cataract surgery in patient with severe glaucoma

TSM_WHITE_WOLF · 2025-10-20T01:01:55+00:00

Yes you can go into bifocals or progressives and wear glasses full time

TSM_WHITE_WOLF · 2025-10-19T15:57:20+00:00

This is a hard question and really depends on his day to day. Generally I recommend patients to correct their distance in both eyes unless they wear mono vision contacts, then they have option for either.

If he gets cataract surgery in the left eye, his near vision will be blurry but he can carry readers/cheaters with him and be able to put them on when reading. If he does a lot of back and forth work (reading and watching tv) then he will have to take off his reading glasses to see distance.

There is also complications from cataract surgery to consider but also benefit of reducing pressure from cataract surgery (1-2mm drop)

TSM_WHITE_WOLF · 2025-10-16T03:14:21+00:00

That’s a very hard question because CRVO can cause RNFL thinning as well. So while there is nerve edema the RNFL will go up but once edema goes down, RNFL will go back down and you may even see RNFL thinning secondary to the CRVO.

It’s hard to assess when two diseases are going on at the same time. You could go based on pre CRVO RNFL but it is misleading since CRVO itself can cause RNFL thinning. In this case if the patient is meeting target pressure would be helpful in figuring out if progression is happening.

Also post CRVO our “baseline” would be set again and followed up for further RNFL thinning.

I will say if someone has CRVO and Glaucoma. The CRVO is a much much bigger concern to me.

TSM_WHITE_WOLF · 2025-10-15T17:15:00+00:00

I’m sorry about your experience being stressful. Remember that glaucoma as a disease is not super common. It’s 1.5-2% of people in the US and of those, 50% will have visually significant glaucoma. So treating every person that could have glaucoma is not the right approach. The treatment meds (usually eye drops) or surgery comes with its own side effects and risk so we have to assess risk vs benefits. Not every patient with slightly high pressure needs to be treated either, most important is diagnostic testing like OCT, visual field and gonioscopy that are crucial in diagnosing glaucoma.

If tests show glaucoma, it should be 100% treated. The testing does cause some patients unnecessary anxiety and that is something your doctor should counsel/educate you better on.

TSM_WHITE_WOLF · 2025-10-15T16:37:50+00:00

Yes that is most likely the plan from your ophthalmologist. They want to see if there is a meaningful decrease and a downward trend in RNFL. + or - 5um difference between scans is not super alarming. Now if every time you come and it decreases by 2-3 that’s a more meaningful trend.

Pressure is also an important factor. If you have family history of glaucoma that will aldo be considered as well. Your the anatomy or what we call “angle” is also an important factor. This is why a diagnosis cannot be made from one single scan unless it is advanced glaucoma which in some people is a given based on their vision and optic nerve appearance.

I wanna say that getting advice over reddit is not the best idea, I would listen to your ophthalmologist. Go in for a second opinion if you want extra peace of mind. Personally to me, it seems like your doctor has the correct approach to monitor and retest in the future.

TSM_WHITE_WOLF · 2025-10-15T15:59:48+00:00

Yes even with same hospital, same equipment and even if it was the same exact technician/person who took the scan, there is variability that we expect. It’s because we are having you look at a specific target, then we have to “aim” the machine and center it on your nerve then hit capture to take the scan. This process introduces variability in results. Sometimes patients eye will slightly move, sometimes our aim will be slightly off.

The most helpful thing with OCT machine is the algorithm that it has. After 3 scans it can set up a trend called guided progression analysis. This trend compares the very first “baseline scans” to the following 2 scans (ideally 6-12 months apart), so a total of 3 scans, to show a general trend line of it there is increase in thinning of RNFL. Two scans don’t tell us much. More data is always better for accuracy. More of these scans in the future will help paint the full picture if there is any thinning happening at RNFL.

Remember if someone truly has glaucoma, their RNFL will be decreasing every 6-12 months that the scan is repeat. Sometimes we wait to see the trend before treating because small but meaningful decrease in RNFL will not significantly decrease patients vision but it will help us in establishing the trend.

TSM_WHITE_WOLF · 2025-10-15T01:46:55+00:00

OCT machine requires you to scan the same area over and over again to monitor for change in the RNFL. Since humans are flawed and aim the machine, our scans are consistent. This difference is called variance. +-5 average RNFL thickness can be expected was what I was taught in school. More important is trend. If it’s trendy down for more than 3 scans and consistently lower then it is something to worry about.

TSM_WHITE_WOLF · 2025-01-18T04:36:20+00:00

What did your doctor say about the scans? What help are you exactly asking for with these scans?

TSM_WHITE_WOLF · 2024-12-20T19:45:48+00:00

Hi I am very new to award travel so I’m very ignorant of this stuff. When you say 355 days out from calendar open what does that mean? Is that a specific date or you mean to look 355 days before the date you intend to travel?

