Your Questions About Glaucoma Treatment by Swaminathan Viramani

William asksâ&#x20AC;Ś

What are the risks of having a cataract operation done? I have bad eyesight from my younger days. Recently I have been diagnosed with Glaucoma (responding to treatment). Dr. says getting a cataract operation will improve my sight. I do not have any cataracts in my eyes. I am 45 years old, female. I have Type 2 Diabetes (though taking Insulin) but no retinopathy. I am short sighted as well as have astigmatism. Is it true that getting a cataract done - replacing lenses has some risks and the operation can go wrong?

admin answers: Risks of cataract surgery As in any surgical procedure, a small element of risk exists. Occasional unavoidable complications may occur during surgery such as infection, retinal detachment, macular swelling, hemorrhage, etc. While these complications are extremely rare, they may occur. In some cases, vision does not improve because of a preexisting condition such as macular degeneration, glaucoma or other diseases of the optic nerve and retina. It is impossible to predict in which patients these complications will occur. In some cases, there is a possibility that your vision may not improve as much as you would have liked. A very rare complication is the possibility that the intraocular lens will require removal or repositioning. No operation of any sort can ever be performed without risk. However, 95% of all patients having cataract surgery will see significantly better without complication. If patients with abnormal retinas are excluded from this group, the success rate becomes even higher.

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Richard asksâ&#x20AC;Ś

What are the best proven over the counter products for the treatment of cataracts? I've come across a product called Brite Eyes III, which supposedly is helpful for cataracts and glaucoma support, but have not found enough information or reviews about the product to make a decision about buying it for my stepdad. Products that can temporarily relieve symptoms of cataracts.

admin answers: None, cataracts are treated with surgery

George asksâ&#x20AC;Ś

Any tips on getting my Grandma with Alzheimer's to get through a laser eye Glaucoma treatment? She cannot be chemically sedated during these procedures. She is going blind and when I tried

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to take her for the procedure previously she flipped out and flailed and screamed until we took her home. She is going blind and needs this procedure. Any tips and or personal stories would be much appreciated!

admin answers: I would first talk with her Primary Care Doctor and see if they have any suggestions.

John asksâ&#x20AC;Ś

What is building up of fluid in the front side of the eye mean? My doctor has advised me to have a laser treatment in the eye to open the part where the fluid is bulding up. Has anyone undergone this type of treatment. Let me know your experience and any tips.

admin answers: There are a number of treatments for glaucoma. Glaucoma is a condition where the nerve at the back of the eye, the optic nerve...becomes damaged somehow related to pressure. This damage eventually goes back to the retinal ganglion cells which die....don't see no more.... In order for the eyeball to stay "firm", it produces aqueous. This is produced by the ciliary epithelium by passive (sort of a filter) and active (requires energy and gland like production of fluid) means.

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If the eye puts....let's say 5 drops of fluid into the eye a day, it'll drain 5 drops a day. If the drain gets a little stopped up for whatever reason...blood cells clogging it up=hemorrhagic glaucoma, white cells clogging it up=leukemic glaucoma or lymphoma, pigment cells clogging it up=pigmentary glaucoma, exfoliation of the lens capsule=exfoliation glaucoma ....whatever the reason... And the drain is clogged, it drains slower...the guys making the fluid don't know. They keep on cranking out that 5 drops a day. The pressure goes up till the fluid is forced out at 5 drops a day. If that pressure is too high for the nerve...and the nerve fibers become damaged and the ganglion cells are damaged and vision is lost...that's glaucoma. The treatment is to either increase the drainage rate OR decrease the production rate. That's IT. So we give people drops to do one of those or a combination of those two things...increase the drain or slow the production of aqueous. The laser treatments vary. The old trabeculoplasty was done around the drain every few degrees so that little scars were formed. These scars pulled on the meshwork between them, pulling open the meshwork in that area. Works for awhile, but it closes up again sooner or later. There are also laser Rx that puts little holes in the trabecular meshwork...hurts a bit, doesn't work all that well, but a good idea. The newest, latest, most coolest glaucoma surgery is done where a small canula is inserted into Schlemm's canal and a large portion of the meshwork is opened into the anterior chamber. This just works nicely with a large percentage of eyes not requiring any medication and pressures maintained in the low teens. Just as a precaution,...there are glaucoma specialists. If it were my eye, I'd see a glaucoma specialist not only for a second opinion, but possibly for the treatment itself. It's not that most general ophthalmologists don't know how to do this, they do. Some just love glaucoma. Some aren't all that fond of it. But the glaucoma guy...that's sort of all he does. Smart decision to travel. Don't not bother. Glaucoma treatments can become nightmare not only for you, for the doc as well. Have you ever seen how an advanced glaucoma person walks? Shuffle, shuffle, shuffle. See the glaucoma guy.

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Steven asksâ&#x20AC;Ś

What is astigmatism, has it anything to do with glaucoma? I want contact lenses and I thought the optician said my eyes were rhetoric, could he have been saying "Toric". I was advised to choose the most expensive daily throw away kind, as I just want to wear them a couple of times a week. I have glaucoma but got permission to wear contact lenses from my eye specialist.

admin answers: The answer by danish was beautifully written but was so GENERAL it could define most visual defects. Wikipedia has a good page explaining it: http://en.wikipedia.org/wiki/Astigmatism?wasRedirected=true If you google astigmatism there are plenty of user friendly sites that give good explanations. But if I were to try and give a simple description I would say astigmatism refers to having light entering the eye coming to focal points at different distances from the retina. Perfect vision requires ALL light entering the eye to come to a focal point EXACTLY where the retina is. The most common form of astigmatism is caused by irregularities in the curvature of the cornea. You can't actually see a persons astigmatic cornea if you wanted to because its actually transparent (invisible) This link below allows you to see what is the physical difference between an astigmatic eye and a normal one. These photos of cornea taken by specialists. It uses colors as a guide to smoothness. Green is normal/regular, blue and red colours however indicate abnormal steepness or flatness in curvature. (i checked the pics myself. They are mainly extreme examples) http://www.google.com/search?site=images&source=mog&gl=us&q=corneal%20topography Astigmatism is very common and effects a lot of people without them even knowing it. One cause discovered is from the pressure placed on the cornea by the eyelids while a person engages in activity such as reading. Due to the fixed position of the eye and the infrequent blinking scientists found that depressions

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can form the surface of the cornea after a long enough period of pressure from the eyelid. They noted though that these depressions usually disappear once the person rests their eyes later. It's also possible for people to be born with astigmatism. The cause of this is often people being born with oval shaped eyeballs. This is hereditary. A type of astigmatism with a completely different origin is one caused by irregularities in the crystalline lens (inside the eye) People with diabetes often develop this issue from having changes in blood sugar levels. Treatment of diabetes often brings the effected persons vision back to normal.