Thanks for bringing this up. I have just started looking at the
research linking flaxseed oil to prostate cancer and it looks pretty
weak from what I have seen so far. I think I'll follow your example
and keep taking my milled flaxseed.
David
http://fiteyes.com/blogs/
Mike
Did your Dr. ever mention, Pilocarpine? It is an old drug, but
sometimes does the trick, It comes in 1,2,3,and 4% in strength. I am
on the same 3 drops you are on, Alphagan only 2 x a day, except I am
also on Pilo 1%, 4 x a day. Hope this helps
Thank You, Tom! I swear as I get older I get "stoopider"! Mary
Hi,
Did you notice I already posted that Trisorb does have preservatives.
" I did get a response from the manufacturer. To their credit, a quick one. Trisorb DOES have preservative.
Other products of theirs don't, but they do not contain the Trisorb. These are the others which are preservative free:
Systane Preservative Free, Bion Tears, and Tears Naturale Free."
I hope this info helps anyone who had been following this theme.
Best,
Lilian
let me just jump in here regarding flaxseed/flaxseed oil. The research that showed the relationship between flaxseed oil and prostrate cancer is, at best, dubious. The so-called research derived data from a sample-set of men who had been on meat-rich diet. Since meat contains alpha-linoiec acid (ALA), this research concluded that diet high in ALA is a risk for prostrate cancer. It is true that flaxseed oil (not milled flaxseed ) contains high level of ALA. That is that - these researchers never actually determined a direct relationship between flaxseed oil and prostrate cancer. In the old world, people have been taking flaxseed oil for centuries.
I am a 42 year old male, and I take a couple of teaspoons of Trader Joe's Blueberry milled flaxseed every day, and it tastes great.
Roy Rogers <lonecowhand@...
Mary,
You take the flaxseed oil orally. I was using the bottled flaxseed oil and
was taking a tablespoon at night and one in the morning. I stopped taking it
because it has been linked to increased risk of prostate cancer in men. So,
don't want to take a chance with that.
Tom
I am on Cosopt 2 x day, Lumgan daily , Alphagan 3 x day and just had Diamox added in an effort to avoid surgery. I had laser treatment in both eyes and my IOP is 12-13, but I am still loosing vison. Thus, my doctor just added Diamox stating that if he can get me down to an IOP of 10 then I will not need surgery. I am loosing too much sight with my present IOP.
I have not tryed any other eye drops and I have read that because of the dorazolamide in the cosopt, is so similar to Diamox, Diamox is almost never used. Thus, I don't expect much help with the Diamox since I am already on Cosopt. At this point I feel surgey is all but certain. He has added the Diamox as a last effort to avoid surgey as he was opposed to adding it 1 year ago when I suggested it. Does anyone have any ideas on what else can be added or modified ?
Lilian,
If you or anyone else has trouble using my blog, please feel free to contact me directly and I'll try to help.
Here are the steps for starting a general discussion on my site:
1. Sign in first.*
2. Go to this link in your web browser: General Discussions
3. Click the button that says "Write a New Post". It is near the upper right of the page, a couple inches down from the top. If you have HTML email, here is what the Write a New Post" button looks like: [INLINE]
4. You will see a form on the page where you can type a subject and a message. Write your message in this form.
5. When finished, click the button that says "Post". This button is in the lower left area of the page.
No, they aren't.
Small pupil (a glaucoma sufferer)
Dr. Ritch,
As always, am grateful for the careful information you posted on Flax seed and how to use.
With great appreciation and regards,
Lilian
Would taking a Vitamin C supplement have any effect on this condition in XFS?
Hi,
"Lillian, I find that Trisorb is available at
Walgreens. Its a non prescription medicine. Click on
this link if you want details. Best wishes from David"
Others have commented on Trisorb. I did get a response from the manufacturer. To their credit, a quick one. Trisorb does have preservative.
Other products of theirs don't, but they do not contain the Trisorb. These are the others: which are preservative free:
Systane Preservative Free, Bion Tears, and Tears Naturale Free.
Thanks to those who responded.
Lilian
I just bought Barlean's fish oil as they seem to have a very good
reputation. Do you know whether they are also so scrupulous about
making sure their fish oil is high quality?
-Deah
I have used flax seed oil for some time now (different need). It is true
that it goes rancid. It oxidizes. For that reason Barlean's, maintained at
most health food stores, is regularly cycled off the shelves (dated) in their
refrigerators. Barleans has a very high recommendation from even
European nutritionists in that they cold press their seeds and constantly
monitor the age of stock maintained by their distributors. You must keep it
refrigerated at home.
ffurgy_|_gruffy, commenting from the Mad Hatter's Picnic
Mary,
You take the flaxseed oil orally. I was using the bottled flaxseed oil and
was taking a tablespoon at night and one in the morning. I stopped taking it
because it has been linked to increased risk of prostate cancer in men. So,
don't want to take a chance with that.
Tom
Just for fun, I will speculate about how Xalatan could cause a frozen shoulder. This is purely speculation. I don't know if Xalatan has ever actually done anything like this. I simply like to think about these things from a biochemical perspective and see if I can see a potential relationship. In this case I'll explain what I think I see in a bit of detail.
Xalatan is a prostaglandin F2-alpha analogue. Prostaglandins are naturally occurring local "hormones" that have diverse and important effects in all human tissues, including the eye. Prostaglandins can be divided broadly into two types depending on their fatty acid precursor: the omega-6 derivatives or omega-3 derivatives. The omega-6 derivatives are metabolites of arachidonic acid, a long-chain unsaturated omega-6 fatty acid. Prostaglandins such as prostaglandin F2-alpha are of this type. That means Xalatan is closely related to the omega-6 derived family of prostaglandins. The omega-6 derived prostaglandins are the inflammatory prostaglandins. Metabolites of this pathway can be potent mediators of inflammation. As Searlaid said below, there can be an inflammatory component to a frozen shoulder. So is there a connection...?
I suppose it would be quite difficult for two drops of Xalatan to have any potent systemic inflammatory effect. Given the fact that most Americans eat 10 or 20 times more omega-6 fatty acids (the ones that metabolize into the inflammatory prostaglandins) than omega-3 fatty acids (the ones that have the opposite anti-inflammatory effect), what could a couple drops of Xalatan contribute to this balance that would be significant? I assume most of us would conclude that Xalatan would not contribute much.
I probably should just delete this email without sending it. However, I'll send it because this discussion has aroused my curiosity about Xalatan's possible connection with inflammation in glaucoma - just pure speculation again. Maybe this is something I'll look at in more detail later...
David
http://fiteyes.com/blogs/glaucoma/
Koliakos GG, Konstas AGP, Schlötzer-Schrehardt U, Holló G, Katsimbris IE, Georgiadis N, Ritch R: 8-Isoprostaglandin F2a and ascorbic acid concentration in the aqueous humour of patients with exfoliation syndrome. Br J Ophthalmol 2003;87:353-356.
