My Low Tension Glaucoma
I have low tension glaucoma and vision loss. Now it is more common to call it Normal Tension Glaucoma. I have had it for quite a few years now. I have lost quite a bit of my peripheral vision in the upper left quadrant of my right eye. When I read it is difficult to use my right eye.
NOTE: Don't take inhaled steroids for allergies or other conditions if you have glaucoma unless you have cleared it with your ophthalmologist!
Please also see My Glaucoma Surgery
In the area where the retina is damaged I have no vision or what I would call distorted vision (an unfortunate term see below). The distortion, when reading, is very annoying so for near vision, like reading, it appears my eyes have adapted in such a way that I primarily read with my left eye. What is funny though, I have better distance vision with my right eye.
I used to play a lot of tennis, but I started to have more and more troubles with my forehand, especially high forehand shots. I believe I was accustomed to using the peripheral vision of my right eye to see the fast moving tennis ball, and with the retina damage I would lose site of the tennis ball and constantly hit bad shots. So my tennis game has faded away, I am still an avid skier though, please see my little write up on Temporary Vision Loss. No migraine with my temporary vision loss.
Low Tension Glaucoma oddities
Low Tension Glaucoma ( Normal Tension Glaucoma )is a disease wherein the pressure in the fluid in the eye damages the retina and optic nerve where it enters the eye. There is no known cause for the problem. Many elderly people have this problem, but I am pretty young to have Glaucoma. For me it is strange that I have significant damage in one eye, but virtually none in the other eye. Apparently this is quite common though. I used to wear hard contact lenses, and at times I certainly broke the rules, for instance, wearing the lenses for almost 16 hours straight without a break, is a no-no. I did have one incident with the hard contacts, after one of these 16 hour days, I had a get together at my house and I guess my eyes dried out. The next morning when I woke up my vision was cloudy, I thought, oh my god I left the contacts in all night, but as it turns out I did not. My eye's corneas must have been scratched. The first day my vision was very cloudy, but after about a week it cleared up. I never did go see the doctor, I should have, and I have always wondered if this contributed to my Low Tension Glaucoma. My doctors have said, not likely at all. Oh well.
So what is Low Tension ( Normal Tension ) ?
It turns out the pressure in my eyes is completely normal, but I have Glaucoma damage; therefore Low Tension (pressure) Glaucoma! Your optometrist will measure your eye's pressure every time you have your eyes checked. It is usually the machine that blows a puff of air into your eyes, which makes you flinch! There are also simple pen like tools that touch your cornea and directly read the pressure.
If you think you have any distortion in your vision make sure you at least see your optometrist and use the term vision loss not distortion!
I believe I detected my Glaucoma two years before it was finally diagnosed. I complained to my optometrist about distorted vision which is how I described what I experienced early on with this disease. Had I said Vision Loss I believe I would have had a Visual Field Test much earlier. When I used the word distortion I believe my optometrist just assumed this was a problem with my eye glass lens's correction. Two years after I detected the problem my optometrist was convinced I might have a problem and he gave my a Visual Field Test. If you have vision distortion or vision loss insist upon a visual field test, your insurance should cover it.
The Visual Field Test
My optometrist had a machine which used an array of green LED's or Light Emitting Diodes, to test my Visual Field. You simply stare at this machine which consists of a circular array of LED's. You sit close enough to the machine so that your entire field of vision is encompassed by this LED array. The machine then proceeds to blink the LED's in random areas of your visual field of view, and if you see the LED blink you hit a button, if you do not hit the button when the LED flashes the machine knows you did not see the blink. The intensity or brightness of the LED's also varies, thereby measuring your eyes sensitivity to light at each point in the visual field. The ophthalmologist has a Visual Field Test machine that is probably more comprehensive. Instead of LED's white light is used and various size spots of light are projected in front of your eyes. This test can be a little unnerving, it feels as if your eye blacks out after a while, and when you blink your vision comes back. You also tend to feel like you could go to sleep! The machine tries many positions and intensities, more than enough to mask any mistakes you might make on pressing the button. The machine produces a printout with darkened areas where you have vision loss. They always check both eyes, it probably takes 4 minutes per eye I would guess. Here is a link to more information from Will's eye hospital: willsglaucoma.org/understanding visual field test taking.
