) (at least if it's not juvenile, have not found such lucky cases yet, unfortunately), on the other hand i don't know whether myopic glaucoma patients are less lucky in this case or not.

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

The general incidence of glaucoma in the general populations with special risk factors that live a normal life span is 2% among high myopes (and your are barely hi myope and at age 18 very unlikely you will get beyound -7.00) the risk may be double, which sounds bad, but that is only 4% so most high myopes don't get glaucoma.   Glaucoma is harder to diagnose because of 2 reasons:   1. The cup/disc ratio is larger in myopes  2. the cornea is generally thinner .   However with visual fields, cornea pachymetry readings,  nerve fiber layer OCT its not all that difficult.  See an Eye MD ophthalmologist every year and going blind from glaucoma is very unlikely.   Most glaucoma patients go blind because they don't use their medicine, stop going to the doctor or don't have the disease diagnosed until end stage.

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

Also recent evidence indicates diet high in colorful vegetables especially dark leafy greens may reduce risk of glaucoma, we have know for several decades those sorts of food reduce risk of age related macular degeneration.

[Kenan2000]

Thank you for your great answer, Dr. Hagan, did you really have severely myopic glaucoma patients?I'm really curious about your practice with such patients.How were they doing in general?With years such patients' condition usually was getting worse or not?

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

Over the years the focus of my practice has changed. I no longer do pediatric strabismus surgery  and glaucoma is a large part of what I do not.  I personally treat over 1000 people with glaucoma. Yes I have high myopes and most of them do very well.  They tend to be very contentious and keep their appointments and use their medication. Plus in the last 3 months two new glaucoma medications have been released in the USA and available most countries world wide. They add to the 4 families of glaucoma medicines we have had for the last 2 decades.  PLUS when cataract surgery is done on difficult to control glaucoma patients now a variety of MIGS (micro invasive glaucoma surgery) is now available. Moreover things will only improve over time.  I also failed to mention we use a lot of laser treatment for glaucoma now (ALT or SLT).

[Kenan2000]

Thank you, Dr. Hagan, your words are truly reassuring!

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

Happy to help, happy to hope