BACKGROUND/AIMS: The authors investigated the concentrations of 8-isoprostaglandin F(2a), a marker of oxidative stress in vivo, and ascorbic acid, a protectant against oxidative damage, in the aqueous humour of patients with exfoliation syndrome (XFS) and cataract and compared the results with those in age matched patients with cataract, but without XFS, to determine whether XFS is associated with increased oxidative stress. METHODS: Aqueous humour was aspirated at the beginning of phacoemulsification cataract surgery from 27 eyes of 27 cataract patients with XFS and 27 eyes of 27 age matched cataract patients without XFS. 8-Isoprostaglandin F(2a)concentration in the aqueous was determined with a commercial immunoassay; ascorbic acid concentration was measured with a microplate assay method. RESULTS: The mean concentration of 8-isoprostaglandin F(2a)in the aqueous from patients with XFS (2429 (SD 2940) pg/ml; range 400-10500 pg/ml) was significantly higher than that measured
in the aqueous of age matched control patients (529.1 (226.8) pg/ml; range 325-1000 pg/ml); (p = 0.0028). Furthermore, mean ascorbic acid concentration in XFS patients (0.75 (0.39) mM; range 0.28-1.70 mM) was significantly lower than that found in control patients (1.19 (0.47) mM; range 0.53-2.4 mM); (p = 0.0005). There was a reverse correlation between 8-isoprostaglandin F(2a)and ascorbic acid concentration. CONCLUSION: 8-Isoprostaglandin F(2a)was significantly increased in the aqueous of patients with XFS, and ascorbic acid was decreased, providing evidence of a role for free radical induced oxidative damage in the pathobiology of XFS.
Here is the handout I give to my patients on flax seed. Also, 2 patients have told me their cholesterol dropped significantly after starting flax seed.
On 4/23/07 9:18 PM, "Mary Aversano" <maa4@...
I'm glad you understand, Lilian, `cause I am still confused! Cheryl, do you put the flaxseed oil into your eyes? If so, can you explain what time of day and how you do this? If anyone else knows, I sure appreciate knowing---either I have been not following this thread correctly or I am getting a fuzzy brain! Thanks for any clarification, Mary
I read eye drops for glaucoma can cause cataracts. Is there any benefit of using normal saline eye drops 10-15 minutes after the glaucoma drops to flush out excess glaucoma drops? Would doing so decrease the chances of cataracts ? Flushing eyes with saline drops after 10 minutes, would that effect the IOP ?
Abu-Amero KK, Morales J, Bosley TM. Mitochondrial abnormalities in patients with primary open-angle glaucoma. Invest Ophthalmol Vis Sci. 2006;47:2533-2541.
PURPOSE: Primary open-angle glaucoma (POAG) is the second most common cause of blindness. It has been linked to mutations in the myocilin (MYOC) and optineurin (OPTN) genes, although mutations have been found in <5% of patients. The pathologic mechanism(s) of POAG remain unknown but may include retinal ganglion cell apoptosis, which causes progressive damage to axons at the optic nerve head. METHODS: In 27 patients with definite POAG, the MYOC and OPTN genes were sequenced, the entire mitochondrial (mt)DNA coding region was sequenced, relative mtDNA content was investigated, and mitochondrial respiratory function was assessed. RESULTS: Only three benign polymorphisms were identified in MYOC and OPTN in patients with POAG and in control subjects. Conversely, 27 different novel nonsynonymous mtDNA changes were found, only in patients with POAG (not control subjects), 22 of which (found in 14 patients) were potentially pathogenic. Unlike Leber hereditary optic neuropathy, most
mtDNA sequence alterations in patients with POAG were transversions-sequence changes that alter the purine/pyrimidine orientation and imply oxidative stress. mtDNA content was relatively increased in 17 patients with POAG compared with age-matched control subjects, also implying a possible response to oxidative stress. Mean mitochondrial respiratory activity was decreased by 21% in patients with glaucoma compared with control subjects (P<0.001). CONCLUSIONS: These results reveal a spectrum of mitochondrial abnormalities in patients with POAG, implicating oxidative stress and implying that mitochondria dysfunction may be a risk factor for POAG. This concept may open up new experimental and therapeutic opportunities.
David,
Thx. Sorry, I don't remember how to "take discussion" to your blog. I also get overwhelmed with blogs, have never joined one. Would like to learn more about ghee for eye health. Could you please direct me to where that info is posted?
Lilian
Here's a similar idea from Ayurveda... this method has been used for
thousands of years: use ghee in the eyes. You can either put a drop of
ghee in at bedtime or you can bathe the eyes in warm ghee. We can take
the discussion to my blog if you want to go into more details about ghee.
David,
Thx. I had seen the box/graphic, I just did not find if it contains preservatives. I e-m the pharmaceutical now, will share the response if I get one.
Lilian
David,
Thx, I had no idea the oils can/do go rancid in gelcaps. Will try to read more before I ask my GS for opinion. I go carefully, have had iridotomy both eyes, and also irridoplasty and SLT about 100 "holes" in right eye.
Lilian
Lillian, I find that Trisorb is available at
Walgreens. Its a non prescription medicine. Click on
this link if you want details. Best wishes from David
http://www.walgreens.com/store/product.jsp?CATID=100216&navAction=jump&navCount=\
1&id=prod5284
Unsaturated oils can (and do) go rancid inside gelcaps. Maybe you
could look for a product that contains an antioxidant like vitamin E
if you really want to avoid contaminants like lipid peroxides.
David
http://fiteyes.com/blogs/
I'm glad you understand, Lilian, `cause I am still confused! Cheryl, do you put the flaxseed oil into your eyes? If so, can you explain what time of day and how you do this? If anyone else knows, I sure appreciate knowing---either I have been not following this thread correctly or I am getting a fuzzy brain! Thanks for any clarification, Mary
Hi smallpupil,
I am currently in Sao Paulo city. I discovered I had
glaucoma just about three months ago. I must say the
medical care has been very good. What kind of glaucoma
do you have and what drops are you using? Have you
done a retinography, pachymetry and visual field test?
I have done all three and its the retinography results
that the doc. looked at the most. I have been asked to
go for a pressure measurement every fifteen days or so
just to keep a track on how I´m doing with the drops.
I am doing that. If with the drops there is some
control I will be more than happy. Must wait and see.
Hugs to all my friends and fellow sufferers. Yáll are
just great. David
Hi Cheryl,
Your message
"The flaxseed oil is in the form of a 1000 mg gelcap" is a great one. I was just thinking yesterday that opening a gelcap would at least insure the flaxseed is not contaminated. Now that I understand what you do, I will ask my GS if it is ok for me to try.
Thanks so much.
Lilian
Hi Brazil :),
Now I wonder if the other David knows if any of these ingredients are preservatives? Most of the time anything in a bottle instead of in individual plastic units for immediate use do have preservatives.
Thanks
Lilian
Dear David Miller,
Bem-vindo ao Brasil (Welcome to Brazil). Are you here for how much time and
living at what city?
The ingredients of Trisorb here in Brazil should be written in Portuguese and
are dextrano, hipromelose and glicerol.
Hugs,
Small pupil (a glaucoma sufferer)
I have an interest in krill oil because it is high in certain carotenoids as well as supplying DHA and EPA. We know DHA and carotenoids are important for vision.
Krill oil may be more effective than fish oil...
This morning I wrote a blog post about krill oil that may interest anyone with glaucoma .
Regards,
David
http://fiteyes.com/blogs/
Dear Sherry,
Please help find the attachment to Dr. Ritch's letter.
I went to the website but couldn't find it there under files eithers.
Thanks,
Sari
Not that anyone has ever reported
On 4/23/07 11:24 AM, "dshale1" <Dshale1@...
Could there be any connection between taking glaucoma eyedrops, such
as the prostaglandins, and cornea arcus in patients who have normal
cholesterol levels?
-Deah
Robert Ritch, MD
Professor of Clinical Ophthalmology
Chief, Glaucoma Service
Surgeon Director
The New York Eye and Ear Infirmary
310 East 14th Street
New York, NY 10003
Medical Director and
Chairman, Scientific Advisory Board
The Glaucoma Foundation
Private - Tel: 212-673-5140
Director of Intelligence: Karen Cheifetz
kcheifetz@...
