Is High BP Indicative Of Glaucoma?

Posted on Thu, 20 Jun 2024

Question: Help -- Is there an opthamologist on-line?? I am looking for some information about the SLT (selective laser trabeculoplasty) procedure. I have been getting eye exams from an opthamologist every 6 months for the last few years because both my siblings - 2 sisters, have glaucoma & are taking Rx eye drops for it. One other relative (grandmother on father's side) also had it. I had cataract surgery on both eyes about 18 & 20 yrs ago & lens replacement (or whatever it's called) by a wonderful doctor in Alaska who has retired and cannot get in touch with him for advice. No other vision problems -- do not have to wear glasses. I moved to XXXXXXX 18 months ago with only one opthamologist in my small town. I have now seen her 3 times for checkups. Pressure was 16/17, then 18/19, then 17/18 on the three visits. On the second visit she prescribed latanoprost drops. Had a severe allergic reaction the second night. Face bright red around cheeks & eyes, swelling and dreadful itching on browbone & cheekbones. Quit using drops but took 2 or 3 days to finally go away. This past visit she wanted to prescribe Timolol. Told her sorry but am not anxious to try any other stuff in my eyes. She told me there was a treatment called SLT that was effective 80% of the time but had no literature or other info to give me. Told me to look it up online. I have NEVER been told I have glaucoma, only that my pressure seems to be high. Both my sisters think it is still within the normal range, not as high as either of theirs reached. Is high pressure the only indication of glaucoma or are there other things to look for? And do I really want to have SLT done on my eyes at this time? Also why both eyes? Why not only the left one that has been showing the higher pressure each time? There is a doctor in XXXXXXX MT who does SLT surgery and my dr has scheduled appt's for me in XXXXXXX It is several hundred miles away (needs overnight stays) all of which will be difficult & expensive for me to do. Sorry to write such a long explanation but wanted to present as many facts as possible. I'm 81 yrs old, still quite healthy. Some arthritis but still go bowling & square dancing every week. Can I just ignore this whole thing for now and maybe just wait to see if my pressure gets higher before doing anything else with my eyes?? My sight is valuable but just do not know what to do.

Answered by Dr. N K Mishra (25 hours later)

Brief Answer:
No hurry to get SLT done.

Detailed Answer:
My dear,
Thanks for sending your query to us.
I have gone through your statement in detail and feel that you have to wait and watch.
There are three changes which point to glaucoma.One is pressure,second is disc changes and third is field mapping to show retinal nerve fibre layer defect.
Though you do have a pisitive family history,but your pressure is again with in normal limits.We consider iop upto 21to be normal upto 25 needs observation and beyond 25 needs treatment.Thats a rule of thumb we follow in our practice.
Pressure is not the only parametre,disc appearence is again to be monitored.To follow the nerve fibre damage if any,field examination is to be done every 6 months to decide if SLT is to be undertaken.
You can in the meantime start Timolol here more than allergy,my worry will be it's cardiac effects,it being a beta blocker.Though the effect of a very low strength drop on an adult body will be minimal,but a cardiologist should be consulted.
Since i did not see any mention of field charting in your narrative,that is what you should start with to monitor progress of glsucoma and if any intervention is needed.
Secondly do start with timolol and see the effect on iop.There should be no hurry about SLT.
Do get back to me in case of any further query in this regard.

Above answer was peer-reviewed by : Dr. Raju A.T