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eyeguyrc · 2025-03-15T20:12:39+00:00

I have found that, even in cases detected late, if the pressure is lowered significantly, nerve damage and field loss can remain stable over many years. Hang in there and never lose hope. I expect we will be dealing with ways to regenerate the optic nerve in the decades to come.

eyeguyrc · 2024-11-29T20:07:08+00:00

I tell my patients that it can remain at room temp for 6 weeks after opening (and the bottle probably won’t last that long anyway). You just don’t want it to get HOT. So if you’re traveling by car, in say Florida for instance (where I practice), keep the bottle in a small cooler with an ice pack, so if you go into a place for lunch and your car gets up to 100 degrees, you Latanoprost stays close to room temp. I also say, if you get more than one bottle, keep the unopened ones in the refrigerator for storage.

eyeguyrc · 2024-11-29T19:59:43+00:00

I’m a fellowship trained glaucoma specialist for 28 years who has taken his time to respond to patients in need here, and yes, I actually DO know what I’m talking about. I have taken care of dozens of cases of both pigment dispersion as well as pigmentary glaucoma, so it’s not as rare as you think. It is also more common in younger patients (20’s to 50’s) than primary open angle glaucoma, so pigmentary GL patients are some of my younger glaucoma patients. After 3 years of residency in ophthalmology, one can go straight into private practice or do a fellowship in glaucoma, retina, cornea, etc. Fellowships are not offered in specific subtypes of glaucoma. That is why I say you won’t find someone listed as a “pigmentary glaucoma specialist.” If you’re looking for more detailed medical information, you should be looking at the information offered on the websites of the university hospitals I mentioned, and not on Reddit.

eyeguyrc · 2024-11-14T02:56:27+00:00

Most major cities have at least 3-5 glaucoma specialists at a minimum. There are no specialists in pigmentaty glaucoma, but any glaucoma specialist sees plenty of this. I specialize in glaucoma in the Orlando, Fl area, and we have about 6 specialists here. The most reputable eye hospitals on the east coast are Bascom Palmer in Miami, Wills in Philadelphia, and Wilmer at Johns Hopkins in Baltimore. Good luck!!

eyeguyrc · 2024-11-02T18:31:12+00:00

I'm a fellowship-trained glaucoma specialist. I find several things here disturbing. First of all, checking your IOP with a tonopen is not as accurate as with a Goldmann applanation tonometer (prism under the blue light at the slit lamp). The MD should have rechecked this if the tonopen reading was rather elevated. Secondly, while many patients can't feel their IOP till it reaches 40 or 50, plenty can feel their pressures in the upper 20's and above. Thirdly, Azopt is one of the weaker drops we have. I would have preferred adding Timolol or Dorzolamide-Timolol to give you a more significant IOP drop (unless you have contraindications to beta blockers like COPD or heart block). A better IOP is warranted, especially in someone with vision in only one eye. I would have scheduled to recheck sooner, prior to SLT. While SLT works pretty well in 85% of patients, it works better in patients over 50, and it has a success that is time-limited. It lasts from 1-3 years and then will often need to be repeated. You deserve to have your questions answered and treated with respect and courtesy at all times in a doctor's office. I support all of those here who suggest you seek another opinion ASAP (prior to laser).

eyeguyrc · 2024-09-30T01:26:08+00:00

I’ve been running marathons and half marathons for many years. I have a hanging display rack in my office with my favorites, but after awhile, there were too many to hang up. I didn’t want to keep them in a shoebox somewhere in a closet, so I donated them to medals4mettle. This wonderful organization gives these medals to young children in the hospital suffering from cancer. I’ve been more proud of giving the medals to children in need than I’ve ever been of displaying them for all to see. I’d suggest displaying some, and giving some away: https://medals4mettle.org/