Patient Appointments - Tel: 212-477-7540
Fax: 212-420-8743
e-mail: ritchmd@...
http://www.glaucoma.net
http://www.nyee.edu
The flaxseed oil is in the form of a 1000 mg gelcap.
Cheryl
Deah,
Have you looked at a possible connection between cornea arcus
appearance (when it wasn't present at birth) and oxidative stress?
David
http://fiteyes.com/blogs/
Hi,
I'm sorry to hear that your son has glaucoma.
I'm personally interested in the medical history and jargon, particularly if you have researched this deeply. I'm interested in any discussion related to hypoxia, immune involvement, oxidative stress and blood flow (retinal perfusion or systemic blood flow issue) and I would be happy to communicate with you on these topics. Maybe we can share ideas. (However, I'm not a doctor and I know nothing about surgery.)
You might also want to check out my blog (see link in my signature).
Regards,
David
http://fiteyes.com/blogs/
Could there be any connection between taking glaucoma eyedrops, such
as the prostaglandins, and cornea arcus in patients who have normal
cholesterol levels?
-Deah
I have an 8 y/o son with glaucoma, diagnosed in Dec 06 with primary
open angle glaucoma-juvenile onset. pressures are not under control
yet, despite the use 4 different drops. We anticpate surgery of some
kind soon. We have done a fair amount of research on surgical options
and are not convinced that the recommended trabeculoplasty(scleral
flap) is the best option. I am looking for points of view from
parents who may have gone through a similiar experience. I have
omitted all the medical history and jargon, but can provide that info
is someone responds and thinks it will be helpful. Thanks, mm.
Hi Lilian,
I looked up the composition of Trisorb as listed on
the box. It is manufactured by Alcon, and has three
ingredients
dextrana
hipromelose
glicerol
The names are in Spanish/Portuguese as I am currently
living in Brazil. The English equivalent should be
there, since Alcon is an international company famous
for its eyedrops. All are soothin to the eye and it
feels soft as silk when applied.
I must say Trisorb has been very effective for me for
dry eyes, extra irritation and so on. As for the
actual glaucoma medication, I am on Timolol twice a
day and Travatan once at night. The Travatan makes my
eyes sore, red, irritable. However it does pull the
pressure down more efficiently than Timolol. With
Timolol my readings were around 20 and the Travatan
addition has dropped it a further four points to 16.
So the discomfort is worth it. And with Trisorb the
discomfort is gone.
--- "Lilian Rosenbaum LCSW-C, Ph.D."
David,
Thank you for your careful response. Sounds like a worthwhile try, will ask my GS to make sure it is ok for my specific situation. So glad it works for you.
Lilian
Hi. I'm new to this group but thought I'd throw in my two cents worth on your frozen shoulder, since I've had major bouts with it. Usually a frozen shoulder is caused by two much repetition of some joint(s). I had both shoulders freeze up. Right one took a very long time to get functional through physical therapy, home exercises, anti inflammatory prescriptions. Heat worked best for me. You should contact a rheumatologist on this as soon as possible. My mom was on Xalatan for many years with no problems. Good Luck.
Pegster
I completely agree with you, Lilian. Dr. Ritch is amazingly generous
in helping us with information and advice. Thanks Dr. Ritch.
David
http://fiteyes.com/blogs/dave/
Thank you Dr. Ritch. You are so generous, work so hard for so many of us to benefit from your research, dedication, and careful work. Will study your paper slowly. A great relief to read about non-pharmaceutical compounds from a trusted source - you :).
Lilian
Cheryl,
Thank you again. Sorry, still not clear if the "stuff" off the shelf is oral or is sold as a form of eye drop.
Lilian
Hi David,
Thank you. I tried to google Trisorb, seems as if it is a product part of another eye drop.
Two questions. 1-Did you find Trisorb by itself or as a component in something else?
2- Is it preservative free?
Thanks again,
Lilian
I had something similar maybe 15 years ago. I kept seeing blue, most around twilight. My ophthalmologist explained it. It was something about blue's place on the spectrum. He said not to worry about it.
Dr. Ritch could surely explain it than I have. I'm not very scientifically minded.
The polka dots sound like something retinal. I have a lot of trouble adjusting from outdoor light to indoor light and have had what I think is similar to what you're describing.
David and Xia
NYC
I recently saw a blue neon stripe across the lower portion of my vision. Also see polka dots when I go out into the sunlight. I also see a section of bluriness out to the edge of my vision. Does anyone have any ideas what this could be?
Cheryl
**************************************
See what's free at http://www.aol.com.
From the last paper I posted
Robert Ritch, MD
Professor of Clinical Ophthalmology
Chief, Glaucoma Service
Surgeon Director
The New York Eye and Ear Infirmary
310 East 14th Street
New York, NY 10003
Medical Director and
Chairman, Scientific Advisory Board
The Glaucoma Foundation
Private - Tel: 212-673-5140
Director of Intelligence: Karen Cheifetz
kcheifetz@...
Patient Appointments - Tel: 212-477-7540
Fax: 212-420-8743
e-mail: ritchmd@...
http://www.glaucoma.net
http://www.nyee.edu
It sounds to me like a coincidence. I did have frozen shoulders and attributed them to radiation treatment in that general area. I had a lot of p.t. also but found massage from a licensed therapist the most helpful treatment. (Sorry for going off-topic briefly.)
I started Xalatan after that and the shoulders haven't frozen again. It seems that, since I seem to have a propensity toward that, it might have if Xalatan causes that.
Just guessing, really.
David
Hello everyone,
After being on Xalatan for 18 months, I suddenly developed a frozen
left shoulder (adhesive capsulitis). My ophthalmologist took me off
eye drops for 3 weeks. Although I have less pain, and in spite of
being in physio 3 times a week, my shoulder is still "frozen". Just
wondering if anyone else has experienced this, if it could be caused
by the Xalatan, if the Xalatan could have contributed to the
development of this condition due to some kind of auto-immune
response, of if it was just an unfortunate case of bad timing (other
factors like the fact that I am 52 and post-menopausal) and taking
this medication.
I take no other medications and there are no other explanations for
the adhesive capsulitis (frozen shoulder).
Alternative eye treatment, i.e. different drops really scares me.
I would really appreciate hearing from others about all of this.
Thank you.
**************************************
See what's free at http://www.aol.com.
thanks for the tip! I don't use drops yet. I am just being watched. I was hoping for some ideas for preventing it from getting worse. Joanne
It just seemed to address the irritation and redness I was getting from the drops and dry eyes.
Cheryl
I recently saw a blue neon stripe across the lower portion of my vision. Also see polka dots when I go out into the sunlight. I also see a section of bluriness out to the edge of my vision. Does anyone have any ideas what this could be?
Cheryl
I just buy the off the shelf stuff.
Cheryl
I have a new post on my blog that should interest you. This is actually the first post on my new glaucoma blog and the article is about our latest understanding of the mechanism that leads to retinal ganglion cell death in glaucoma.
It is a fairly technical article. It attempts to explain the exact biochemical and cellular mechanisms that lead to loss of vision in glaucoma. However, if the article doesn't make complete sense, please leave comments or questions on my blog and I will attempt to clarify things further. You can leave comments (after signing in) by scrolling down to the bottom of the article and typing your comment or question into the text box - then click submit.