My glaucoma visual field test results from Will's Eye.
Click on the images below for full size test results and even the bill! These are large files and may take a while to open.
The visual field test itself cost $103, which I think is typical. You can see a visit to Will's Eye can add up! But you are also visiting the best in the nation. I visited Will's Eye after a referral from Dr. Jordan whom I mention later.
My Optometrist is somewhat upset and gives me the bad news.
Bob you do have some significant vision loss and I recommend you see an ophthalmologist within the week. My optometrist's recommendation to see Dr. Geetter turned out to be an excellent one. My experience with Dr. Geetter was always positive.
My first Ophthalmologist, Dr. Geetter.
Please note that it is with regret I have to report the passing of Dr. Geetter; he will be greatly missed. Bob.
Dr. Geetter gave me a visual field test with the more advanced machine and confirmed my optometrist's results. He then proceeded to do a close visual examination by smearing a lens with optical goo (index material) and slapping it on my eye, he was able to get a very close look at my retina and optic nerve. They rinse the goo out of your eye after the exam. It is not very uncomfortable at all, the light used is extremely intense so you are blinded for a minute or two afterward. Dr. Geetter reported significant signs of damage and inflammation in my right eye, and also a very small amount of damage in my left eye. Unfortunately for me this had gone undetected because my eye pressure is normal and eye pressure is the normal test for detecting Glaucoma. A series of detailed photos of both of my retinas was also taken for future reference. I did ask Dr. Geetter "Can you recommend a comprehensive text on the subject", and Dr. Geetter replied, "I wish you wouldn't pursue that". And I feel I did receive good care without bothering the doctor with many technical questions. I am an electrical engineer and any time I was not comfortable with anything I did ask questions but I did not try to give myself a degree in ophthalmology either, and this worked out well! The closest reference I can find to Dr. Geetter is to one of his associates at: http://wehsociety.org alumni alumni AlumniInfo.php?AlumniID=86 The phone number will reach Bucks Mont Eye Associates ask for Dr. Geetter.
The first step is medication
I started out with Timolol, and another visit in three months. After three months there is still signs of inflammation and my eye pressure has not come down enough. They look for a 30% reduction in eye pressure, and this is 30% below normal eye pressure! So now Timolol and Alphagan, still not good enough. Another 3 months still inflammation, now I am taking Timolol, Alphagan, and Xalatan drops. Xalatan is a bit inconvenient because it has to be refrigerated. Also there must be five minutes between each medication. The preservatives in the medications are not compatible and would destroy the efficacy of the medications. By waiting 5 minutes between drops the preservatives dissipate enough to not affect the next medication. Dr. Geetter explained each of these medications work in an independent way so they are all effective. With this regimen Dr. Geetter is still not satisfied with the pressure reduction.
Next ALT (argon laser trabeculoplasty), laser surgery
For an ALT treatment you usually do visit the hospital but typically for only about an hour and a half. When you first arrive for an ALT treatment you are given drops to anesthetize your eye. These drops take almost an hour to provide full effect, so there you sit as many people with cataracts go in and out of the laser room. When I was finally invited into the laser room I noted that I was at a different machine than the cataract patients. First they apply optical goo to a lens, press the flat side of the lens onto the surface of your eye, which I believe then flattens your cornea. You then rest your chin and forehead against the laser and the doctor begins to fire the laser in a radial pattern around the edge of your iris, about 40 shots. The argon laser is powerful and even with the anesthesia you feel a powerful pin pricking for each shot the doctor gives you. I have had the ALT treatment twice, the second time was funny. The doctor uses a foot peddle to fire the laser. Perhaps because of the way I was sitting, twice, the doctor stepped on my toes. "Ahh, doctor, that is my foot not the laser foot peddle". Dr. Geetter says "that's never happened before!"