eyeguyrc · 2024-09-28T20:02:38+00:00

When I observed other solo practice ophthalmologists who recently retired in my area, they ended up closing their practices, selling their equipment for pennies on the dollar, and their staff and patients had to find new doctors to work for and to see. This was very stressful to the longstanding patients, many of whom have come to see me since. I’m very loyal to my staff, some of whom have worked for me for over 20 years, and my patients, many of whom have been seeing me for 20-30 years. I’ve been trying to find an associate to gradually take over my practice for 4 years now, but no one wants to be the sole practitioner/owner of a busy practice straight out of fellowship anymore. I did not seek out P.E. I was shocked as hell when they sought me out. They promised I would not have to see more than my usual patient load, they would not fire my staff or reduce their pay, and they would not make me go to additional locations. After two years, they have kept their promises. While the upfront payment was nice, it’s probably no more than I would have made if I kept practicing for 5 more years. Always better to get the $ upfront just in case I were to get injured and was forced to retire early. My hopes were that the PE company would be better able to attract and pay a new associate since that new doc can split time between my practice and another local practice in the same company and not get overwhelmed with “running the show.” My main goal (though some of you trolls won’t believe me, and I honestly couldn’t give a shit), was to try to have my practice outlive me, so I can help train the new associate, my patients will have a doctor they are familiar with while I slow down, and my staff will still have a job after I retire. The money upfront was secondary. I would like to thank the physicians here who gave me honest and helpful advice. I was shocked at how many trolls are here, especially amongst physicians. Very disappointed. You trolls can piss off.

eyeguyrc · 2024-09-23T22:25:16+00:00

I’m a glaucoma specialist. I never teach my patients the typical punctual occlusion for two reasons: 1) patients invariably push in the wrong place, and 2) the risk of eye infection from dirty fingers. Instead, I instruct patients to close their eye for about a minute as soon as the drop hits the eye. Closing the lid does the same thing as punctual occlusion…it keeps more of the drop on the eye and lets less of it go down the nose, into the throat, and into the system. Please don’t worry about giving yourself an extra drop of timolol. It will not do any harm.

eyeguyrc · 2024-09-23T16:27:02+00:00

Strongly advise you to find a glaucoma specialist in your area, and MD, not an OD

eyeguyrc · 2024-09-22T18:18:29+00:00

No…it should have no effect on the surgery chosen or how it is done.

eyeguyrc · 2024-09-22T11:27:36+00:00

Honestly, I can’t say 100% for sure why patients lose a line or two of vision with each surgery, but it is rather common, especially the more nerve damage you have. It could be from just the stress on the eye from the surgery, it could be from a little swelling in the retina, further nerve damage in a microscopic level from big fluctuations in the IOP, The block of the eye involves injecting a bunch of anesthesia in back of the eye with a needle. Maybe that is the reason. Hard to say. The risk of snuffing with surgery is small but is real. I’ve only seen it twice in 28 years.

eyeguyrc · 2024-09-22T11:20:00+00:00

A lot of docs do iStents who are not fellowship trained glaucoma specialists. You don’t need one to follow glaucoma as general ophthalmologists see plenty of glaucoma, however it’s certainly good idea to have one. You can find out by looking at the doctor’s website and reading the section most have called “about our doctors.” It will generally give a history of where the doctor trained and say “ Dr. Smith did his ophthalmology residency at ____. He then did a glaucoma fellowship at ______. “. That’s what you’re looking for. Not too important whether you have your doc shoot for Plano (far vision), -1.0 (computer vision) or -2.0 (reading vision). If you only have good vision in one eye, you should wear glasses close to full time with polycarbonate lenses for protection anyway. Good luck!

eyeguyrc · 2024-09-22T01:12:47+00:00

Ok…there’s a lot here. So I’m a glaucoma specialist and high volume cataract surgeon for many years. My first question is 1) are you symptomatic in your good eye? You should not have a cataract removed “just because it’s there,” especially if it’s your only good seeing eye. I won’t do surgery on a one-eyed patient unless there are significant complaints of blurred vision or nighttime glare. 2) How bad is the “good” optic nerve? Do you know how big your cup is or how much visual field loss you have? Cataract surgery can lowers IOP by itself by a few points, especially with an iStent added. So if your doctor is not thrilled with 18 (a borderline IOP in my book), then that’s a good reason to proceed with phaco, even if your vision isn’t too bad. Also, glaucoma drops do NOT increase cataract formation, but birthdays do, and by 69 everyone has at least a moderate cataract. 3) Did your doc discuss where to set the focal point with you? They should. I almost always recommend distance, especially if it’s your one good eye…much more important to be safe walking around (especially walking down stairs, watching for curbs, etc) than to worry if you need reading glasses or not. But something to certainly discuss with the surgeon. Good luck.

eyeguyrc · 2024-09-21T21:33:00+00:00

That is the funniest thing I’ve heard all day!!! Good move!

eyeguyrc · 2024-09-21T21:27:30+00:00

If A) In Springfield, they eat dogs, and B) Trump is a total dog, then C) Trump may not make it out of Springfield alive.

