Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Is Surgery Advisable When Diagnosed With Open Angle Glaucoma?
Question: Hi,
My mother in law has been diagnosed with open angle glaucoma since a few years ago. She has been treating it with a combination of several kinds of eyedrops. She also takes vitamins and supplements for eye health. Her eye pressure however has been within the normal range.
An eye test done last week, indicated that the nerves and eyesight in the right eye are severely damaged, while in the other eyethere is less damage to the nerves, but macular edema is present.
We are wondering what could be the best treatment under these circumstances. Could eye surgery be a good solution for improving/preserving her eyesight?
I could send you detailed scans of both her eyes, from the last examination in case you may need more information about her condition.
Your opinion on this is truly appreciated.
Many thanks.
My mother in law has been diagnosed with open angle glaucoma since a few years ago. She has been treating it with a combination of several kinds of eyedrops. She also takes vitamins and supplements for eye health. Her eye pressure however has been within the normal range.
An eye test done last week, indicated that the nerves and eyesight in the right eye are severely damaged, while in the other eyethere is less damage to the nerves, but macular edema is present.
We are wondering what could be the best treatment under these circumstances. Could eye surgery be a good solution for improving/preserving her eyesight?
I could send you detailed scans of both her eyes, from the last examination in case you may need more information about her condition.
Your opinion on this is truly appreciated.
Many thanks.
Brief Answer:
Surgery is required
Detailed Answer:
Hello, Madam.
I can certainly understand your concern.
I have worked through the attached images.
Yes, there seem to significant eye damage in the right eye.
Surgery is an indication in both eyes, therapeutic in the right eye and prophylactic in the left eye.
The standard usual surgery for the right eye is trabeculotomy and in the left eye is laser trabeculotomy.
You need to consult your eye surgeon with regards to above.
Surgery will not cure the condition, but will prevent further worsening of nerve function.
Post your further queries if any.
Thank you.
Surgery is required
Detailed Answer:
Hello, Madam.
I can certainly understand your concern.
I have worked through the attached images.
Yes, there seem to significant eye damage in the right eye.
Surgery is an indication in both eyes, therapeutic in the right eye and prophylactic in the left eye.
The standard usual surgery for the right eye is trabeculotomy and in the left eye is laser trabeculotomy.
You need to consult your eye surgeon with regards to above.
Surgery will not cure the condition, but will prevent further worsening of nerve function.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks doctor.
If surgery will not cure the condition, does that mean that there will be no improvement in her eyesight after it, even by using corrective eyeglasses?
Right now, in her condition, using prescription eyeglasses seems not to be working well.
Also, are there any contraindications for having surgery at her age, 83? Can the condition continue to be controled with medications only? Are there any oral medications available, in addition to eyedrops?
Thank you.
If surgery will not cure the condition, does that mean that there will be no improvement in her eyesight after it, even by using corrective eyeglasses?
Right now, in her condition, using prescription eyeglasses seems not to be working well.
Also, are there any contraindications for having surgery at her age, 83? Can the condition continue to be controled with medications only? Are there any oral medications available, in addition to eyedrops?
Thank you.
Brief Answer:
Corrective glasses will not improve the eye sight.
Detailed Answer:
Hello, Sir.
I can certainly understand your concern.
Glaucoma associated retinal nerve finer damage is irreversible.
As said earlier surgery can only prevent further never finer damage by improving the flow of aqueous in the eye.
Yes , there are other oral medications in addition to eye drops.But these pills are only useful for controlling the pressure changes within the eye and don't directly improve the vision.
These pills are indicated only under special circumstances.
And eye glasses are not effective in vision improvement in Glaucoma as it's progressive disorder.
Surgery can be safely performed at the age of 83 when other vital health parameters are within normal limits.
Post your further queries if any.
Thank you
Corrective glasses will not improve the eye sight.
Detailed Answer:
Hello, Sir.
I can certainly understand your concern.
Glaucoma associated retinal nerve finer damage is irreversible.
As said earlier surgery can only prevent further never finer damage by improving the flow of aqueous in the eye.
Yes , there are other oral medications in addition to eye drops.But these pills are only useful for controlling the pressure changes within the eye and don't directly improve the vision.
These pills are indicated only under special circumstances.
And eye glasses are not effective in vision improvement in Glaucoma as it's progressive disorder.