ALT a temporary success
A week after the first treatment my eye pressure had dropped significantly, Dr Geetter was thrilled and thought perhaps I could even stop the medication. But unfortunately 3 months later my eye pressure was climbing back up to normal and mine needed to be 30% below normal so there will be no more retinal damage. We proceeded with the second pass of ALT, another 40 shots and again after 3 months pressure is going back up.
Bob, I am going to put you on the most powerful medication regime possible.
So now I am taking COSOPT, Alphagan, and a new medication Travatan in place of the Xalatan. This is truely four medications because COSOPT is Timilol combined with yet another drug. These drugs are expensive, but if I want to save my vision, I have no choice. At first I was concerned about the temperature constraints the manufacturers put on the labels of these drugs. I used to carry them in a cool sack when I traveled, it turned out I did not need to worry, I received an explanation from the manufacturer of Alphagan that reduced my worries
The medications are successful!
With this new series of medications my eye pressure is staying 30% below normal which is what the ophthalmologists shoot for. My eye pressure has been stable for several years now and my Visual Field Test results have remained stable as well. I am never quite sure, however, whether my problem keeps getting slightly worse over time.
I have a new ophthalmologist Dr. Arthur J. Jordan Jr., O.D. of the Northeastern Eye Institute (NEI)
Dr. Jordan's BIO.
Since I moved to this area, I have been seeing Dr. Jordan. Not too long ago, due to unemployment,
I lost my medical insurance, and due to what I believe is a misunderstanding, it appears no insurer will take me, at least at a reasonable
rate. Oh well, so I am uninsured like 50
million other Americans. Please see my write up on Health Insurance Denied. When my
COBRA coverage was coming to its end I did really press Dr. Jordan regarding actual eye surgery.
Dr. Geetter had mentioned surgery may be in my future. Dr. Jordan strongly recommended against this type of surgery, Dr. Jordan does do these surgeries. The surgery involves putting a tube into your eye to facilitate fluid drainage and pressure reduction. Here is one informative
article about various surgeries: geteyesmart.org
HRT Heidelberg Retina Tomograph II
I have now had two HRT scans, Heidelberg retinal tomography version II. This is a laser scan of your optic nerves. This is a very non-invasive test that takes at most 5 minutes. If you ever have this test make sure you ask for copies, remember you paid for it!
Even if you are insured you paid for it. Your employer considers your insurance part of your compensation package (pay). Your employer may say to you you are getting a "gift" with Health Insurance benefits, you are not, guaranteed your employers financial reports call your insurance, compensation to you. Your hard work pays for that insurance and, recently, you are directly paying for it!
HRT results ( and bill ! )
My left eye does have some Glaucoma damage, but it is slight and the test results are within the normal constraints. My right eye however is an example of an eye with quite a bit of damage. Click on the thumbnails below to see the test results. These are fairly large image files, 275K, so please be patient. My eyes have both had detectable lesions, which unfortunately for me, the eye's vascular condition is a window into your brain's vascular health. Click on the images below to see the results. The files are quite large (290K) so they may take a while to open.
Here is a link to heidelbergengineering.com. You will find a PDF document explaining these results in the HRT area. Look under Products, HRT, Product Literature.
SLT (Selective laser trabeculoplasty)
For more recent information regarding surgery please also see:
I have now had SLT Laser surgery on my left eye, unfortunately there was really no affect to my eye. Dr Jordan had seen an inflammation in my left eye and he was very worried, therefore the SLT attempt to reduce eye pressure even further. Both my eyes, under medication, usually hover at a pressure of 12 or 13 mm Hg which is quite good, but apparently in my case there is still ongoing damage and the pressure should be lower. Dr. Jordan would like to see 10 mm Hg pressure. So there is still the ongoing consideration of trabeculectomy surgery.
Please remember I am not a doctor, these are my observations about a condition which has occurred to me. I hope this description of my experiences from a patients perspective is helpful to anyone who may be encountering Glaucoma for the first time.
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