Many of my past blog articles have focused on intraocular pressure. However, thanks to guidance from Dr. Ritch, I am now expanding my focus to other issues related to glaucoma. This article is the first of many I hope to write on topics related to the latest research in glaucoma.
Please visit my blog and let me know if you enjoy this article - leave comments on my blog.
Regards,
David
http://fiteyes.com/blogs/glaucoma/
Hello everyone,
After being on Xalatan for 18 months, I suddenly developed a frozen
left shoulder (adhesive capsulitis). My ophthalmologist took me off
eye drops for 3 weeks. Although I have less pain, and in spite of
being in physio 3 times a week, my shoulder is still "frozen". Just
wondering if anyone else has experienced this, if it could be caused
by the Xalatan, if the Xalatan could have contributed to the
development of this condition due to some kind of auto-immune
response, of if it was just an unfortunate case of bad timing (other
factors like the fact that I am 52 and post-menopausal) and taking
this medication.
I take no other medications and there are no other explanations for
the adhesive capsulitis (frozen shoulder).
Alternative eye treatment, i.e. different drops really scares me.
I would really appreciate hearing from others about all of this.
Thank you.
I had this and according to what the doc. told me it
was dry eyes. He recommended using Trisorb - dont know
if it is available where you are. It can be bought at
any drugstore, does not require a prescription, and it
soothens the eyes. He said I could use it without
restriction. I do use it as and when I need it and it
works. Another thing he told me is that its not
uncommon to use glaucoma medication for a long time
with no reaction at all, and then to start getting
allergy symptoms. This aspect, as to whether you are
developing an allergy, can only be figured out by your
specialist I guess.
--- "Lilian Rosenbaum LCSW-C, Ph.D."
Cheryl,
Thanks so much. It does some to be dry eye. I had read your posts before but not followed the chain that carefully, and thought you were drinking the Flax seed oil. I take orally 1,000 mg cap/day. Are there any precautions to type of flax seed oil so as not to get infection? Is there a special formulation for eye drops, or use some version of organic flax seed oil normally taken orally? I assume w/out preservatives?
Thanks so much,
Lilian
David,
This may be very hopeful, but If I am reading correctly, aren't we
talking about mice?
As I understand, we already know how to cure glaucoma in mice, but
not all is translating to humans.
Are we talking about humans or mice in this article?
Kathy Jundt
I was about to ask the same question! Mary
can I ask, what does the flax seed oil do? I am a glaucoma suspect,and looking for ways to prevent my pressure from going higher! Thanks, J
1000 mg. of flax seed oil. Put drops in pocket, not directly onto eye.
Cheryl
Can you identify the medications in their colloquial terms?
Cheryl
Hello,
I have seen posts on conjunctivitis, but have no idea what my recent symptoms are (will try to see my GS next week). The "white" is slightly red near the tear duct, and after I put in drops (Azopt and Lumigan) which I have been using successfully for many years I now get a burning sensation.
Have been trying to review if I did something different. Possibly, b/c of surgery (not in eyes) I was a little less careful to use non Rx drops like Endura in between the Rx drops. My plan is to use those several times between the Rx drops during the weekend. I don't have pain or other symptoms, and it does not feel like an emergency so if possible prefer to wait until I can see my GS. Should I be doing something else or go to an ER (usually no glaucoma experts there).
Thank you so much.
Lilian
This abstract summarizes some things that should interest the group:
Chidlow, Glyn, John P M Wood, and Robert J Casson. "Pharmacological
neuroprotection for glaucoma." Drugs 67, no. 5 (2007): 725-59.
Glaucoma represents a group of neurodegenerative diseases
characterised by structural damage to the optic nerve and slow,
progressive death of retinal ganglion cells (RGCs). Elevated
intraocular pressure is traditionally considered to be the most
important risk factor for glaucoma, and treatment options for the
disease have hitherto been limited to its reduction. However, visual
field loss and RGC death continue to occur in patients with well
controlled intraocular pressures and, thus, a consensus has recently
emerged that additional treatment strategies are needed. One such
strategy is pharmacological neuroprotection, which in the context of
glaucoma, refers to the situation in which a drug is deployed to
interact with neuronal or glial elements within the retina/optic nerve
head and thereby facilitate the survival of RGCs. The advent of animal
models of chronic glaucoma has enhanced our understanding of many of
the pathological processes occurring in glaucoma and, in doing so,
described logical targets for pharmacological intervention. Such
targets, which have been manipulated with varying degrees of success
in relevant animal paradigms include glutamate receptors, autoimmune
elements, neurotrophin deprivation, nitric oxide synthesis, oxidative
stress products, sodium and calcium channels, heat shock proteins and
apoptotic pathways. With exciting data now emerging from many research
laboratories, it is obvious that pharmacological neuroprotection for
glaucoma without doubt represents an exciting development in the
search for a treatment modality for this debilitating disease.
David
http://fiteyes.com/blogs/dave/
Clinical Update: Glaucoma
Overlap Syndrome: The Multiple Factors of Multiple Glaucomas
By Miriam Karmel, Contributing Writer
Your glaucoma patient has long been stable on pressure-lowering therapy. So
how do you now explain a sudden spike in pressure and new progression of
visual field loss? Before changing the medication or blaming patient
noncompliance, you might want to consider what Robert Ritch, MD, calls
³overlap syndrome.²
Overlap gives name to the situation in which the patient with glaucoma
develops a newand differentglaucoma risk factor that can speed
glaucomatous damage. Overlap can also be used to describe the coexistence of
two or more frank glaucomas in one eye, each of which may have a distinct
etiology, time of onset, presentation and clinical course. Recognizing
overlap conditions allows for new ways of treating patients, particularly
those with secondary and normal-tension glaucomas.
Dr. Ritch, who is a professor of clinical ophthalmology and chief of the
glaucoma service and surgery director at the New York Eye and Ear Infirmary,
said, ³Basically, if you have a patient with glaucoma who has been
well-controlled and clicking along for some time, and then all of a sudden
either the pressure goes up in one eye or a visual field destabilizes, that
suggests the development of a second condition superimposed on the
glaucoma.²
Explaining Overlap
The overlap concept was first introduced in 1990, in a report of five
middle-aged patients with increasingly uncontrollable IOP.1 All patients had
exfoliation syndrome (XFS) and were then found to have had pigment
dispersion syndrome (PDS) as well.
Following that report, Dr. Ritch and colleagues conducted a retrospective
chart review of records at New York Eye and Ear Infirmary, and identified an
additional 26 patients who had combined PDS/XFS. 2, 3 Those two glaucomas
have no known etiologic relationship.
XFS is the most common identifiable disorder leading to the development of
open-angle glaucoma worldwide, and it constitutes about 12 percent of
glaucoma in the United States, where the combination could affect up to half
a million individuals. In the context of PDS/ XFS, the overlap theory
explains why patients with previous pigment dispersion syndrome who go on to
develop exfoliation may be more susceptible to elevated IOP than patients
with XFS who have not had PDS. The reason: preexisting damage to the
trabecular meshwork.
Helpful model. While there can be other overlap combinations, PDS/XFS was
chosen as a paradigm for the syndrome because of the ease of diagnosis and
its prevalence. ³Itıs easy and straightforward to look at patients who have
clinical evidence of PDS and pseudoexfoliation,² said Raghu Mudumbai, MD, a
coauthor of the overlap studies and assistant professor of ophthalmology, at
the University of Washington, Seattle.