Surgery can be safely performed at the age of 83 when other vital health parameters are within normal limits.
Post your further queries if any.
Thank you
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor.
Will both the operations be effective, although eye pressure has been and is normal?
What do you mean by prophylactic surgery in the left eye and therapeutic in the right eye? Could you kindly elaborate a bit more on that?
Also in terms of eyesight percentage/rate, you would classify her sight in each eye as how strong? How impacted could she be in her ability to perform daily tasks inside the home and outside?
If corrective eyeglasses do not help, what other aids are recommended?
Thank you
Will both the operations be effective, although eye pressure has been and is normal?
What do you mean by prophylactic surgery in the left eye and therapeutic in the right eye? Could you kindly elaborate a bit more on that?
Also in terms of eyesight percentage/rate, you would classify her sight in each eye as how strong? How impacted could she be in her ability to perform daily tasks inside the home and outside?
If corrective eyeglasses do not help, what other aids are recommended?
Thank you
Brief Answer:
Relevant information provided.
Detailed Answer:
Hello, Madam
I can understand your concern.
Yes, these surgical procedure will be effective in treating the symptoms
Right eye seems to be more damaged due to Glaucoma, hence we need a surgical procedure, that can directly treat the damage.Hence it is termed as therapeutic.
For Left eye the damage is less severe and is more
prone to subsequent damage lie the right eye.Hence we need another unique surgical procedure that can "prevent" these changes.Hence it is termed as " prophylactic".
For classifying her visual acuity( eye sight), it's important to get Snellen's Visual acuity testing both with and without glasses.This has to be supplemented with Visual field testing.Only with these tests one can comment on eyesight.
Corrective glasses will help to carry daily tasks and other activities only when they are prescribed after assessing the refractive state of the eye post surgery.
Other visual aids are not required.
Post your further queries if any.
Thank you.
Relevant information provided.
Detailed Answer:
Hello, Madam
I can understand your concern.
Yes, these surgical procedure will be effective in treating the symptoms
Right eye seems to be more damaged due to Glaucoma, hence we need a surgical procedure, that can directly treat the damage.Hence it is termed as therapeutic.
For Left eye the damage is less severe and is more
prone to subsequent damage lie the right eye.Hence we need another unique surgical procedure that can "prevent" these changes.Hence it is termed as " prophylactic".
For classifying her visual acuity( eye sight), it's important to get Snellen's Visual acuity testing both with and without glasses.This has to be supplemented with Visual field testing.Only with these tests one can comment on eyesight.
Corrective glasses will help to carry daily tasks and other activities only when they are prescribed after assessing the refractive state of the eye post surgery.
Other visual aids are not required.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again doctor.
You are saying that the surgery for the right eye is trabeculotomy and in the left eye is laser trabeculotomy. Why can't laser surgery be performed for both eyes?
What does it mean that the refractive state of the eyes post surgery may change? Does it mean that there might be a possibility that she could see better?
In your previous messge you were saying that corrective glasses will not improve her eye sight. Did you mean in the present condition, i.e. before the surgery?
Is there a possibility that after the surgery, corrective glasses will help her more than presently, to carry daily tasks and other activities?
Also, if no surgery is performed in either of the eyes, are you suggesting that the poor condition of the right eye will continue to negatively affect the left eye?
With thanks and best regards.
You are saying that the surgery for the right eye is trabeculotomy and in the left eye is laser trabeculotomy. Why can't laser surgery be performed for both eyes?
What does it mean that the refractive state of the eyes post surgery may change? Does it mean that there might be a possibility that she could see better?
In your previous messge you were saying that corrective glasses will not improve her eye sight. Did you mean in the present condition, i.e. before the surgery?
Is there a possibility that after the surgery, corrective glasses will help her more than presently, to carry daily tasks and other activities?
Also, if no surgery is performed in either of the eyes, are you suggesting that the poor condition of the right eye will continue to negatively affect the left eye?
With thanks and best regards.
Brief Answer:
Right eye changes can negatively influence the left eye
Detailed Answer:
Hello, Madam.
I can certainly understand your concern.
It's Laser Trabeculoplasty.It's a relatively minor procedure generally done on preventive basis.
Whereas Trabeculotomy is a major procedure done in definitely more established cases of Glaucoma.
