Q&A on Glaucoma

Questions were answered by Burt Dubow, OD, and Charles Slonim, MD

Q: My eye specialist has stated that I may be developing glaucoma. Can it be avoided? Are there things I could do now to delay or prevent it from occurring? — G.K., Ontario, Canada

A: Glaucoma is an eye condition whereby the optic nerve fibers die from a lack of blood supply (nutrition). This used to be associated only with high pressures. We now know that it is the blood flow to the optic nerve, which connects the back of the eye to the brain, that makes a difference in glaucoma — not just eye pressure. Unfortunately, once optic nerve fibers die, they cannot be rejuvenated.

So, can you do something to prevent glaucoma? Good question. We don't really know the answer. I can tell you that current research is suggesting that optic nerve nutrition can be enhanced with certain drugs and also with certain nutritional agents, like gingko biloba.

My suggestion would be to avoid smoking and excessive alcohol, eat a healthy diet, keep your weight down, exercise, take nutritional products, and be sure to see your eye specialist on a regular basis. — Dr. Dubow

Q: Have you heard about a test to measure nerve fiber thickness to help in the early detection of glaucoma? It is done with a machine called GDx. — S.H., California

A: Yes, the machine you refer to performs a very detailed optic nerve analysis for the diagnosis of glaucoma. The manufacturer claims that the very early glaucomatous changes can be determined. The test takes only a few seconds. — Dr. Slonim

Q: What are the signs of glaucoma? I have polarized glasses and see rays reflected from car headlights. Could it be because of cataracts? — E.S., California

A: Usually there are no signs of the most common type of glaucoma (chronic open-angle glaucoma). Slowly rising pressure inside the eye can be detected only by having the intraocular pressure (IOP) checked at an eye doctor's office.

Cataracts are possible with those symptoms. Sounds like you could use a thorough eye exam. — Dr. Slonim

Q: I have glaucoma and a cataract. Will I have good results with my cataract surgery? — A.P.

A: The combination of these two conditions does not reduce the success of the cataract surgery. Cataract surgery alone will not alleviate your glaucoma. Your glaucoma can still progress whether or not you have cataract surgery. The results of your surgery usually depend on your surgeon and what happens at the time of your surgery. — Dr. Slonim

Q: How can one have high eye pressure and not have glaucoma? At what high range do the eye drops start? — E.C., Pennsylvania

A: Normal pressure in the eye is between 12 and 21mm Hg. Some patients are fortunate in that their optic nerves can tolerate pressures outside this range.

If there are no other signs of glaucoma (i.e., visual field defect or optic nerve changes), then high pressures can be followed and simply observed. Most docs will, however, treat a pressure greater than 30mm Hg. Those patients with higher than normal pressure but no evidence of glaucoma are referred to as ocular hypertensives (no relationship to blood pressure). — Dr. Slonim

[Read more about ocular hypertension and visual field testing.]

Q: My son, who is 11 years old, is under glaucoma treatments. He has had a pressure curve test, an RHT, and slit lamp examination. All info confirms diagnosis of juvenile hereditary glaucoma, in the early stage.

He was given some drops to use regularly, but I was informed that some drugs can induce sexual problems due to beta blocking action. Are there new drugs that are more reliable for this illness? — A.G., Argentina

A: Many of the anti-glaucoma mediations can have systemic side effects. As the drops are absorbed into the eye, some of the medication gets absorbed into the blood stream and can, therefore, affect other parts of the body.

There are a number of good glaucoma medications. However, each has its own set of potential systemic side effects. The main goal is to keep the eye pressure under control with the minimal amount of medication.

Some beta blocker type glaucoma medication can cause impotence and/or reduce one's libido. If an unwanted systemic side effect does occur, then another medication may need to be substituted. — Dr. Slonim

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[Page updated July 2009]