Dr. Mudumbai reiterated Dr. Ritchıs definition of overlap glaucomas. ³In
patients whose glaucoma is decompensating, and itıs not an effect of the
medication not working as well, or the patient not being compliant, perhaps
itıs a third possibilitythat a new comorbidity has been introduced that has
exacerbated the underlying glaucoma.²
Not necessarily obvious. Some overlap combinations, in fact, may not be
readily apparent to the ophthalmologist, Dr. Mudumbai said. For example,
after developing glaucoma, a patient may develop another risk factor that
may not be as self-evident as pseudoexfoliation, but which may nevertheless
contribute to the decompensation of the patientıs glaucoma. ³Overlap
syndrome is a two-hit hypothesis,² he continued. ³One hit is your initial
glaucoma process that causes some damage and some difficulty with pressure
control, for example. Youıve been able to manage it fairly well with
medication. But now, you introduce a second problem that overwhelms the
system and as a result of that, decompensation takes place.² The second hit
could be the appearance of XFS in patients who previously had pigmentary
dispersion syndrome, or it may be a pressure-independent process.
Pigment, pigment everywhere. ³Overlap is a useful concept about which
ophthalmologists need to be aware,² said Donald S. Minckler, MD, professor
of ophthalmology and pathology, University of California, Irvine. Dr.
Minckler said that the PDS/XFS combination, as described by Drs. Ritch and
Mudumbai, provides a very good basis for establishing the concept of
overlap. ³The important point is that patients with pigmentary dispersion
with or without glaucoma have pseudoexfoliation-associated risks added to
those of pigmentary dispersiona double whammyprobably with a worse
prognosis,² he said. ³Common sense dictates that the physician should watch
for pseudoexfoliation to appear in pigmentary dispersion patients. Since we
only see what we are looking for, being aware of the possibility is
important for the small percentage of such patients whom we might
encounter.²
Take care in the OR (and the gym). Another example, Dr. Minckler said, is a
patient with open-angle glaucoma whofor various reasons, sometimes ocular
surgerydevelops progressive angle closure with a significant change in
symptoms. ³I have also rarely encountered patients without typical pigment
dispersion who developed remarkable IOP rise postcataract surgery, probably
provoked by intraocular manipulations and resulting in iris pigment release,
with obstruction of outflow channels. Such pigment stormsı can be confused
with uveitis and can also occur in rare cases after vigorous exercise in
patients with pigmentary dispersion syndrome.²
Borrowing From Beyond the Eye
Thereıs precedent for looking beyond any single etiology for a particular
pathology, said Dr. Mudumbai, noting that cardiovascular disease provides an
example to support the overlap syndrome. ³Who ever would have thought that
tooth cavities or gum disease would be related to cardiovascular disease?
But itıs been shown that having poor dental health can lead to inflammatory
factors that can lead to cardiovascular disease.²
The cardiovascular example, which involves factors not typically related to
heart disease, suggests that ophthalmologists who concentrate solely on IOP
might not be able to control the glaucoma if they neglect to consider
pressure-independent risk factors.
IOP not always revealing. When he elaborated the concept for Eye M.D.s at a
1999 meeting of the American Ophthalmological Society, Dr. Ritch told
colleagues, ³We are entering an era in which we are becoming more aware of
the existence of an ever increasing list of nonpressure-dependent risk
factors for glaucomatous damage.² The risk factors he cited included: atrial
fibrillation, vasospastic or autoregulatory disorders, nocturnal
hypertension, abnormal platelet aggregation, hemorheologic abnormalities,
sleep apnea and autoimmune phenomema. The development of one of those
non-IOP-dependent risk factors may cause the sudden acceleration of
glaucomatous damage.
³If somebodyıs been controlled for a long time and then goes out of control,
donıt just juggle the medications,² Dr. Ritch said. ³You have to look for a
new kind of glaucoma starting up, or a non-IOP related risk factor. Look for
something new thatıs developed.²
Advice to clinicians. Dr. Mudumbai agreed. The sudden decompensation should
be a red flag, he said. ³You should at least go through the mental process
of seeing whether another problem has been introduced thatıs feeding into
the change thatıs occurred.²
Donıt doctors ordinarily do that? ³They do,² Dr. Mudumbai said. ³But you
should be more in tune for the possibility that another process may be going
on that is affecting the patientıs glaucoma. Itıs fairly easy to say, Okay,
the medicationıs not working; I need to add another medication,ı as opposed
to saying, Maybe something else is happening. Maybe I should look again for
pseudoexfoliation.ı²
Dr. Ritch added that a better understanding of the etiology of new risk
factors is required before appropriate treatments can be devised. In the
meantime, he said that thinking in terms of overlap can form the basis for
³understanding the sequential appearance of various risk factors over the
course of the life of a patient with glaucoma.²
In their 2000 Ophthalmology report, Drs. Ritch and Mudumbai expressed hope
that awareness of newly arisen risk factors ³will stimulate both a search
for the specific causes in a particular patient workup and interdisciplinary
investigations to identify these risk factors, with the goal of expanding
our therapeutic armamentarium.²
As far as I know, antibiotics remain ineffective against viral
problems. They are often given to prevent a "secondary bacterial
infection" -- but often there is no justification for giving
antibiotics for a viral infection. Unless things have changed
dramatically since I last researched this, antibiotics are
overprescribed and are often just given so the patient doesn't walk
out empty-handed.
It might be worth verifying whether your condition is viral or bacterial.
When I first started on LUmigan I had bad congestion which turned into a sinus
infection. But after that first infection those nasty side effects went away.
Has anyone had sinus problems since using glaucoma eye drops. I have
had quite a few problems and some sinus infections since I started the
drops and wondered if anyone else has had a similar problem. I am
very careful to use the proper technique when putting in the drops.
Grace
I was having a problem and started using 1000 mg. of flax seed oil (geltabs). It seemed to have resolved. However, I use Xalatan, not travatan. I did have a reaction to travatan.
Cheryl
Does anyone know which stereoisomer of resveratrol was used in this study?
Doganay, Selim, Mehmet Borazan, Mustafa Iraz, and Yilmaz Cigremis.
"The effect of resveratrol in experimental cataract model formed by
sodium selenite." Current eye research 31, no. 2 (February 2006): 147-53.
Wine, grapes and peanuts have the trans isomer, but the herb most
commonly used to make resveratrol supplements (Polygonum cuspidatum)
contains an equal mixture of cis and trans isomers.
I'm trying to make an informed decision whether to use Polygonum
cuspidatum-based products or an alcohol-free red wine extract product
or something else. Any opinions?
David
http://fiteyes.com/blogs/dave/
I've been having problems with conjunctivitis of the eye this past winter. This has happened about 5 times since Sept. I have both macular degeneration and glaucoma and am on Travatan drops once a day for the Glaucoma. I am very careful to wash my hands thoroughly and dry them with my own towel before putting my glaucoma drops in my eyes.( I have been on Travatan since 2003.) Each time this happens I have to go to the doctor and get an antibiotic for the conjunctivitis. I can't understand why these infections continue to occur! Has anyone else had this eye problem and what can one do to prevent this from happening again? Thank you in advance for any advice you could give me about this.
Lorraine
I had thought of making a comment along the lines of Mary's doctor's but did not want to seem to be stifling conversation or one-upping people. I do agree with what he said and feel that darkening under the eyes can be covered by make-up for women and probably just laughed off by men who are not film or television performers.