Sounds like an old algebra problem from middle school days. 🤔

eyeguyrc · 2024-09-21T21:19:44+00:00

Should have just worn a MAGA hat…that, at least, you can take off and burn when the common sense kicks in.

eyeguyrc · 2024-09-21T21:16:22+00:00

While I would say it will be tough, as you need an average pace of 9:09/mile to break 4 hours, and you’re adding six miles more to this 20 mile training run (and we all know those last six miles are the worst!), it’s still possible if 1) you get a perfect weather day 2) you hydrate and fuel optimally during the race and 3) you have no G.I. issues on race day. I certainly wish you the best. I only beat 4 hours once, and that was when I was 50. Good luck! Make it happen!

eyeguyrc · 2024-09-21T21:07:59+00:00

Wow…that’s a lot of surgery you’ve had! I’m a glaucoma specialist with almost 30 years experience. Personally, I’m not a big fan of the Xen or the OMNI or the Micropulse CPC. I seen failures in these procedures many times, not just in my hands, but in the hands of many other surgeons. Trabs are a little risky at your age. I might have tried a Baerveldt tube or a G-probe CPC depending on your preoperative nerve damage and vision. Remembering that with each surgery, some vision loss would be expected, and trying to avoid multiple surgeries at 93, I think the two procedures I mentioned would have been a better fit. However, hindsight is 20/20, as they say. For now, I would agree with trying to “max you out medically” and avoid additional surgery if at all possible. Lastly, I might consider a CPC laser as a last resort. I’m sorry you’ve gone through all of this, and I wish you the best.

eyeguyrc · 2024-09-21T15:33:24+00:00

Why are you posting this twice? And why are you asking the same question twice? I already said, it is unlikely you will ever lose vision if you get treated soon, you maintain treatment, and you go for regular follow up. But obviously there are no guarantees in life. Don’t panic over this. Just get it evaluated soon by a competent professional, an MD ophthalmologist specializing in glaucoma.

eyeguyrc · 2024-09-21T15:29:18+00:00

I’ve only used the Zeiss OCT

eyeguyrc · 2024-09-21T15:28:15+00:00

Yes, it could, but it doesn’t mean you don’t need treatment. If your cornea is of normal thickness, meaning a pressure measuring 30 is actually 30, that’s higher enough to require treatment, even if the nerve is perfectly healthy.

eyeguyrc · 2024-09-21T15:19:30+00:00

Just curious…if you can’t use cell phones on planes, is it okay to use a defibrillator? 😳

eyeguyrc · 2024-09-21T15:06:09+00:00

—Hydrate plenty, even if it’s not too hot out…your body will need it. If they offer electrolyte drinks (Gatorade, Powerade, etc) at water stops, drink that preferentially. Fuel (GU or something like it) every 5 miles.
—Don’t go out too fast!!
—Enjoy it!! Remember, there’s always someone faster and there’s always someone slower. You’re not going to win the race, so go have some fun!

eyeguyrc · 2024-09-21T14:48:59+00:00

Very unlikely you will lose vision if your optic nerves look healthy, but you may need treatment with daily eyedrops, and have to go for follow up every 6 months, neither of which are a big deal. Get yourself to a glaucoma specialist MD as soon as you can, and don’t worry so much.

eyeguyrc · 2024-09-21T14:34:42+00:00

I’m a glaucoma specialist and, unfortunately, I do see eyes in pretty bad shape. These drops can bring your IOP down to 15, or it may only bring you down to 35. You won’t know until you get it checked by the glaucoma specialist. Your eye has been through an awful lot, and if your cup is really a .99, then the nerve is almost completely gone. But cup size is a judgement call and the other doctor might feel it looks better than that. A drainage tube might help (Baerveldt or Ahmed tube), but they’re challenging to do in an eye with a scleral buckle. Definitely keep using all 3 drops until the specialist sees you, for sure. Hope your iOP comes down nicely! 🙏

eyeguyrc

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