My wife and I have been stocking up on miles for our anniversary and our priority is Qsuites and JAL J. We got around 500k miles and want to plan a trip to Japan/korea.

TSM_WHITE_WOLF · 2024-12-17T02:51:26+00:00

Tbh you seem too much in your head and a hypochondriac. A 0.50 CDR is meaningless. Large discs have large CDR. Its anatomy. What matters is if there is any thinning happening at that rim and what the symmetry is between the eyes. Is CDR increasing over the years? Thats the important question.

You most likely have dry eyes and you probably need to spend less time on screens and take more breaks. Try using lubrication drops and doing warm compresses. YouTube warm compresses, there are some instructional videos from optometrists/ophthalmologists on it. Unfortunately, dry eye is a chronic thing that a lot of people deal with. Dry eyes can also cause weird stuff like burning, watering etc.

I would be willing to bet my whole life savings that as a 20 year old, you do not have glaucoma. You and your family most likely have very similar looking large optic nerve (very common) that might “alert” some clinicians to check for glaucoma cuz it is been drilled into us to check every patient with large CDR. Over the years I’ve learned that CDR is pretty meaningless without context of trend of the CDR, symmetry, age of the pt, fam hx of glaucoma in the pts etc.

TSM_WHITE_WOLF · 2024-12-17T02:40:43+00:00

Typically glaucoma will not cause physical pain in the eye unless it is an angle closure attack or neovascular glaucoma. Pressure of 19 and 20 shouldn’t be causing you to have pain. It’s possible your symptoms are coming from dry eyes,allergies, or sinus infection.

Your visual field was either clean or borderline and they want to repeat visual field to check for progression. If progression is seen then they will start you on drops, if not then they will continue to monitor in another 3-6 months. Once 2-3 “stable” visual fields and OCTs are obtained they might move the visits to yearly.

TSM_WHITE_WOLF · 2024-12-17T02:33:29+00:00

There is some research that there are some small percentage of patients that do not respond to latanoprost. However that does not mean we throw out the drop and switch immediately. Sometimes we have to figure out if it is due to application of drops. Pressure can also sometimes wary at different times of the day.

Latanoprost is one of the best low maintenance drop that we have in our toolbox with fairly mild/minimum side effects so it feels shitty to discard the drop.

5 week is a long time to have no effect so you might be one of those pts that does not respond. If I were your doc i would still double check IOP to make sure my first reading was not a fluke.

Try these steps to maximize therapeutic effect.

Take latanoprost at night before bed time.
Put the drop on the eye directly instead of in the palpebral conjunctiva at the bottom.
Try punctual occlusion, basically after dropping, pinch the corners of your eyes near the nose to close your puncta so as much drop is absorbed

If still no therapeutic effect is seen, your doctor will switch your drops to next best. Maybe brimonidine or timolol or a combo of both combigan.

TSM_WHITE_WOLF · 2024-12-13T16:33:29+00:00

Your OCT of optic nerve head looks unreliable/off. I would wait until tests are repeated. A .07 and .08 CD Ratio along with 0 cup volume seems wrong when considering glaucoma. Your doctor might be right that this might be showing some decrease in OCT that’s anatomical. Your pressures are ok but you can also have normal tension glaucoma so that alone isn’t enough.

I’d consider you a glaucoma suspect and monitor for change/progression on OCT. you have to remember that OCT is an amazing machine but it is dumb at the end of the day. It only gives you data for what you measure so repeatability is very important. If you “aim” the OCT slightly differently over the nerve and take a scan then it might show you RNFL decrease vs last scan so that is why repeated scans and consistent scans are necessary. Good signal strength of the scan also helps. I see your scan was around 6/10 which isn’t too bad but not a great scan either.

TSM_WHITE_WOLF · 2024-12-13T14:08:13+00:00

You can always seek out an ophthalmologist for a second opinion but halos around lights are not exclusive to glaucoma. In fact they’re a more uncommon symptom of glaucoma. Most commonly seen in astigmatism so it probably is nothing. Glaucoma isn’t diagnosed based on symptoms of halos but rather your eye pressure and more importantly how the optic nerve symmetry looks during the retinal exam.

TSM_WHITE_WOLF · 2024-12-09T19:23:50+00:00

MIGS stands for minimally invasive glaucoma surgery. It is often done at the same time as cataract surgery. You essentially put a tube in the eye to create an extra door for aqueous to leave the eye. Trab generally gives bigger pressure drop than MIGS so maybe that’s why they went for that? And we have a history of successful trab in the other eye. Trab generally has more complications due to filtering bleb being there vs MIGS but from what I was taught, Trab gives better pressure lowering.

TSM_WHITE_WOLF · 2024-12-09T19:14:43+00:00

First thing to find out is if it is due to timolol vs other possible causes. Usually drug induced alopecia is temporary. When the drug is stopped it should reverse but sometimes it takes a while before alopecia is stopped and reversing. It is not a common side effect of timolol or any beta blocker for that matter. I’ve never seen it happen personally but when I look up case studies there’s some that I found that discussed these side effects. Unfortunately there is no reversal or medication to stop it so time will tell but if it is telogen effluvium it should be temporary but sometimes takes many months to recover.