To clarify, a little about my history with glaucoma: I was diagnosed about 30 years ago, when I was in my late twenties. My ophthalmologist, an eminent doctor but not a glaucoma specialist, tried pilocarpine on me. Because I was then actively highly myopic -- that is, I wore hard contact lenses with each a minus 21 correction -- the pilo made me seem to go blind within ten minutes. This was the only drop she offered -- maybe the only one that existed back then? -- and she said she'd just *observe* the pressures.
My subsequent doctor, a renowned expert on retinitis pigmentosa, which I also have, tried various drops on me and all had very painful side-effects. He did numerous laser procedures to try to bring down the pressure and none did a thing. (When I was under the knife for cataract surgery, that specialist tried other procedures for the pressure but they failed also.) (He did finally get me on Trusopt and Xalatan and I started again on pilocarpine this year.)
Bottom line: I now have almost no sight and wouldn't know if I had dark circles or confetti glued under my eyes.
My point is that most of the people on this list seem to be very proactive, to be seeing glaucoma specialists, reading up on glaucoma through the Internet and asking their doctors questions. I can understand that the circles might seem unnerving initially and could cause one to wonder *Am I the only one who's ever had this response?* But in the overall scheme of glaucoma and eye disease, they do not seem too serious. Take it from someone who seems to have done things wrong and learned the hard way.
Regards,
David and Xia
original message
his response was very direct and matter of fact. "It is a side effect that you'll just have to live with in treating your glaucoma and there is nothing you can do to prevent it."
**************************************
See what's free at http://www.aol.com.
Thank you all for responding about darkened skin from
the drops. At least I know now that its a common side
effect.I guess if it happens we have to live with it,
see the funny side and call it our special racoon look!
I raised this issue of darkened skin from the drops with my glaucoma specialist some time ago and his response was very direct and matter of fact. "It is a side effect that you'll just have to live with in treating your glaucoma and there is nothing you can do to prevent it." He did say to be sure to keep the drops in the eyes and off the skin because some drops can be irritating to the skin itself in people with sensitive skin.
Mary
**************************************
See what's free at http://www.aol.com.
Normally this happens with Travatan, Lumigan or Xalatan, but I don't
think you've been on the Travatan long enough to see that effect.
However, darkening of the tissue surrounding the eyes is common with
that class of eyedrop. I've heard of people putting vaseline on the
skin around their eyes before administering the drops. All I do,
however, is cover the dark circles with makeup.
-Deah
Same thing happened with my mom. In one eye, however, the pressure
eventually went back up again, so she is currently on glaucoma
eyedrops for just the one eye. Pressure has remained low in the other
eye, but she never had any vision loss in that eye either, so now her
doctor says she doesn't have glaucoma in that eye.
-Deah
Hi everyone! Does anybody have this problem and how do you deal with
it? I was recently diagnosed with glaucoma and use one drop of
Timoptol twice a day and a drop of Travatan once at night. Its been
two months with the Timoptol and a week with the Travatan. This
morning I noticed that there is a definite darkening of the skin under
my eyes. Does anybody else have this? I know its a minor issue
compared to our eye problems but nevertheless it is upsetting. Thanks.
Yup...permanent mascara I calls it....
gruffy
millerdavid2002 <millerdavid2002@...
Hi everyone! Does anybody have this problem and how do you deal with
it? I was recently diagnosed with glaucoma and use one drop of
Timoptol twice a day and a drop of Travatan once at night. Its been
two months with the Timoptol and a week with the Travatan. This
morning I noticed that there is a definite darkening of the skin under
my eyes. Does anybody else have this? I know its a minor issue
compared to our eye problems but nevertheless it is upsetting. Thanks.
You may or may not get a pressure rise from inhaled steroids. If you need them, you need them. You should just get your pressure checked while taking them and if it starts to go up, then find an alternative.
R
On 4/14/07 6:16 PM, "MairCH@..." <MairCH@...
Dr. Ritch,
I was recently diagnosed with COPD following a bout with bronchial pneumonia and the pulmonologist said that I desperately needed to get the lung and bronchial inflammation under control with steroid inhalers. I objected because of my low tension glaucoma but he said that it should not be a problem since it is breathed in and not ingested. He did add, however, that he is unfamiliar with low tension glaucoma and to discuss this with my opth. My glaucoma specialist is on vacation and the general opth didn't really know how to answer this. The pulmonologist wants me to use two puffs of the steroid twice daily for a month and then reduce to one puff twice daily thereafter. Please tell me if I am risking my sight prematurely by trying to save my respiratory tract??? This is very scary to me and I'm not sure how great the risk really is. My pressures were 13 and 14 when last checked. I am using Lumigan one drop in each eye at bedtime. My opth said that my recent HRT
indicated that we will probably be adding a second drop at my next appointment in June.
Any advice and/or input will be greatly appreciated. I am petrified of losing my sight but I certainly want to breathe.
Thank you in advance,
Mary in Colorado
**************************************
See what's free at http://www.aol.com.
Robert Ritch, MD
Professor of Clinical Ophthalmology
Chief, Glaucoma Service
Surgeon Director
The New York Eye and Ear Infirmary
310 East 14th Street
New York, NY 10003
Medical Director and
Chairman, Scientific Advisory Board
The Glaucoma Foundation
Private - Tel: 212-673-5140
Director of Intelligence: Karen Cheifetz
kcheifetz@...
Patient Appointments - Tel: 212-477-7540
Fax: 212-420-8743
e-mail: ritchmd@...
http://www.glaucoma.net
http://www.nyee.edu
Thanks so much for the reminder to change the subject line when the topic
changes!
Also it really helps me out if you all would make sure you trim your posts
before sending replies - esp anything not pertinent to your response and of
Dr. Ritch,
I was recently diagnosed with COPD following a bout with bronchial pneumonia and the pulmonologist said that I desperately needed to get the lung and bronchial inflammation under control with steroid inhalers. I objected because of my low tension glaucoma but he said that it should not be a problem since it is breathed in and not ingested. He did add, however, that he is unfamiliar with low tension glaucoma and to discuss this with my opth. My glaucoma specialist is on vacation and the general opth didn't really know how to answer this. The pulmonologist wants me to use two puffs of the steroid twice daily for a month and then reduce to one puff twice daily thereafter. Please tell me if I am risking my sight prematurely by trying to save my respiratory tract??? This is very scary to me and I'm not sure how great the risk really is. My pressures were 13 and 14 when last checked. I am using Lumigan one drop in each eye at bedtime. My opth said that my recent HRT
indicated that we will probably be adding a second drop at my next appointment in June.
Any advice and/or input will be greatly appreciated. I am petrified of losing my sight but I certainly want to breathe.
Thank you in advance,
Mary in Colorado
**************************************
See what's free at http://www.aol.com.
Moderator of the glaucoma group:
Perhaps I am being too concerned about a detail, however, it seems to me
that if someone wants to comment on a certain subject line--that subject
line should remain the same. If the next message is one of birthday
greetings and a different subject entirely it would be helpful for the
subject line to change. When I post requesting any ideas regarding a
concern, I want to be able to follow that subject line for good
responses. Just a thought to help everyone!
linjan
Good afternoon, All.
Does anyone know of any PC program that can interpret Humphrey Visual
Field data taken from a VF test of a person (GAZE.DAT, GAZE.IDX,
PATS.DAT, PATS.IDX, PDB.DAT, RXS.DAT, RXS.IDX, SITES.DAT, SITES.IDX,
TESTS.DAT, TESTS.IDX), so that we can print the VF test without using
the Humphrey machine?
Thanks,
Small Pupil
My name is Greg and I am on Predinsone (currently 25 mg. down from a
high of 60 mg.) for an autoimmune disease (Wegner's Granulomatosis WG).
