Glaucoma is not a disease many people know much about. It is a disease with practically no symptoms. If left untreated it could lead to blindness. African Americans and Hispanics are at increased risk of developing glaucoma. It is estimated that nearly 1.5 million Americans are walking around undiagnosed.
I have been getting an annual eye examination from the same ophthalmologist for years. I have always worn prescription glasses for poor visual acuity. So, other than occasional periods of blurred vision, that has been the extent of my vision issues. I simply attributed the blurred vision to not blinking enough when working on the computer at work. Then one day while having a casual conversation with a co-worker, I found out that she had also, in the past, gone to my eye doctor. But for some reason, she decided to try someone new. She was now seeing Dr. Dina Weintraub, a glaucoma specialist. She suggested I give her doctor a try. I told her thanks but no thanks. Well, I thought that was the end of it. But every time I would see her, she asked had I given her doctor a try? I really had no reason to believe another doctor would find anything else wrong with my eyes. But to stop her from asking me that question, I made an appointment. I am so lucky I did.
Dr. Weintraub is one of the most caring, soft-spoken and knowledgeable doctors I have ever met.
After an extensive examination, she gave me her diagnosis. “You have open-angle glaucoma.” But before I was able to process that revelation, she went on to say I had extensive optic nerve damage to both eyes. And the damage was irreversible. The pressure in the left eye was 52 and the right eye was 46. Normal intra-ocular pressure is 0-21. If you did not have so much damage already, we could gradually bring down your pressures. Some people may be okay even with pressures this high. But not you. She said we had to immediately get my eye pressure down before the optic nerve is completely destroyed. At 62 years old to find out I could go blind was shocking. I told myself this could not be happening. I was in total denial. How could that be? This has to be a mistake. I insisted she does the tests over. I was certain my eye doctor who had given me an annual exam for years would have detected a problem with my eyes before now. Dr. Weintraub tried to make sense of it. Maybe your pressures were not elevated on the day you went for your annual check-up. And maybe the doctor never examined your optic nerves.
When I calmed down, she carefully explained to me what glaucoma is. She said that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a space called the anterior- chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.
In open-angle glaucoma, even though the drainage angle is “open”, the fluid passes too slowly through the meshwork drain. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged by increased pressure, open-angle glaucoma and vision loss—may result. You would first start losing your peripheral vision. That’s why controlling the pressure inside the eye is important. So I was handed four eye drops prescriptions and a tablet prescription for the drug Diamox. This drug has a side effect of weight loss, which was very profound in my case. The goal was to get the pressure down to a very low level and to maintain that low pressure.
After using the different eye drops and taking the Diamox for weeks, my pressures were up and down like a roller coaster. When I started using the drops, getting the drops accurately into my eyes and not running down my cheeks was a challenge. When I would visit the doctor and be told the pressures were still high, I attributed it to me not doing a proper job of getting the drops into my eyes. I then bought a gadget that was to improve my accuracy. It was much easier to feel the refrigerated eye drops when the cold drop hit my eyeball. After instilling the drops, I was told to apply pressure to the corners of the eye along the bridge of the nose, hold for a few seconds. This prevented any drug from escaping the eye out through the nasal lacrimal duct.
Unfortunately, despite my best efforts, the pressures wouldn’t stay low. Dr. Weintraub was not happy. “I think it’s time we consider surgery”, she said. This was not what I wanted to hear. Just the mention of the word surgery, caused my claustrophobia to kick in. I could not see myself buckled down on an operating room table, unable to move. She saw I was uncomfortable with her suggestion.
So she tried to get me to focus on the benefits of surgery, and the importance of vision. Without surgery, I would have to continue using the eye drops. But more importantly, I could still lose my sight. So I settled down and focused on what I had to lose without the surgery. Never to be able to see my beautiful wife’s face was just one factor that weighed heavily on my decision. I am an avid reader. I read at least ten books, at a time, on my kindle fire. I also look forward to every spring working in my garden. I eagerly await the appearance of my tulips and other beautiful flowers that decorate my garden. Plus not to be able to continue to write my blog and to draw would leave too deep of a void in my life.
She recommended Dr. James McDermott, a surgeon she trusts. When her father needed surgery, she sent him to Dr. McDermott. Despite her confidence, I was still nervous. I wanted the assurance everything was going to work out.
After meeting and talking with Dr. McDermott, I felt confident I would be in good hands. He told me I would be a candidate for an operation called a Trabeculectomy. He said it was a procedure that creates a new drainage channel for the aqueous humor to leave the eye. During the procedure, a small flap is made in the sclera (the outer white coating of your eye). A filtration bleb, or reservoir, is created under the conjunctiva – the thin, filmy membrane that covers the white part of your eye. Once created, the bled looks like a bump or blister on the white part of the eye above the iris, but the upper eyelid usually covers it. The aqueous humor can now drain through the flap made in the sclera and collect in the bleb, where the fluid will be absorbed into blood vessels around the eye. He had successfully performed this operation numerous times. He also instructed residents on the proper surgical techniques.
The surgery on the left eye had to be done first because it had the most optic nerve damage. This was performed at New York Eye and Ear Infirmary of Mount Sinai on October 25, 2011. The surgery on the right eye was performed on November 22, 2011.
Although Dr. McDermott told me the operation had gone well, I needed to see proof through my own eyes. After each operation, the waiting was nerve wrecking. All day every day, I wondered whether or not my vision would return to normal?
I couldn’t see clearly out of the un-bandaged eye. I couldn’t read. I could barely watch television. Periodically, my claustrophobia would kick in. I needed an escape. I was desperate to get back to work simply for the distraction. But instead, I had to remain home and ponder my fate. I was going stir crazy. I would go for long walks in the sunshine to renew my spirits. Eventually, my vision did return to normal. The pressures in my eyes remained low. But, as a result of the surgery, cataracts developed in both eyes. So far they have not posed a big problem. Removing cataracts could possibly reverse the good results of the surgery. So, I will refrain from having cataracts removed for as long as possible.
I am so grateful to Dr. Dina Weintraub for diagnosing my glaucoma condition and to Dr. James McDermott for performing the surgery.
Now that I been through this experience, I would like to share with you a few tips that
may help you avoid a similar situation
TIPS:
• Get an eye exam at least twice a year.
• Ask your eye doctor to check your eye pressures on each visit
• Keep a record of eye pressures after each visit.
• If you are older than 50yrs, periodically request a visual field and optic nerve exam.
• If on eye drop medication, keep a daily log of date and time you put in the drops. Make the entry after instilling the drops, not before. Sometimes you may be interrupted by a phone call or conversation and not recall if the drops were put in. You don’t want to either under-medicate nor over-medicate.
• For more information visit https://www.nei.nih.gov/health/glaucoma/glaucoma_facts
Remember: glaucoma does not come with warning signs.