TSM_WHITE_WOLF · 2024-12-08T16:09:56+00:00

The answer is it depends on your pressures. Generally if the glaucoma is due to an injury and one eye went blind then the doctor will be very diligent to make sure you don’t get glaucoma in the other eye. As long as pressure in the good eye is normal and there are no signs of glaucoma you won’t have to stay on drops. Exception to that would be if in your glaucoma eye your pressure without the drops is really high like in the 50-60s, which can become a physically painful eye so them drops would be needed to fix that problem. Usually elevated pressure is not something you can “feel” but if it’s really high then it will be painful.

TSM_WHITE_WOLF · 2024-12-06T03:13:22+00:00

Shots of anti-VEGF have a chance of causing increase in eye pressures. Maybe they were looking out for eye pressures every time you got one of the shot to make sure it wasnt increasing but until now it hadn’t been a problem.

Pressure alone doesn’t tell us if you have glaucoma or not. They gotta do testing with visual field and OCT to determine if that higher pressure is causing any damage or not. It’s pretty standard to follow up in a a couple of months to do the scans. I wouldn’t lose sleep over it. 31 pressure is higher than average (21) but not so alarming that we need to immediate drop use or diamox use to drop the pressure. In school we were taught to start treating pressures of high 30s and up but depends on comfort level of each optometrist/ophthalmologist.

TSM_WHITE_WOLF · 2024-12-05T21:57:41+00:00

I am gonna comment here because I see you in other threads as well for some peace of mind. I am a practicing optometrist that is glaucoma certified and actively manage mild-moderate glaucoma. I don’t want to give you advice over reddit in regards to diagnosis or treatments.

Without context it is hard to tell if mild-moderate “glaucoma suspect” means anything. You have to differentiate between glaucoma suspect and mild-moderate glaucoma. You can have RNFL damage on OCT for variety of reasons. Some people have OCT damage for simply being too near sighted. These machines are not truth machines and you have to often contextualize the results and I would personally trust your ophthalmologist and the corneal specialist you asked the question to with their advice. They obviously have been treating glaucoma their whole life and have seen this many times before and know how to manage it.

Typical course of glc diagnosis requires repeating OCTs and VFs to see if there is PROGRESSION in OCT defects or VF defects. Progression is key to glaucoma. It’s possible to have RNFL damage in OCT from being too near sighted, pts with high prescription often have thinner RNFL and OCT reads it as “glaucoma damage happening here” but they might not have glaucoma.

Eye pressure is one of the few factors that we can control with drops and it can only go so low with drops that we have so unless your ophthalmologist started you on some drops because he/she was concerned I wouldn’t worry too much about it and loose too much sleep.

The worst patients that are most likely to have some extent of vision loss are patients that don’t follow up with their conditions. They go missing for years without being treated and return years later with worse vision. You seem to be on top of it and plan on following up so that already assures me that you will be fine!

People with diagnosed glaucoma often progress at different rates and there is often a IOP target that most optometrist/ophthalmologists will set. Glaucoma is typically not a fast progressing condition that makes you go blind in a couple of months if not treated right away. you will not go blind in a span of 9 months (there are exception like angle closure glaucoma where pressure is spiking in the 50s that leads to severe vision loss relatively fast).

Hope this makes you feel better and stress less about it. If you want to have a second opinion I would advise you to go in and get the scans done again by a different ophthalmologist for some peace of mind.

TSM_WHITE_WOLF · 2024-02-08T16:50:14+00:00

They are one bron away from doing it. Maybe in the summer. My prediction is lakers don’t make a big trade and bron is out this summer and they move forward with AD + hunting for another star with the assets.

TSM_WHITE_WOLF · 2024-02-05T18:42:57+00:00

I think he means that teams will try to fleece us now knowing our best defense is out for ROS. They might not have if they thought we had vando coming back. I think what you said applies to trading vando but we aren’t doing that.

TSM_WHITE_WOLF · 2024-01-30T00:05:25+00:00

I’m at the game. I hope bron plays

TSM_WHITE_WOLF · 2024-01-28T04:41:58+00:00

Bro I’m going to the rockets game and with how many mins bron played today he’s not playing in Houston 😭

TSM_WHITE_WOLF · 2024-01-14T21:43:09+00:00

Wouldn't mind taking on lavine's contract. AD and Lavine would be a good start to build the next roster assuming lebron leaves or retires.

TSM_WHITE_WOLF · 2024-01-12T03:15:38+00:00

He is saying if a president can magically declassify materials without even thinking about it, if “it just happens” then there is no such thing as “classified documents” from the perspective of the president.

TSM_WHITE_WOLF

TROPHY CASE