I am also on Methotrexate 20 mg. I have had Scleritis in both eyes
where it started in the left eye (this is part of the WG). Currently
the Scleritis is calm after a recent flare in late Feb-early March. I
have been having problems with eye pressure and mostly in the left eye
due to the oral predinsone which I started in August 06. I have/am
being treated with Cosopt, Alphagan, Xalatan and Diamox (500mg. BID).
This assortment of medicines was able to lower my pressures to 20/high
teens for about 4 months, until the last Scleritis flare. My pressure
for the left eye (only) varies from the high 20's (28-9) to the low 30
(31-3) range and has been edging up the past three weeks even though
the prednisone has been tapered from 40 mg to 25 mg in that same time
period. My Glaucoma specialist is recommending that I have seton valve
surgery due to the Scleritis issue.
All the doctors (7) involved in my treatment have indicated that once I
am off the oral predinsone or the dose is lower than 10 mg. I will not
have the eye pressure problem. I am looking for any suggestions or
cases similar to mine for information and alternatives if any.
Sincerely,
Greg Pakieser
My Mom had cataract surgery and her IOP came down. The
doc said this is because the cataract was removed.
Hope this info. helps. Thanks for sharing the news
about flax seed oil and allergic conjunctivitis. Must
try it.
I don't know if any of you have heard of the Brick Awards, but it's an award
given to young people for making the world a better place.
http://www.dosomething.org/brick
Jennifer Staples, the founder, president and CEO of Unite for Sight
http://www.UniteforSight.org won a Golden Brick Award last night, which gave
her $25,000 for her organization! http://www.cwtv.com/thecw/brick
Unite for Sight is a world-wide organization of 4,000 volunteers and has
served over 400,000 people in Jennifer's quest to improve eye health and
eliminate preventable blindness. Her organization has an amazing 98% of
income going to programs and only 1% each to fund raising and
administration!
You can read an interview with her at
http://people.howstuffworks.com/do-something-brick-awards-winner-jennifer-st
aple.htm.
She's an amazing young lady whom I had the pleasure of meeting a few years
ago. Let's all give her a big thanks for her hard work and hearty
congratulations for the recognition she's received!
Sherry
Thank you, Dr. Ritch. For those of us who have lost vision and
continue to lose it, the hope of regaining it some day is of immense
importance. It is especially significant for those of us with normal
tension for whom lowering IOP has little effect in slowing progression.
Some days when I am filled with despair because I can tell that I have
lost even more vision, the hope that I may some day get it back and
view the world normally again is all that keeps me going.
-Deah
The first stem cell transplant for retinitis pigmentosa was done the other day in Germany. Hang in there
R
On 4/11/07 10:49 PM, "nan bhan" <knstock2@...
i can see this kind of a headline within five years re: glaucoma.
http://www.baltimoresun.com/news/health/bal-te.diabetes11apr11,0,7517225.story?coll=bal-health-headlines
Dear Dr. Ritch,
Thank you so much or the recent important links you posted. I am of course surprised and disappointed by the notes on Memantine and the apparently less hopeful news on neuroprotective agents such as memantine. Is this a good summary of the state of this research, from two of those links? While the afirst rticle is in the context of Alzheimer's, it does mention glaucoma. The second article I saw is even less hopeful. I did not study all the links you provided us, wondering if there is a hopeful one in there??
Regards.
Lilian
"There is still some hope that memantine will prove effective in lowering the rate of visual decline in glaucoma. A paradigm shift expected in glaucoma therapy will probably not occur, however, and, for many years to come, glaucoma treatment will probably be restricted to lowering IOP when attempting to preserve glaucoma patientsĦŻ vision.
WHY CLINICAL TRIALS HAVE FAILED
There are many reasons for the continuous, consistent failures of neuroprotective drug candidates in phase 3 clinical trials after they have exhibited effectiveness in earlier phases of drug development.
Therapeutic Index
These compounds have a relatively low therapeutic index. The secondary degeneration-inducing molecules such as glutamate have essential physiological functions, and effectively blocking them necessarily causes undesirable side effects.
Multiple Pathways
The process of secondary degeneration has multiple pathways. Blocking the activity of only one of those pathways (eg, blocking glutamate by using memantine) is therefore unlikely to effectively prevent continuous degeneration.
second article I saw:
Neuroprotection: Fact or Fiction?
By Richard A. Lewis, MD, Chief Medical Editor
Only a few years ago, ophthalmologists and glaucoma patients were encouraged by the early promises of neuroprotection, a new concept for many of us. Terms such as apoptosis and free radicals cropped up in dinner meetings for comprehensive ophthalmologists. There was a sense that, after 100 years of glaucoma treatment directed at lowering IOP to prevent visual loss, therapy would soon become more sophisticated and specific to protecting the optic nerve head. The provocative data were initially derived from research using an optic nerve crush model in rats. Brimonidine administered before the injury appeared to partially protect the ganglion cells from the trauma to the optic nerve.^1
To its credit, Allergan, Inc. (Irvine, CA), launched what may be the most expensive study yet in treating glaucoma. Many of us clamored to be a part of the clinical study of memantine. Unlike any prior glaucoma trial, this one established a visual field and optic disc reading center to assess progression instead of depending on IOP as an endpoint. Ten years and millions of dollars later, Allergan recently provided us with a glimpse of the data. Surprisingly, the information was not presented at an investigators meeting, at a glaucoma forum, or in a peer-reviewed journal. Instead, it was noted in a brief press release intended for financial analysts.^2 The data released were vague but suggest negative results. We can only hope a detailed analysis is presented and published, because we have much to learn about the natural history of advanced glaucoma as assessed from changes in the visual field and optic disc. Whether or not intervention with memantine was successful, future
therapeutic studies in glaucoma must go beyond medications that lower IOP if we are to make any progress in helping our patients.
In this issue of Glaucoma Today, Michael Belkin, MA, MD, Professor of Ophthalmology at Tel Aviv University in Israel, offers an analysis of the limited information available on the memantine trial and looks at the hurdles of developing a neuroprotective agent, of which memantine is the latest example. Whether the drug is ultimately found to be clinically useful or not, the challenge remains to develop a therapy for treating glaucoma that moves beyond the lowering of IOP to treat the source of visual loss, the degeneration of the optic disc.
1. Wheeler LA, Gil DW, WoldeMussie E. Role of alpha-2 adrenergic receptors in neuroprotection and glaucoma. Surv Ophthalmol. 2001;45(suppl):S290-S294; discussion: S295-S296.
2. Allergan reports fourth quarter operating results [press release]. Irvine, CA: Allergan, Inc.; January 31, 2007. Available at:
http://www.shareholder.com/agn/ReleaseDetail.cfm?ReleaseID=227679. Accessed February 15, 2007.
i can see this kind of a headline within five years re: glaucoma.
http://www.baltimoresun.com/news/health/bal-te.diabetes11apr11,0,7517225.story?coll=bal-health-headlines
Earle, Happy Birthday, and thank you so much for
sharing your life with glaucoma with all of us. I was
recently diagnosed and have been nearly paralyzed with
fear and plagued with the what ifs - the chief one
being what if nothing works and I go blind. To read
your story gives me hope. A first person account like
yours is worth a hundred articles. Thanks a lot.
Sari,
That's the hard part for treating glaucoma, from both the doctor's and the
patient's perspectives. Some of us do very well with trabs, drops, no
drops, etc and the damage never progresses. Others have bad reactions to
drops, failed surgery or the optic nerve damage progresses no matter what -
fortunately those numbers are few and my heart does go out to those who are
dealing with this.