Hence right eye which is more damaged is chosen for trabeculotomy.
Definitely there will be possibility that she could see better after the surgical procedure.
Yes, I meant in the present condition, spectacles will not help her.But post surgery, change of spectacles will help her.
Yes, in the absence of surgery the changes in the right eye can negatively affect the left eye.
Post your further queries if any.
Thank you.
Right eye changes can negatively influence the left eye
Detailed Answer:
Hello, Madam.
I can certainly understand your concern.
It's Laser Trabeculoplasty.It's a relatively minor procedure generally done on preventive basis.
Whereas Trabeculotomy is a major procedure done in definitely more established cases of Glaucoma.
Hence right eye which is more damaged is chosen for trabeculotomy.
Definitely there will be possibility that she could see better after the surgical procedure.
Yes, I meant in the present condition, spectacles will not help her.But post surgery, change of spectacles will help her.
Yes, in the absence of surgery the changes in the right eye can negatively affect the left eye.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks again!
Are there any risks associated with both surgeries? Which surgery shall be done first?
Could risks outweigh the benefits?
Her vital functions are generally fine, except for slightly elevated blood sugar during the last examination. Also she has partly obstructed carotids in her neck.
What happens if only the left eye laser surgery is done?
Are there any risks associated with both surgeries? Which surgery shall be done first?
Could risks outweigh the benefits?
Her vital functions are generally fine, except for slightly elevated blood sugar during the last examination. Also she has partly obstructed carotids in her neck.
What happens if only the left eye laser surgery is done?
Brief Answer:
Surgical Risks are minimal.
Detailed Answer:
Hello Madam.
I can certainly understand your concern.
The risks associated with both the surgeries are minimal when performed in experienced hands.
Risk benefit ratio CA only be clearly used and defined by your treating Surgeon.
Trabeculotomy is usually done first.
Partially obstructed carotids and Mildly elevated blood sugar might not be contraindications fr surgery.
Left eye can alone can be be operated.But later right eye vision continues to drop and this creates gross disturbances in vision.So at that point , right eye has to be operated.
Post your further queries if any.
Thank you.
Surgical Risks are minimal.
Detailed Answer:
Hello Madam.
I can certainly understand your concern.
The risks associated with both the surgeries are minimal when performed in experienced hands.
Risk benefit ratio CA only be clearly used and defined by your treating Surgeon.
Trabeculotomy is usually done first.
Partially obstructed carotids and Mildly elevated blood sugar might not be contraindications fr surgery.
Left eye can alone can be be operated.But later right eye vision continues to drop and this creates gross disturbances in vision.So at that point , right eye has to be operated.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor.
She has been told that the vision in her right eye is almost 0 and in the left one 0.1, and surgery could not be beneficial. Could this be the case?
She has been told that the vision in her right eye is almost 0 and in the left one 0.1, and surgery could not be beneficial. Could this be the case?
Brief Answer:
That's true
Detailed Answer:
Hello, Madam.
Yes, indeed there is such a possibility.
If vision is completely absent owing to grossly damaged retina, then practically there is no use of improving the aqueous outflow through surgery (ie; via trabeculotomy and trabeculoplasty).
Post your further queries if any.
Thank you.
That's true
Detailed Answer:
Hello, Madam.
Yes, indeed there is such a possibility.
If vision is completely absent owing to grossly damaged retina, then practically there is no use of improving the aqueous outflow through surgery (ie; via trabeculotomy and trabeculoplasty).
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks. But she csn still do the surgery in her left eye, although vision is only 0.1?
Brief Answer:
Surgical outcome may be poor
Detailed Answer:
Hello, Madam.
As the left eye is associated with macular edema, in the setting of very low vision (0.1), the outcome of surgery on this eye will be poor.
Hence, your opthalmologist might not considered it.
But, there are few new drugs that can prevent worsening of Macular edema.Please check with your opthalmologist if he can consider the same.
Post your further queries if any.
Thank you.
Surgical outcome may be poor
Detailed Answer:
Hello, Madam.
As the left eye is associated with macular edema, in the setting of very low vision (0.1), the outcome of surgery on this eye will be poor.
Hence, your opthalmologist might not considered it.
But, there are few new drugs that can prevent worsening of Macular edema.Please check with your opthalmologist if he can consider the same.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