Some people aren't even diagnosed until their glaucoma is well advanced and
by then it's too late to save the eyesight.
Glaucoma is such an individual disease and each person with it must be
treated as an individual. There is no "one-size-fits-all" for this monster!
The only thing we can do is learn all we can about it, do all we can to win
the battle and accept the ultimate outcome, knowing that we've fought a good
fight. I have a lot of other health issues going on right now that are
bigger battles for me than my glaucoma and I have to keep reminding myself
of this! Life is full of battles and we win some and we lose some.
Sherry
Was that just during the healing phase or afterwards?
Us trab patients certainly don't want *anything* to mess up the trabs,
that's for sure! It's such a grueling surgery and not something that *I*
want to go through again anytime soon! I'm praying for a long life for my
trabs <rbg
Sherry
Sherry,
On-going restriction. This doc gave an anecdotal experience of
someone using mega doses of C and the trab failed. I have typically
taken 1-2 grams of C until now and find that my immune system became
accustomed to the C. Colds and gum issues have now become common.
Need input from others as to their intake of C--and any negative
experiences. You are right--would't want to mess with a functioning
trab!!
My trabeculectomy was performed October 2005 and doc advised against
taking Vitamin C. He believes it can create healing of the tissue that
is not desirable. Has anyone else gotten this advice--and does anyone
take doses larger than 250 mg.?
David,
Bright light lowers my IOP as I think David [freeradical]has now posted.
I live in the NW of Scotland so the sun here is not going to be as
strong as other parts of the world, in fact we've been lucky to see it
at all this winter!
I do believe some of our problems with the sun, both skin and eyes,
are partly nutritional.
Joyce
Well, too bad those studies don't mention the harmonica. When playing the
harmonica the flow of air is obstructed briefly by raising the tongue against
the roof of the mouth while inhaling and exhaling regularly, to create a
chugging sound. I wonder if that counts. I guess in some respects that
resembles the Valsalva manuever, except it's only for a split second. How long
does one perform the Valsalva manuever? When someone plays an instrument like a
trumpet, oboe, etc., they're blowing continuely into a hole which offers
resistance. Hmm..
Jim,
The AT555 is house-friendly, about the size of my computer and sits on
my desk.
Weight 30 pounds
Height 17 inches
Width 9 1/2 in
Depth 13 1/2in
Type it into google and you'll probably see a picture!
Joyce
Hi Dr. Ritch,
As always, thank you for info. I am posting for some who may not be familiar with Valsalva its definition below. My question to you: Seems to me that the essence of the concern about exercise/weights on IOP is the specific breathing pattern and particularly Holding the breath with or without Valsava. I make a very focused effort 1- not to hold my breath, especially benchpress or the "pull down" which I do lying down, and 2- head slightly higher than feet even when lying down. Unlike some musical instruments, I believe there is no high resistance breathing during exercise above. Seems to me that is very different from holding breath and from Valsava. Is it ?
Thank you so much
Lilian
From Wikipedia, the free encyclopedia
Jump to: navigation, search
In medicine, the Valsalva maneuver is performed by forcibly exhaling against closed lips and pinched nose, forcing air into the middle ear if the Eustachian tube is open. This maneuver with slight modifications can be used as a test of cardiac function and autonomic nervous control of the heart or to clear the ears (equalize pressure) when ambient pressure changes, as in diving or aviation.
The technique is named for Antonio Maria Valsalva, the 17th Century physician and anatomist from Bologna, whose principal scientific interest was the human ear. He described the Eustachian tube and the maneuver to test its patency.
[INLINE]
Reply to newby in Chicago area. I have been seeing Dr. Brown at The Chicago Glaucoma Assoc. He is partnered with Dr. Gorla and a new women associate whose name I do not know. He is very helpful and explains things pretty well to you. Answers questions and is very patient. He has offices in Evanston, Glenview and at Rush in Chicago. Dr. Brown is very busy so it could take a while to get in, can't really say but possibly one of the partners may be quicker. Dr. Brown has done surgery on my eyes and I have had great results. He makes you feel very comfortable. Try to keep on top of things and they won't get out of control (Hopefully).
Good luck E
Thanks, Sherry, I appreciate this.
On 20 May 2006, Dr. Ritch posted the following:
"No connection between glaucoma and vitamin C, good or bad. Only connection
is that people with exfoliation syndrome have decreased ascorbate in the
anterior chamber (the eye concentrates ascorbate to about 40 times its blood
concentration) and this is probably why people with XFS get cataracts."
And again in a different post on the same day
"The work on lowering IOP with ascorbate was done in the 1960s in Italy, and
a huge amount was given - enough to make the patient acidotic, which
probably accounted for any decrease in IOP."
Sherry
There is an article on my blog about playing wind instruments. High
resistance wind instruments do raise IOP and there is evidence that
long term playing leads to visual field defects.
David
http://fiteyes.com/blogs/dave/
I'd be very careful about spending time outside without wearing sunglasses.
Sunlight is strongly implicated in cataract development and macular
degeneration. You can still get the warmth of the sun on your face and eyes
when you're wearing sunglasses.
I was chatting with my optician last year, who had just gotten back on a
trip to Mexico with the Lion's club. They had gone down there to do cataract
surgery and pass out eyeglasses and sun glasses. She said that cataracts
were rampant where they went because the people never wore eye protection.
And they were found in *young* people. Some of the people they operated on
were so thankful because for many years they weren't able to see because of
the cataracts.
Both hubby's cousin and father had severe macular degeneration - they both
spent a lot of time outdoors on or near the water without eye protection.
Since we've been discussing stress and IOP, I wonder if the warmth from the
sun doesn't relax us so the IOP lowering effect is from the relaxation
rather than any direct relationship to the sun?
It's so darn frustrating because I'm quite light sensitive, yet I need good
light to see well! Makes it hard when I'm out in the sun..... I see better
without sun glasses (I have prescription lenses) but definitely need the eye
protection, as well as a wide-brimmed hat to keep the glare from coming in
around my lenses on the side and top.
Sherry
Joyce, thank you for taking the trouble to reply and
providing us information about the home measuring
meter.
If you can bear to be badgered with questions, please
could you tell me what effect exposure to light has on
your IOP readings. I dont know whether or not to use
sunglasses always when outside, and if this will help
in anyway in lowering the IOP. My eyes are slightly
light sensitive after starting the drops but nothing
significant, and I have somehow never used sunglasses,
prefering the warmth of the sun on my face and eyes.
But if it is bad for the IOP I shall use them.
Hi Joyce,
I find your purchase of a AT555
testing device fascinating.
You are to be commended for your
care of your eyes. Your eye health
and mental state are certainly worth
whatever you have to spend.
You say your AT555 is easy to use, that is good,
is it very large?
What I am asking is it house-friendly?
Is it the size, say, of a microwave,
or perhaps the size of a large computer printer?
Jim Griffin
Forest Hills, NY
Jim,
Yes I invested in a machine for home use and mine cost a bit more than
below with delivery.
I consider my eye health and mental state worth it!!
The machine is idiot proof even to a technophobe like me.
Joyce
Anyone know if playing the harmonica would raise IOP? Due to the breathing
patterns.
Jim,
Yes I invested in a machine for home use and mine cost a bit more than
below with delivery.
I consider my eye health and mental state worth it!!
The machine is idiot proof even to a technophobe like me.
Joyce